Philippe Camus, M.D.

Dijon, France

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The Drug-Induced Respiratory Disease Website and App

Excipients-Vehicle-Preservatives (of drugs)

E.g.: crospovidone, PVP, starch, cellulose, lactose, propylene glycol, castor oil, lipids, wax, soybean oil, cremaphor. When a diverted i.v. route is used, tablets may elicit pulmonary foreign body reaction and/or vasculitis, causing PHTn (see under foreign body bronchiolitis, ILD, vasculopathy and under PHTn). In vitro drug and excipient incompatibilities are not covered here. Review of compounds and tinctorial staining characteristics on PMID 25341165

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.c

Eosinophilic pneumonia (pulmonary infiltrates and eosinophilia)
I.d

Acute eosinophilic pneumonia (AEP)
I.e

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

Pulmonary fibrosis
I.n

ILD with a granulomatous component
I.u

Pneumoconiosis (silicosis, talcosis...)

II - Pulmonary edema - Acute lung injury - ARDS

II.a

Pulmonary edema, noncardiogenic (NCPE)

IV - Airway involvement

IV.a

Bronchospasm - Wheezing - Asthma
IV.b

Severe or catastrophic bronchospasm or asthma attack (can be fatal)
IV.z

Foreign body aspiration bronchiolitis

VII - Pulmonary vasculopathy

VII.b

Pulmonary arterial hypertension
VII.e

Fat/oil embolism - The FES embolism syndrome
VII.g

Foreign body pulmonary vasculopathy (Excipient lung disease)

X - Systemic/Distant conditions, syndromes and reactions

X.f

Anaphylaxis-Anaphylactoid reaction (can be fatal)
X.h

Protracted, prolonged anaphylaxis
X.i

Hypersensitivity reaction (may manifest with fever and/or skin, throat or airway involvement)
X.w

Multiple organ dysfunction/failure (MODS/MOF)

XI - Miscellaneous

XI.e

Metabolic acidosis (incl. lactic acidosis/-gap). May cause hyperpnea/dyspnea

XII - Cardiovascular involvement / toxicity

XII.o

Cardiovascular collapse - Cardiogenic shock - Hypotension

XVI - Imaging

XVI.q

Imaging: A pattern similar/consistent to/with IPF
XVI.v

Imaging: Centrilobular micronodules (can be diffuse)

XIX - Pathology

XIX.ab

Path: Foreign body deposits/granulomatous reaction
XIX.be

Path: Lipid/fat embolism (see also VIe)