Drug-induced airway diseases
Section snippets
Bronchospasm-asthma
Drug-induced bronchospasm is a common manifestation that is provoked by many agents; however, the pathophysiologic mechanism that underlies drug-induced bronchospasm may differ. The list of agents that cause bronchospasm is exhaustive and the common drugs are listed in Table 1. Drugs that are produced by pharmaceutical industries also can lead to occupational asthma (Box 1). Bronchospasm may present as an isolated event or as part of drug-induced anaphylaxis. Asthma usually is considered a risk
Cough
Cough is a common symptom in respiratory practice and some pharmaceutical agents are well-known to cause or provoke cough (Box 2). The pathophysiology is obscure with many agents, but with some drugs, like angiotensin-converting enzyme inhibitors (ACEI), possible mechanisms for the cough have been postulated. The most common reason for cough is airway irritation that is produced by inhaled medications like corticosteroids, amphotericin B, and desflurane (50%). Fentanyl can provoke cough by
Bronchiolitis obliterans organizing pneumonia
Bronchiolitis obliterans organizing pneumonia (BOOP) is characterized by formation of polypoid endobronchial connective tissue masses that contain myxoid fibroblastic tissue that fills the lumina of the small airways and extends in a continuous fashion into the alveolar duct and alveoli [72], [73]. The cellular features include clusters of mononuclear inflammatory cells and chronic inflammation in the airway walls and alveoli with reactive type 2 cells and foamy macrophages (refer to the
Bronchiolitis obliterans
Obliterative bronchiolitis affects the small airways proximal to the terminal bronchioles with virtually no involvement of the alveoli. Pathologically, this condition is characterized by widespread cicatrization and obliteration of small bronchi and bronchioles by scanty fibrous tissue with sparing of the alveoli (Fig. 3) [74].
A proportion of patients who has rheumatoid arthritis and other collagen vascular diseases that are treated with penicillamine develop progressive breathlessness that is
Summary
Drug-induced airway disease is a significant problem and must be considered in the differential diagnosis. A history of drug intake with a temporal association should raise the physician's suspicion toward a drug-induced cause. Because most of the conditions are amenable to withdrawal of the offending agent, an early diagnosis is essential. Conditions like obliterative bronchiolitis, are usually irreversible, but timely stoppage of the provoking agent can prevent further progression of the
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