Zusammenfassung
Medikamentennebenwirkungen an den Atmungsorganen können alle Kompartimente des respiratorischen Systems betreffen und vielfältige bronchopulmonale Erkrankungen imitieren. Das Spektrum medikamenteninduzierter Lungen- und Bronchialerkrankungen reicht vom banalen Husten über die Induktion von Bronchialobstruktionen bis hin zur Bronchiolitis obliterans. Im Lungenparenchym treten Alveolitiden und Lungenfibrosen auf. Weitere Reaktionsmuster sind das nichtkardiogene Lungenödem oder die diffuse alveoläre Hämorrhagie. Es kann zur Ausbildung eines medikamenteninduzierten ARDS kommen. Medikamente sind potenzielle Ursachen von eosinophilen Lungenerkrankungen, von pulmonal-vaskulären Krankheiten oder von Pleuritiden. Selten liegt ein pathognomonisches Muster vor, sodass medikamenteninduzierte Erkrankungen oft eine Differenzialdiagnose von genuinen pneumologischen Krankheiten darstellen. Die Diagnostik stützt sich vorwiegend auf den Nachweis eines kompatiblen Krankheitsbilds, den Ausschluss von Differenzialdiagnosen sowie die Bewertung des zeitlichen Zusammenhangs und der Effekte einer Medikamentenkarenz. Eine Reexposition ist selten indiziert. Die Karenz ist die wichtigste therapeutische Maßnahme, eine zusätzliche medikamentöse Therapie, meist mit Glukokortikosteroiden, kann notwendig sein.
Abstract
Adverse effects of drug therapy may affect all compartments of the respiratory system and simulate a wide variety of bronchopulmonary disorders. The spectrum of drug induced lung and bronchial diseases include simple cough, bronchial obstruction, and obstructive bronchiolitis. Lung parenchyma may be affected by alveolitis/pneumonia or lung fibrosis. Further damage pattern are noncardiac pulmonary edema, diffuse alveolar damage or diffuse alveolar hemorrhage. Drugs are potential causes of eosinophilic lung diseases, pulmonary vascular disorders as well as pleural affections. These side effects rarely have pathognomonic features. Therefore they are relevant differential diagnoses of genuine pulmonary diseases. Diagnostics is mainly based on the verification of a compatible disease pattern, exclusion of differential diagnoses, assessment of the temporal relationship and the consequences of drug abstention. Reexposure is rarely indicated. Strict elimination of the responsible drugs is the most important therapeutic measure. Additional drug therapy, mostly with glucocorticosteroids, may be indicated.
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Schreiber, J. Medikamenteninduzierte Lungenerkrankungen. Pneumologe 6, 113–124 (2009). https://doi.org/10.1007/s10405-009-0307-3
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DOI: https://doi.org/10.1007/s10405-009-0307-3