[Iatrogenic drug-induced bronchospasm, cough, and bronchiolitis. Etiologic and physiopathologic aspects]

Iatrogenic respiratory disorders include bronchic manifestations (asthma, bronchospasm, cough) and bronchiolar manifestations (constrictive or proliferative bronchiolitis). Many pharmacologic agents can induce a bronchospasm. The bronchospasm induced by acetylsalicylic acid and nonsteroidal anti-inflammatory agents, often severe, is mediated by the inhibition of the cyclooxygenase enzyme; it can be prevented by eviction of the drug or desensitization. Leukotriene receptor antagonists and 5-lipoxygenase inhibitors may also be useful. Beta-blockers including cardioselective beta-blockers, cholinergic agonists, inhaled agents, angiotensin-converting enzyme inhibitors (ACE), vindesine, histamine liberators, etc..., can also induce a bronchospasm. Most of the same agents can also induce an isolated cough, particularly beta-blockers, inhaled agents, and ACE, which cause 75% of the reported cases of iatrogenic cough. ACE-induced cough usually disappears within 1 to 4 days after withdrawal of the treatment, confirming the diagnosis; ACE-induced cough may be prevented by sodium cromoglycate. The risk of obliterans bronchiolitis with expiratory airflow impairment during rheumatoid arthritis is increased by D-penicillamine. Many drugs can be involved in the pathogenesis of bronchiolitis obliterans organizing pneumonia, which presents with various clinical and radiological aspects. The physician has to keep in mind that bronchospasm, cough, or bronchiolitis of unknown origin, may have a iatrogenic cause.