Bronchospasm drug-induced

Hypersensitivity responses occur shortly after rapid IV drug perfusion and include hypotension, fever, chills, urdcaria, and bronchospasm. The fact that about a third of all reactions occur following the drst exposure to the drug and that the severity of the responses is dose related suggest that this is not a true immune response to the drug but may be related to a drug-induced histamine release. 

Sympathomimetics (drugs that mimic the sympathetic nervous system) are used primarily to treat reversible airway obstruction caused by bronchospasm associated with acute and chronic bronchial asthma, exercise-induced bronchospasm, bronchitis, emphysema, bronchiectasis (abnormal condition of the bronchial tree), or other obstructive pulmonary diseases. 

Bronchial asthma is defined as a chronic inflammatory disease of the lungs it affects an estimated 9 to 12 million individuals in the U.S. Furthermore, its prevalence has been increasing in recent years. Asthma is characterized by reversible airway obstruction (in particular, bronchospasm), airway inflammation, and increased airway responsiveness to a variety of bronchoactive stimuli. Many factors may induce an asthmatic attack, including allergens respiratory infections hyperventilation cold air exercise various drugs and chemicals emotional upset and airborne pollutants (smog, cigarette smoke). 

D-tubocurarine can induce a release of histamine which results in a massive drop of blood pressure, an increase of saliva and mucus secretion and laryn-gal and bronchospasms, which can interfere with the intubation. In patients with asthma bronchiale on an allergic basis the use of this drug should be avoided. Due to its ganglion blocking properties D-tubocurarine can induce a histamine-independent drop in blood pressure. 

Adverse reactions to the administration of adenosine are fairly common however, the short half-life of the drug limits the duration of such events. The most common adverse effects are flushing, chest pain, and dyspnea. Adenosine may induce profound bronchospasm in patients with known reactive airway disease. The mechanism for bronchospasm is unclear, and the effect may last for up to 30 minutes despite the short half-life of the drug. 

When the drug is used to prevent exercise-induced bronchospasm, administer the dose at least 30 to 60 minutes before exercising... 

Cromolyn sodium (disodium cromoglycate) and nedocromil sodium are stable but extremely insoluble salts (see structures below). When used as aerosols (by nebulizer or metered-dose inhaler), they effectively inhibit both antigen- and exercise-induced asthma, and chronic use (four times daily) slightly reduces the overall level of bronchial reactivity. However, these drugs have no effect on airway smooth muscle tone and are ineffective in reversing asthmatic bronchospasm they are only of value when taken prophylactically. 

The adverse effects of beta-blockers are usually mild, with occurrence rates of 10-20% for the most common in most studies. Most are predictable from the pharmacological and physicochemical properties of these drugs. Examples include fatigue, cold peripheries, bradycardia, heart failure, sleep disturbances, bronchospasm, and altered glucose tolerance. Gastrointestinal upsets are also relatively common. Serious adverse cardiac effects and even sudden death can follow abrupt withdrawal of therapy in patients with ischemic heart disease. Most severe adverse reactions can be avoided by careful selection of patients and consideration of individual beta-blockers. Hjrpersensitivity reactions have been relatively rare since the withdrawal of practolol. Tumor-inducing effects have not been estabhshed in man. 

Salbutamol (4) has been extensively studied by oral (4 mg), inhalation (200 pg),2 intravenous,2 and intramuscular22 administration and found to be effective in the inhibition of exercise induced bronchospasm.2 No drug tolerance was observed in chronically pre-treated guinea pigs.28... 

Dyspnea upon exertion Exercise-induced bronchospasm Suspected arterial desaturation with exercise Evaluation of ventilatory limitations to exercise Evaluation of cardiac limitations to exercise Assessment of general fitness or conditioning Evaluation of cardiopulmonary disability Establishment of safe levels for exercise Evaluation of drug therapy... 

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