DRUG INDUCED PULMONARY DISEASES

ASTHMA AND BRONCHOSPASM

Asthma is a frequent ailment affecting approximately 1–18% of the population in extraordinary countries worldwide and is characterised through airway inflammation, bronchial hyper responsiveness, and airway obstruction that is generally reversible spontaneously or with treatment. Airway obstruction causes most of the scientific signs and symptoms and signs of asthma, which include shortness of breath and bronchospasm, cough, mucus secretion, and bronchial hyper responsiveness. The prevalence of asthma is increasing, especially among children, in many areas of the world, including Africa, Latin America, Eastern Europe, Asia, and the United States. For example, in the United States, the prevalence of asthma increased by 14.8% in less than 10 years. Prevention and avoidance can help to reduce the effect of asthma.

There are various causative agents but most of the causative agents are aspirin, nonsteroidal anti- inflammatory agents (NSAIDs), β- adrenergic receptor antagonists (β- blockers), radiocontrast dyes, sulfites, and angiotensin- converting enzyme (ACE) inhibitors. A number of mechanisms are connected with drug Induced asthma and bronchospasm. Bronchospasm can be provoked by means of direct infection of the airway from N- acetyl cysteine or bisulfites, IgE- mediated reactions in anaphylaxis, precipitation of IgG antibodies that may also show up in affiliation with methyldopa, mast- cell degranulation, or as a end result of an meant or unintended pharmacologic effect in sufferers taking aspirin or β-blockers. Aspirin- exacerbated respiratory disease is characterized by airway irritation and hyper responsiveness related with drugs that inhibit COX-1 such as aspirin and NSAIDs. Beta-blockers competitively inhibit stimulation of β-adrenergic receptors, ensuing in unopposed parasympathetic tone, which can end result in bronchoconstriction.

The most important risk aspect for drug- triggered bronchospasm is pre- current asthma. However, smoking, pre-existing airway disease, older age, and respiratory infection can also increase the risk for drug- prompted bronchospasm. Aspirin- exacerbated respiratory ailment happens especially in adults and generally does now not appear till the 30s or 40s. The threat of aspirin exacerbated respiratory disease (AERD) additionally increases with a patient’s asthma severity; the incidence is doubled in sufferers with severe chronic asthma. Women are affected 2–2.5 instances extra regularly than men. ACE- inhibitor–induced cough occurs extra regularly in woman patients, in those of Chinese origin, and in non-smokers. ACE-inhibitor induced cough is now not dose- related and can show up in sufferers taking preliminary beginning doses.

The prevention and avoidance asthma are the causative agents, risk factors. Avoid smoking, Use cardio selective beta blockers, avoid aspirin and desensitisation, use alternatives like celecoxib,meloxicam, avoid ACE-inhibitor and use angiotensin receptor blockers. The biggest benefit used to be associated with leukotriene receptor antagonists, with 50% of patients closing on chronic leukotriene receptor antagonist remedy for AERD. Counselling for patient about asthma is very crucial. Patients with AERD ought to be suggested to keep away from powerful COX-1 inhibitors such as aspirin, ibuprofen, ketoprofen, and others. Inhibitors of COX-1 and COX-2 (e.g., acetaminophen, salsalate) can also be used. If the affected person is prescribed a beta blockers the patient should be recommended no longer to take extra than the prescribed dose.

Asthma is a preventable and controllable disease. Importance of adherence of medications are essential to treat asthma. Above approaches emphasize need to consider biological and social factors to understand and treat the disease effectively. Always be prepared for a flare-up or attack with a rescue Inhaler.

Book Refrence:

Drug-Induced Dieases by Tisdale

( 3rd edition, 2018)

Section 5, chapter 22

Picture Reference:

https://community.aafa.org/blog/what-happens-in-your-airways-when-you-have-asthma