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Organophosphates

Review at PMID 25419614. Recent (2018) concerns about Novichok agents (PMID 30003185), warfare agents which may cause ARF and death. Cardiac manifestations and complications at PMID 19267290 & 19963204

Last update : 09/09/2018

I.w Rapidly progressive ILD/pulmonary fibrosis (Hamman-Rich syndrome)

II.a Pulmonary edema, noncardiogenic (NCPE)

II.b ARDS - Acute lung injury

IV.t Sptutum production - Bronchorrhea - 'Bronchitis'

IX.a Diaphragm/inspiratory muscle weakness/paralysis (w/wo ARF)

IX.d Respiratory failure from ventilatory depression (due to neuromuscular blockade/paralysis)

IX.j Phrenic nerve injury - Hemi- or bilateral diaphragmatic paralysis

XI.g Aspiration, aspiration pneumonia (w/wo demonstrable pharyngeal dysmotility)

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

More detailed checklist

The Drug-Induced Respiratory Disease Website

Philippe Camus, M.D.

Dijon, France