Pneumotox » Drug » Herbals - Dietary botanical therapy - Health products/food - Plants

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

5

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'

Last update : 07/06/2019

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

1

I.b Pneumonitis (ILD)

2

I.m ILD with a granulomatous component

1

II.a Pulmonary edema, noncardiogenic (NCPE)

1

II.b ARDS - Acute lung injury

1

II.q Respiratory distress or failure, not otherwise specified

1

III.a Alveolar hemorrhage (AH), diffuse AH (DAH)

1

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

3

V.u Eosinophilic pleuritis

1

VI.a Pulmonary embolism - Venous thrombosis/thromboembolism

1

VI.b Pulmonary arterial hypertension

1

VIII.a Angioedema (may cause UAO, asphyxia and death)

3

VIII.c Upper airway obstruction other than angioedema or hematoma

1

VIII.w Uvulitis, uvular edema

1

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

1

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

1

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

2

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

1

X.w Eosinophilia myalgia syndrome (EMS)

1

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

1

XI.h Esophageal pathology (erosion, ulcer, tear, rupture, fistula)

1

XI.r Death following exposure or poisoning

1

XI.bi Cyanide poisoning

1

XII.d Myocarditis (can be fulminant)

1

XII.f Cardiomyopathy (acute, subacute, chronic)

2

XII.h Eosinophilic myocarditis

1

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

1

XII.m Cardiac- cardiorespiratory/pulmonary arrest

1

XII.n Cardiovascular collapse - Cardiogenic shock - Hypotension

1

XII.r Heart failure (biventricular, congestive)

1

XII.w Asystole

2

XII.ag Bradycardia

1

XII.ah Tachycardia

1

XII.ai Cardiotoxicity

2

XV.c Path: Organizing pneumonia (OP/BOOP) pattern (see also Id)

1

XV.f Path: Diffuse alveolar damage (DAD-pattern) (see also IL)

1

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

2

XIX.d BAL: Gross or microscopic bleeding/hemorrhage

1

XXIV.i Veterinary: Respiratory/Ventilatory depression

1

XXIV.j Veterinary: Cardiotoxicity

1

Diagnosing DIRD

1

Drug and radiation history

2

Drug singularity - Correct identification of the drug

3

Consistent timing of exposure v. onset of symptoms

4

Clinical, imaging, BAL, pathological pattern consistent with the specific drug

5

Careful exlusion of another cause

6

Remission of symptoms with removal of drug

7

Recurrence with rechallenge (rarely advisable)

8

Causality assessment

More detailed checklist