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  • Image not available. Select populations may be more susceptible to toxicities associated with specific agents.
  • Image not available. Primary treatment is discontinuation of the offending agent and supportive care.

On completion of the chapter, the reader will be able to:

  • 1. List the drugs and risk factors that can induce apnea.
  • 2. Explain the pathophysiologic mechanisms underlying aspirin-induced asthma.
  • 3. Discuss the following options for the treatment of aspirin-sensitive asthma: avoidance, desensitization, and leukotriene modifiers.
  • 4. Explain the concerns regarding the use of β-blocker therapy in asthmatics.
  • 5. Critique the use of ethylenediamine tetraacetic acid (EDTA) and benzalkonium chloride as additives to nebulization preparations.
  • 6. Compare and contrast the treatment options for angiotensin-converting enzyme (ACE)-inhibitor induced cough.
  • 7. Describe the mechanism of latex allergy.
  • 8. Explain the pathogenesis of pulmonary edema.
  • 9. List the drugs that have been associated with Loeffler syndrome.
  • 10. Explain the mechanism of oxygen toxicity.
  • 11. List the groups of chemicals that can induce pulmonary fibrosis.
  • 12. List predisposing factors for the development of cytotoxic drug-induced pulmonary fibrosis.
  • 13. List the risk factors for bleomycin-induced pulmonary fibrosis.
  • 14. Discuss monitoring procedures to prevent or detect bleomycin-induced pulmonary fibrosis.
  • 15. Describe the clinical manifestation of methotrexate lung toxicity.
  • 16. Explain the risk factors for amiodarone-induced pulmonary fibrosis.
  • 17. Explain the mechanism of primary pulmonary hypertension caused by anorexic agents.

The manifestations of drug-induced pulmonary diseases span the entire spectrum of pathophysiologic conditions of the respiratory tract. As with most drug-induced diseases, the pathological changes are nonspecific. Therefore, the diagnosis is often difficult and, in most cases, is based on exclusion of all other possible causes. In addition, the true incidence of drug-induced pulmonary disease is difficult to assess as a result of the pathological nonspecificity and the interaction between the underlying disease state and the drugs.

Considering the physiologic and metabolic capacity of the lung, it is surprising that drug-induced pulmonary disease is not more common. The lung is the only organ of the body that receives the entire circulation. In addition, the lung contains a heterogeneous population of cells capable of various metabolic functions, including N-alkylation, N-dealkylation, N-oxidation, reduction of N-oxides, and C-hydroxylation.

Evaluation of epidemiologic studies on adverse drug reactions provides a perspective on the importance of drug-induced pulmonary disease. In a 2-year prospective survey of a community-based general practice, 41% of 817 patients experienced adverse drug reactions.1 Four patients, or 0.5% of the total respondents, experienced adverse respiratory symptoms. Respiratory symptoms occurred in 1.2% of patients experiencing adverse drug reactions. In a recent retrospective analysis of clinical case series in France, 898 patients had reported drug allergy, with a bronchospasm incidence of 6.9%. When these patients were rechallenged with the suspected drug, only 241 (17.6%) tested positive. The incidence of bronchospasm in patients with positive provocation test was 7.9%.2

Adverse pulmonary reactions are uncommon in the general population but are ...

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