Drug-induced asthma

　　To date, hundreds of drugs have been found that may induce asthma attacks, which can be roughly divided into the following several major categories:

　　1、解热镇痛药

　　主要包括阿司匹林和各种非甾体类抗炎药物，这是一类具有解热镇痛作用且疗效显著的药物，包括某些复合制剂. This includes aspirin, compound aspirin (APC), analgin (Solpium), antipyrine, aminophenazone, anisodamine, paracetamol, cold medicine, compound theophylline, compound antihistamine, Antigen 5, phenylbutazone, ketsukensa, rapid cold capsules, indomethacin, ibuprofen (Fenbid), naproxen, ketoprofen, flurbiprofen, piroxicam (Piroxicam), mefenamic acid, chlorfenac, diclofenac, sulindac, enanthic acid, naproxen, phenylbutylphenylbutyric acid, ketobutylphenylbutyric acid.

　　2、抗菌药

　　Penicillin, ampicillin, cefametin, cefathiamine, erythromycin, polymyxin B, streptomycin, vancomycin, bleomycin, neomycin, tetracycline, chloramphenicol, griseofulvin, spiramycin, gentamicin, lincomycin, gyromycin, amphotericin, pingyangmycin, oleander glycoside, pipemidic acid, sulfonamides, furan derivatives. Patients may have a history of many types of drug allergies. Asthma may occur during the process of taking medication, and some patients may also develop asthma during allergy tests. When asthma is induced, it is often accompanied by symptoms of other allergic diseases, such as rash, edema of the throat, shock, etc.

　　3、β-受体阻断剂

　　心得安，心得平，心得宁，心得静，噻吗心安、阿替洛尔和美托洛尔等. It is noteworthy that people with no history of heart or lung disease may also develop asthma when taking high doses of propranolol. In addition, for susceptible patients, even 0.5% timolol eye drops may induce severe bronchospasm.

　　4. Angiotensin-converting enzyme inhibitors

　　Captopril, enalapril, benazepril, perindopril, ramipril, lisinopril, and spirapril, these drugs can inhibit the degradation of bradykinin, thereby triggering high airway reactivity.

　　5. Iodinated contrast media

　　Such as iodinated oil, ethyl iodinated oil, iodobenzene, iodoform, iohexol, Isovue, iopamidol, etc., the incidence is less than 2%, and severe asthma attacks, even death, can be caused by injection of 0.5-1.0ml of iodinated contrast medium. Any iodinated contrast medium can trigger asthma, but the contrast medium containing methylglucamine has the highest incidence of asthma.

　　6. Anesthetics and muscle relaxants

　　Procaine, lidocaine, cocaine, thiopental, pancuronium bromide, tubocurarine chloride, succinylcholine, the mechanism by which these drugs trigger asthma is still unclear.

　　7. Protein and enzyme preparations

　　Insulin, ACTH, cytochrome C, pituitary posterior lobe powder and extracts, streptokinase, trypsin, alpha-chymotrypsin, antipain enzyme, various vaccines and antitoxin sera, oral pollen preparations, nandrolone phenylpropionate, gamma-globulin, adenosine triphosphate.

　　8. Cholinergic agents

　　Acetylcholine, acetylmecholcholine, pilocarpine, succinylcholine, eserine, neostigmine, galantamine, atropine, muscarine, antivert, amitriptyline, chlorpromazine, calcium gluconate, sodium cromoglicate, hydrocortisone (alcoholic preparation), dexamethasone, beclomethasone propionate aerosol, and others all have the potential to trigger asthma attacks.

　　9. Antihypertensive drugs

　　Reserpine, methyldopa, guanethidine.

　　10. Antiarrhythmic drugs

　　Quinidine, procainamide, digitalis, amiodarone.

　　11. Sympathomimetic drugs

　　Isoprenaline (asthmazole), adrenaline, ephedrine, which are often related to large doses of medication.

　　12. Antihelminthic drugs

　　Drivamine, praziquantel, pentamidine, dipterex.

　　13. Antituberculosis drugs

　　Para-aminosalicylic acid, pyrazinamide, ethambutol, ethionamide, rifampicin.

　　14. Others

　　Certain vaccines, tetanus antitoxin, pyrazolone derivatives, Vascor, aminophylline, chlorphenamine, azathioprine, caffeine, morphine, sodium dehydrocholate, thiourea, codeine, warfarin, barbiturate, vitamin B6, vitamin K, camphor tincture, dextran, acetazolamide, cimetidine, mannitol, progesterone, anisodamine, atropine, histamine, antivert, amitriptyline, chlorpromazine, calcium gluconate, sodium cromoglicate, hydrocortisone (alcoholic preparation), dexamethasone, beclomethasone propionate aerosol, and others all have the potential to trigger asthma attacks.

　　1. Bronchitis and lung infection:It is currently recognized that respiratory viral infections can trigger and exacerbate the attacks of bronchial asthma and are prone to secondary bronchitis and lung infections. Therefore, patients should pay attention to improving their immune function, preventing colds, and maintaining unobstructed breathing to reduce infections.

　　2. Pneumothorax and mediastinal emphysema:The incidence is relatively low, accounting for about 5%, and is caused by overexpansion of alveoli or the formation of bullae due to airway obstruction. If the intrapulmonary pressure is too high, such as during severe coughing or forceful expectoration, the alveoli may rupture, leading to gas entering the subcutaneous tissue of the chest and abdomen, mediastinum, and causing pneumothorax and subcutaneous emphysema, which can be life-threatening.

