Drug-induced airway diseases

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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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References (78)

  • R.S Gruchalla

    Drug metabolism, danger signals, and drug-induced hypersensitivity

    J Allergy Clin Immunol

    (2001)
  • D.A Moneret-Vautrin et al.

    Anaphylaxis to muscle relaxants: cross-sensitivity studied by radioimmunoassays compared to intradermal tests in 34 cases

    J Allergy Clin Immunol

    (1988)
  • K Umemura et al.

    Thromboxane A2 synthetase inhibition suppresses cough induced by angiotensin converting enzyme inhibitors

    Life Sci

    (1997)
  • P.L Malini et al.

    Thromboxane antagonism and cough induced by angiotensin-converting-enzyme inhibitor

    Lancet

    (1997)
  • M.R Hargreaves et al.

    Inhaled sodium cromoglycate in angiotensin-converting enzyme inhibitor cough

    Lancet

    (1995)
  • A.J McAdams

    Bronchiolitis obliterans

    Am J Med

    (1955)
  • T Williams et al.

    Fibrosing alveolitis, bronchiolitis obliterans, and sulfasalazine therapy

    Chest

    (1982)
  • J.D Leuppi et al.

    Drug-induced bronchospasm: analysis of 187 spontaneously reported cases

    Respiration (Herrlisheim)

    (2001)
  • M Odeh et al.

    Timolol eyedrop-induced fatal bronchospasm in an asthmatic patient

    J Fam Pract

    (1991)
  • J.M Raine et al.

    Near-fatal bronchospasm after oral nadolol in a young asthmatic and response to ventilation with halothane

    Br Med J (Clin Res Ed)

    (1981)
  • J.M Fallowfield et al.

    Propranolol is contraindicated in asthma

    BMJ

    (1996)
  • J.D Myers et al.

    Attenuation of propranolol-induced bronchoconstriction by frusemide

    Thorax

    (1997)
  • P.W Trembath et al.

    Effect of propranolol on the ventilatory response to hypercapnia in man

    Clin Sci (Lond)

    (1979)
  • C.P Mustchin et al.

    Reduced respiratory responses to carbon dioxide after propranolol: a central action

    BMJ

    (1976)
  • S Salpeter et al.

    Cardioselective beta-blocker use in patients with reversible airway disease

    Cochrane Database Syst Rev

    (2001)
  • K Bauer et al.

    Osmotic release oral drug delivery system of metoprolol in hypertensive asthmatic patients. Pharmacodynamic effects on beta 2-adrenergic receptors

    Hypertension

    (1994)
  • J Sturtevant

    NSAID-induced bronchospasm—a common and serious problem. A report from MEDSAFE, the New Zealand medicines and medical devices safety authority

    N Z Dent J

    (1999)
  • J Hedman et al.

    Prevalence of asthma, aspirin intolerance, nasal polyposis and chronic obstructive pulmonary disease in a population-based study

    Int J Epidemiol

    (1999)
  • S.T Holgate et al.

    Anaphylactic- and calcium-dependent generation of prostaglandin D2 (PGD2), thromboxane B2, and other cyclooxygenase products of arachidonic acid by dispersed human lung cells and relationship to histamine release

    J Immunol

    (1984)
  • L Churchill et al.

    Cyclooxygenase metabolism of endogenous arachidonic acid by cultured human tracheal epithelial cells

    Am Rev Respir Dis

    (1989)
  • A.H Subratty et al.

    Role of circulating inflammatory cytokines in patients during an acute attack of bronchial asthma

    Indian J Chest Dis Allied Sci

    (1998)
  • B Stringer et al.

    Alveolar macrophage uptake of the environmental particulate titanium dioxide: role of surfactant components

    Am J Respir Cell Mol Biol

    (1996)
  • M Stuhrmann et al.

    Prenatal diagnosis of congenital alveolar proteinosis (surfactant protein B deficiency)

    Prenatal Diagn

    (1998)
  • P.E Christie et al.

    The potent and selective sulfidopeptide leukotriene antagonist, SK&F 104353, inhibits aspirin-induced asthma

    Am Rev Respir Dis

    (1991)
  • A.S Cowburn et al.

    Overexpression of leukotriene C4 synthase in bronchial biopsies from patients with aspirin-intolerant asthma

    J Clin Invest

    (1998)
  • S Bianco et al.

    Efficacy and tolerability of nimesulide in asthmatic patients intolerant to aspirin

    Drugs

    (1993)
  • M Kosnik et al.

    Relative safety of meloxicam in NSAID-intolerant patients

    Allergy

    (1998)
  • A Szczeklik et al.

    Salmeterol prevents aspirin-induced attacks of asthma and interferes with eicosanoid metabolism

    Am J Respir Crit Care Med

    (1998)
  • O.P Schaefer et al.

    Aspirin sensitivity: the role for aspirin challenge and desensitization in postmyocardial infarction patients

    Cardiology

    (1999)
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