Philippe Camus, M.D.

Dijon, France

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The Drug-Induced Respiratory Disease Website and App

Herbals - Dietary botanical therapy - Health products/food - Plants

Including food and dietary supplements, herbals available on e-shops on the Internet, plants (e.g. aconite-nape, Atropa, scopolamine). Browsing the literature indicates nonpulmonary (neurotoxic, hepatic, cardiac, metabolic, genitourinary) adverse effects as well as possible pharmacokinetic/metabolic interactions with therapeutic drugs. Death can occur following exposure. See PMID 9528737, 21896525, 21972388, 22045882. Caution needed about herbals used to treat asthma or obesity, as these may contain steroids or amphetamines respectively (PMID 2323261; http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm238491.htm). Patients should be prudent with herbal 'sexual enhancers', as these may contain undeclared active drugs (PMID 22365331, 25459948). Quality of publications regarding ILD, assessment and attribution of causality is 'wide-ranging'

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 (ILD)
I.b

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

ILD with a granulomatous component

II - Pulmonary edema - Acute lung injury - ARDS

II.a

Pulmonary edema, noncardiogenic (NCPE)
II.e

ARDS - Acute lung injury
II.r

Respiratory distress or failure, not otherwise specified

III - Pulmonary/alveolar./airway hemorrhage/bleeding

III.a

Alveolar hemorrhage (AH), diffuse AH (DAH)

IV - Airway involvement

IV.x

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

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

V.a

Angioedema (may cause UAO, asphyxia and death)
V.c

Upper airway obstruction other than angioedema or hematoma
V.w

Uvulitis, uvular edema

VI - Pleural and/or pericardial involvement

VI.a

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

Eosinophilic pleuritis

VII - Pulmonary vasculopathy

VII.a

Pulmonary embolism - Venous thrombosis/thromboembolism
VII.b

Pulmonary arterial hypertension

IX - Neuromuscular / CNS involvement - Disordered breathing (during sleep)

IX.a

Diaphragm/inspiratory muscle weakness/paralysis (w/wo ARF)
IX.d

Respiratory failure from ventilatory depression (due to neuromuscular blockade/paralysis)

X - Systemic/Distant conditions, syndromes and reactions

X.f

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

Multiple organ dysfunction/failure (MODS/MOF)
X.y

Eosinophilia myalgia syndrome (EMS)

XI - Miscellaneous

XI.b

Chest pain (acute or subacute), lone or prominent
XI.o

Death following exposure or poisoning
XI.bd

Cyanide poisoning

XII - Cardiovascular involvement / toxicity

XII.d

Myocarditis (can be fulminant)
XII.g

Cardiomyopathy (acute, subacute, chronic)
XII.i

Eosinophilic myocarditis
XII.n

Cardiac arrhythmias or dysrhythmias (AF, VT, VF, TdP)
XII.o

Cardiovascular collapse - Cardiogenic shock - Hypotension
XII.s

Heart failure (biventricular, congestive)
XII.t

Heart block (bundle branch- or AV-)
XII.u

Cardiac- cardiorespiratory/pulmonary arrest
XII.y

Asystole
XII.ai

Bradycardia
XII.aj

Tachycardia
XII.ak

Cardiotoxicity

XIII - Esophageal involvement

XIII.b

Esophageal pathology (erosion, ulcer, tear, rupture, fistula)

XVIII - Cytological, biochemical features of/in BAL, pleural fluid or FNA

XVIII.d

BAL: Gross or microscopic bleeding/hemorrhage

XIX - Pathology

XIX.d

Path: Organizing pneumonia (OP/BOOP) pattern (see also Id)
XIX.o

Path: Diffuse alveolar damage (DAD-pattern) (see also IL)
XIX.aq

Path: Obliterative (constrictive) bronchiolitis (see also IVc, IVn)

XXVI - Veterinary medicine

XXVI.k

Veterinary: Cardiotoxicity
XXVI.m

Veterinary: Respiratory/Ventilatory depression