The Drug-Induced Respiratory Disease Website

Beta-blockers

Severe or catastrophic bronchospasm or asthma attack (can be fatal)

Can be fatal in minutes

Morales DR, Lipworth BJ, Donnan PT, Jackson C, Guthrie B

Respiratory effect of beta-blockers in people with asthma and cardiovascular disease: population-based nested case control study.

BMC medicine 2017 01 27;15;18 — 2017 01 27 — 18

Johnston SL, Edwards MR

Mechanisms of adverse effects of {beta}-agonists in asthma.

Thorax 2009 Sep;64;739-41 — 2009 Sep — 739-41

Spitz DJ

An unusual death in an asthmatic patient.

The American journal of forensic medicine and pathology 2003 Sep;24;271-2 — 2003 Sep — 271-2

Fallowfield JM, Marlow HF

Propranolol is contraindicated in asthma.

BMJ (Clinical research ed.) 1996 Dec 07;313;1486 — 1996 Dec 07 — 1486

Leuppi JD, Hartmann K, Ciociaro C, Reinhart WH, Kuhn M

[Side effects of drugs on the respiratory tract: experiences of the Swiss Drug Monitoring Center from 1991 to 1995].

Praxis 1996 Oct 29;85;1394-7 — 1996 Oct 29 — 1394-7

Diagnosing DIRD

Drug and radiation history

Drug singularity - Correct identification of the drug

Consistent timing of exposure v. onset of symptoms

Clinical, imaging, BAL, pathological pattern consistent with the specific drug

Careful exlusion of another cause

Remission of symptoms with removal of drug

Recurrence with rechallenge (rarely advisable)

Causality assessment

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