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Pulmonary Complications of Drug Therapy

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Pulmonary Complications of Non-Pulmonary Pediatric Disorders

Part of the book series: Respiratory Medicine ((RM))

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Abstract

Every medical treatment—pharmacologic or not—carries an inherent risk of complications. Adverse pulmonary effects have been reported as a result of medications (drug-induced respiratory diseases, DIRD) (Foucher et al., The Euro Respir J 10:265–279, 1997), radiation, oxygen administration, and surgical procedures. More than 600 drugs have been reported to cause pulmonary toxicity. There is no accurate estimate of the incidence of these complications, since they are vastly underreported. The diagnosis of a pulmonary complication of a drug is a challenge, and it usually comes as a diagnosis of exclusion (Steinfeld and Schidlow, Pediatric respiratory medicine, Mosby Elsevier, Philadelphia, 2008; Henry and Noah, Kendig & Chernick’s disorders of the respiratory tract in children, W.B. Saunders, Philadelphia, 2012; Camus et al. Respiration 71:301–326, 2004). The challenge is the result of (a) the absence of a specific and sensitive test (Lindell and Hartman, Clin Chest Med 25:15–24, 2004; Rossi et al., Radiographics 20:1245–1259, 2000) that could conclusively provide the diagnosis, (b) the complexity of the interactions between multiple drugs, (c) the clinical resemblence of the pulmonary complication to the disease undertreatment (this is particularly common in the case of rheumatologic disorders (Kremer et al., Arthritis Rheum 40:1829–1837, 1997) and inflammatory bowel diseases (Mansi et al., Am J Respir Crit Care Med 161:1051–1054, 2000; Valletta et al., BMC Gastroenterology 1:13, 2001), (d) the variety of clinical patterns of lung toxicity that can arise even from a single drug, (e) the fact that lung biopsies are not commonly performed in pediatric patients and even when pathology is available it may not be pathognomonic (Flieder and Travis, Clin Chest Med 25:37–45, 2004), (f) the time course between exposure and onset of DIRD that can vary tremendously (Tashiro et al., Tohoku J Exp Med 216:77–80, 2008; Kubo et al., Respir Investig 51:260–277, 2013), and response to drug withdrawal that is not always predictable (Kubo et al., Respir Investig 51:260–277, 2013). Therefore, the pediatrician should always have a high index of suspicion (Liles et al., Cleveland Clin J Med 75:531–539, 2008) and obtain a thorough history, including usage of alternative medicines, supplements, and herbs; illicit drug abuse is also important. Since this field is constantly enriched with new knowledge, it is essential for the busy clinician to check for updates and resources in highly sophisticated relevant websites (http://www.pneumotox.com/).

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Authors and Affiliations

  1. University of Nicosia Medical School, Nicosia, Cyprus

    Dimos K. Gidaris M.R.C.P.C.H., M.R.C.P.E., Ph.D.

  2. Allergy-Pneumonology Department, University of Athens, School of Medicine, Athens, Greece

    Kostas N. Priftis M.D.

  3. Department of Pediatrics, Pulmonary Division, Medical School of the University of Patras, Rion, Greece

    Michael B. Anthracopoulos M.D.

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  1. Dimos K. Gidaris M.R.C.P.C.H., M.R.C.P.E., Ph.D.
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Correspondence to Dimos K. Gidaris M.R.C.P.C.H., M.R.C.P.E., Ph.D. .

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  1. George Washington University School of Medicine, Children’s National Medical Center, Washington, DC, USA

    Anastassios C. Koumbourlis

  2. Ann & Robert H. Lurie Children’s Hospital, Northwestern Feinberg School of Medicine, Chicago, Illinois, USA

    Mary A. Nevin

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Gidaris, D.K., Priftis, K.N., Anthracopoulos, M.B. (2018). Pulmonary Complications of Drug Therapy. In: Koumbourlis, A., Nevin, M. (eds) Pulmonary Complications of Non-Pulmonary Pediatric Disorders. Respiratory Medicine. Humana Press, Cham. https://doi.org/10.1007/978-3-319-69620-1_14

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