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Diagnosing DIRD
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The Drug-Induced Respiratory Disease Website
Philippe Camus, M.D.
Dijon, France
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Drugs
Patterns
VIII.ad
Osteonecrosis of the jaw
Last update :
01/01/1970
Causative drugs
4
Alendronate - Alendronic acid
IV.s
IV - Airway involvement
IV.s - Lolalized airway inflammation/burgeoning/stenosis: The pill aspiration syndrome
VIII.d
VIII - Central-large-upper airway (incl. pharyngeal-nasal) involvement
VIII.d - Thermal (burns, frostbite), chemical or caustic injury on the face, mouth, tongue, pharynx or upper airway
VIII.ad
VIII - Central-large-upper airway (incl. pharyngeal-nasal) involvement
VIII.ad - Osteonecrosis of the jaw
X.b
X - Systemic/Distant conditions, syndromes and reactions
X.b - Antiphospholipid antibodies w/wo the APL syndrome
XI.i
XI - Miscellaneous
XI.i - Esophageal toxicity
XI.o
XI - Miscellaneous
XI.o - Dysphagia
XV.bh
XV - Pathology
XV.bh - Path: Foreign body reaction in large airway walls
2
Anti-angiogenesis/-angiogenic agents
VIII.ad
VIII - Central-large-upper airway (incl. pharyngeal-nasal) involvement
VIII.ad - Osteonecrosis of the jaw
XI.w
XI - Miscellaneous
XI.w - Cavitation/necrosis of lung tumor or metastases
XII.ai
XII - Cardiovascular involvement / toxicity
XII.ai - Cardiotoxicity
1
Biphosphonates
VIII.ad
VIII - Central-large-upper airway (incl. pharyngeal-nasal) involvement
VIII.ad - Osteonecrosis of the jaw
2
Denosumab
I.b
I - Interstitial/parenchymal lung disease
I.b - Pneumonitis (ILD)
I.ao
I - Interstitial/parenchymal lung disease
I.ao - Pulmonary infiltrates
VIII.a
VIII - Central-large-upper airway (incl. pharyngeal-nasal) involvement
VIII.a - Angioedema (may cause UAO, asphyxia and death)
VIII.ad
VIII - Central-large-upper airway (incl. pharyngeal-nasal) involvement
VIII.ad - Osteonecrosis of the jaw
IX.h
IX - Neuromuscular / CNS involvement - Disordered breathing during sleep
IX.h - Dyspnea, unexplained otherwise
IX.z
IX - Neuromuscular / CNS involvement - Disordered breathing during sleep
IX.z - Hypocalcemia (may lead to respiratory muscle weakness and RF)
X.s
X - Systemic/Distant conditions, syndromes and reactions
X.s - Vasculitis, pulmonary (w/wo AH), extrapulmonary, systemic: ANCA-positive
1
1
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Identify causative drugs
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
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