　　3. Severe asthma with respiratory failure:Due to inadequate ventilation, infection, improper treatment, improper medication, as well as complications such as atelectasis and pulmonary edema, respiratory failure may occur, making the treatment of drug-induced asthma more difficult. It is necessary to treat the triggering factors early to prevent respiratory failure.

　　It often manifests as paroxysmal wheezing, cough, chest tightness, and dyspnea, etc. There are hundreds of drugs that can induce asthma attacks, among which antipyretic and analgesic drugs, antibiotics, beta-blockers, iodinated contrast agents, and protein preparations are more common. Drug-induced asthma is a special type of asthma. Due to the clear etiology, once diagnosed, it can be effectively prevented. Therefore, the diagnosis of drug-induced asthma is particularly important in the prevention and treatment of asthma.

　　Since most patients with drug-induced asthma are not aware of which drugs can induce asthma, prevention is often difficult to start. Therefore, clinical doctors should pay attention to the following points in the prevention of drug-induced asthma:

　　1. Any known asthma-inducing drugs should be discontinued immediately. At the same time, the name of the asthma-inducing drug (including other trade names) should be explained to the patient and family, and recorded on the first page of the medical record to avoid repeated use of such drugs in the future.

　　2. For every asthmatic patient who comes for treatment, it is necessary to carefully inquire about their history of drug allergies or asthma induced by drugs.

　　3. When asthmatic patients use new drugs, they should be carefully observed for any adverse reactions.

　　4. If the symptoms of asthma patients do not improve but worsen during the treatment process, in addition to considering various factors of the disease itself, one should always consider the possibility of drug-induced asthma. If suspected to be drug-induced asthma, a trial of drug discontinuation should be observed.

　　Before using iodinated contrast agents, an allergy test must be performed. For asthmatic patients with allergic constitution or a history of iodine allergy, it is best to avoid iodinated contrast agents. If it is indeed necessary to use them, antihistamines and corticosteroids (such as prednisone 5mg, once every 6 hours, for a total of three times) should be administered 18 to 24 hours before taking the medication.

　　Common laboratory tests

　　1. Sputum smear:Visible features include small airway casts and broken products of eosinophils, all of which are characteristic of asthma. To identify infection, examine sputum smears for broken products of eosinophils and Gram staining for bacteria.

　　2. Skin sensitivity test:Cautiously perform skin scratch or intradermal tests on suspected allergens to help determine the allergen.

　　3. Determination of IgE and IgA in blood and respiratory tract secretions:IgE levels increase during allergic reactions, while IgA levels increase or decrease during viral or bacterial infections.

　　4. Airway sensitization test:To observe the reactivity of the airway to certain known allergens, use them to stimulate the airway.

　　Patients with drug-induced asthma generally have no special dietary requirements, but it is best to: 1. mainly consume light and nutritious foods, and pay attention to dietary regularity. 2. eat a diet as recommended by the doctor.

　　1. Oxygen therapy, timely sputum aspiration, and other symptomatic treatments to keep the respiratory tract unobstructed.

　　2. Antihistamines, β2-agonists, anticholinergic drugs, or oral corticosteroids should be administered according to clinical conditions. In critical conditions, adrenaline can be administered subcutaneously, and in severe conditions, intravenous infusion of high-dose corticosteroids can be given. However, attention should be paid to the fact that for asthma patients caused by corticosteroids, other anti-allergic drugs should be chosen.

　　3. When treating asthma patients caused by the use of drugs such as propranolol, a larger dose of β2-agonists should be given.

　　4. For patients with severe drug-induced asthma, it is necessary to perform tracheal intubation and mechanical ventilation assistance in time.

　　5. Immunotherapy, 'BA cell immunotherapy' is a therapy that treats both the symptoms and the root cause. Since the Beijing Guojizhong Hospital of Traditional Chinese Medicine has adopted 'BA cell immunotherapy', it has been hailed as the 'most popular asthma treatment method'. This therapy helps restore the patient's own physical function, gradually improve resistance, and gradually repair damaged lungs and trachea, regulate internal organs, and achieve the goal of clinical cure.

　　BA cell immunotherapy is mainly based on the principles of cellular and molecular immunology. It isolates the immune cells, DC and CIK cells, which are specifically used in the patient's own immune system to kill inflammatory cells that cause high airway reactivity in asthma, from the venous blood, cultures them in a GMP special laboratory to multiply their numbers and increase their activity, and then returns them to the patient's body. After being infused back into the patient, these cells make precise, specific, and active attacks on the viral cell nuclei and inflammatory cells, killing the viral cell nuclei and inflammatory cells within the body. BA cell immunotherapy can not only eliminate the root cause of asthma but also eliminate the already occurred inflammatory reactions and cell accumulation. It is widely recognized as the most effective and safest emerging treatment technology in the field of asthma treatment in the medical community, truly realizing precise and root treatment, and increasing the clinical cure rate by nearly a factor of two. It has completely said goodbye to the traditional treatment methods of simply anti-inflammatory and antispasmodic, which can only temporarily relieve symptoms but cannot solve immune balance, leading to repeated attacks and long-term treatment without cure!