Philippe Camus, M.D.

Dijon, France

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Chemicals

See also under 'gases' and 'chemical weapons'. PMID 31018070. This is not (yet) a comprehensive review of all chemical-related adverse respiratory effects. We plan to subsume the 'chemical' group in the future. Numerous nontherapeutic chemicals (hydrocarbons, solvents, insecticides, pesticides, rodenticides, herbicides (paraquat, glyphosate), solvents, alcohols, fuels, glues, household compounds, diacetyl, fluoroethane, pool disinfectants (sodium dichloroisocyanurate, HBr) have a propensity to cause airways, lung (chemical pneumonitis and ARDS) or pleural injury. Careful history taking is indicaded. These substances can injure the lung via inhalation, aspiration, transdermally or parenterally. See PMID 14973213, 21896525, 21972388, 22045882. 24275172, 30608256, 31018070

Frequency - Incidence

Incidence of respiratory adverse event(s) due to the specific drug as assessed by number of reported/published cases in the literature. Red digits in stars indicate: 0 = Very rare, questionable signal · 1 = < 10 cases · 2 = 10-50 cases · 3 = 50–100 cases · 4 = 100-200 cases · 5 = >200 cases

Evidence level/grade

Evidence level for respiratory adverse event(s) due to the specific drug as estimated using Hill’s (1965), Naranjo’s (1981), and Bégaud’s (1985) criteria applied to published cases. Blue digits in stars indicate: 0 = Questionable · 1 = Low · 2 = Moderate · 3 = Robust · 4 = Definite · 5 = Unquestionable, pathognomonic

I - Interstitial/parenchymal lung disease

I.a

Pneumonitis (interstitial lung disease/ILD)
I.b

Pneumonitis (ILD), acute and/or severe (may cause ARDS)
I.e

Organizing pneumonia pattern (an area or areas of consolidation on imaging)
I.k

Exogenous lipoid pneumonia (subacute, acute)
I.ag

Chemical (toxic) pneumonitis

XLI - Pulmonary edema - Acute lung injury - ARDS

XLI.a

Pulmonary edema, noncardiogenic (NCPE)
XLI.e

ARDS - Acute lung injury

XLII - Pulmonary/alveolar./airway hemorrhage/bleeding

XLII.a

Alveolar hemorrhage (AH), diffuse AH (DAH)
XLII.b

Pneumorenal syndrome (w/wo ANCAs)

XLIII - Airway involvement

XLIII.h

Reactive airway dysfunction syndrome (RADS)
XLIII.x

Obliterative bronchiolitis (a pattern consistent with) (see also IVn, XVx)
XLIII.ag

Obstructive airway dysfunction (see also IVc, XVx)

XLIV - Central-large-upper airway (incl. pharyngeal-nasal) involvement

XLIV.c

Upper airway obstruction other than angioedema or hematoma
XLIV.f

Vocal cord dysfunction, adduction, closure, injury

XLV - Pleural and/or pericardial involvement

XLV.a

Pleural effusion (uni- or bilateral) (can accompany DI-LDs)

XLIX - Systemic/Distant conditions, syndromes and reactions

XLIX.o

Vascultis (pulmonary, extrathoracic or systemic)-ANCA status unknown or negative)
XLIX.w

Multiple organ dysfunction/failure (MODS/MOF)
XLIX.ae

Anti-GBM antibody disease (Goodpasture-like or flare of preexisting GS)

L - Miscellaneous

L.p

Sniffing death - Death from inhalation of compound

LI - Cardiovascular involvement / toxicity

LI.u

Cardiac- cardiorespiratory/pulmonary arrest

LIII - Hemoglobinopathies - Abnormal hemoglobin states (acquired)

LIII.a

Methemoglobinemia
LIII.c

Sulfhemoglobinemia

LV - Imaging

LV.ac

Imaging: Cavitating/cavitary lung nodule, mass or nodules (see also Iq, XIs, XIIi, XVIaa and XVIIp)

LVIII - Pathology

LVIII.al

Path: Acute/subacute bronchiolitis (see also IVc, IVi)

LIX - Infections & related conditions

LIX.p

Lung abscess/abscesses (see also VIr)