International Congress Amsterdam 2015



Iatrogenic drug

Hot topics
Chairs: Venerino Poletti (Forli, Italy), Athol Wells (London, United Kingdom)
Aims: Since 2010, many novel biological drugs for primary or secondary solid neoplasms and haematologic malignancies have become available. Each of these drugs or drug classes produces a well-defined pattern of respiratory involvement. These patterns must be separated from the patterns imposed by the underlying disease, the effect of other drugs/radiation, and the effect of infections. If these patterns are not discriminated, the patient is at risk of unnecessary drug withdrawal, which could have adverse consequences on the underlying respiratory condition . Those patients must also be followed in a preventive manner by pulmonologists according to established guidelines before complications develop. Moreover, many new illicit drugs, substances of abuse, drugs on the internet, and inhalants are now available. Many can cause acute respiratory emergencies or death. Identification of the culprit drug is problematic in the obtunded patient. Pulmonologists must be cognisant of these possible problems and to advise ICU and emergency department colleagues in a precise and timely manner. The risks of e-cigarettes should also be reviewed since some e-liquids contain illegal drugs. In addition, a host of non-drug compounds are now being used in orthopaedic and plastic surgery (e.g., silicone, 150 hydrogel, and methacrylate glue). These compounds can access the lung, causing mysterious and severe lung and sometimes brain involvement. Late diagnosis is common. Clinicians should be updated about these risks. Finally, it was shown that 9% of patients with drug-induced respiratory injury die (Pneumotox.com ®). Sadly, but interestingly, a sizable fraction of these fatal cases could have been avoided by implementing the guidelines, evaluating the lung adequately before therapy, ensuring the absence of premedication, making an early diagnosis, and eliminating management errors . If one wants the number of drug casualties to diminish in the future, all preventive actions should be reviewed carefully and presented to clinicians.
Target audience: Clinicians, intensivists, ICU physicians, emergency department doctors and nurses, radiologists, and anaesthesiologists.

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 [+]  Webcast Slide presentation Multimedia files 4718 Emerging biologicals: separating drug-related injury from the underlying disease-related lung injury
Maureen Horton (Baltimore, United States of America)
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 [+]  Webcast Slide presentation Multimedia files 4719 Respiratory emergencies caused by novel substances of abuse
Bruno Megarbane (Paris, France)
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 [+]  Webcast Slide presentation Multimedia files 4720 Pulmonary and systemic vasculopathies caused by drug excipients, cutting agents and adulterants
Philippe Bonniaud (Dijon, France)
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 [+]  Webcast Slide presentation Multimedia files 4721 Avoiding drug-induced casualties: a critical mission
Philippe Camus (Dijon, France)
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