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Chronic Drug-Induced Lung Disease from Long-Term OTC Cold Medicine Use

Core Concepts
Long-term use of over-the-counter cold medicine can lead to drug-induced interstitial lung disease.
Abstract and Introduction Rare case of drug-induced interstitial lung disease from OTC cold medicine used daily for 25 years. Patient's symptoms improved upon stopping the medication but worsened upon resuming it. Cold medicine containing codeine and caffeine may contribute to lung damage. Drug-induced interstitial lung disease can occur after long-term OTC cold medicine use. Case Presentation 77-year-old man with worsening cough after 25 years of daily OTC cold medicine use. Lung biopsy showed organizing pneumonia pattern. Symptoms improved upon stopping medication and taking prednisolone. Disease worsened upon resuming cold medicine. Conclusions Drug-induced interstitial lung disease from OTC cold medicine should be considered in cases of diffuse lung disease. Lack of regulation in selling OTC cold medicine may contribute to long-term use and adverse effects. Introduction Lack of detailed questioning by drugstore sellers may lead to prolonged use of OTC cold medicine. Mechanisms of drug-induced lung disease involve immune system dysregulation and oxidative injury. Drug-induced lymphocyte stimulation test may not always be positive. Addictive effects of some OTC cold medicines may contribute to prolonged use.
"We report a rare case of drug-induced interstitial lung disease due to over-the-counter cold medicine taken daily for 25 years to clear the patient's head." "He reported taking the same over-the-counter cold medicine daily for the past 25 years to clear his head." "However, 6 months later, he resumed the same treatment because of a cold." "We diagnosed drug-induced interstitial lung disease." "He improved by stopping the cold medicine again and taking prednisolone." "In cases of diffuse lung disease, we should consider drug-induced interstitial lung disease due to over-the-counter cold medicine, which patients have been taking not only for weeks or months but also years."
"Over-the-counter cold medicines are easily accessible at the drugstore." "The mechanisms through which drug-induced lung disease occurs are likely to involve direct damage to alveolar epithelial or capillary endothelial cells, dysregulation of the immune system, systemic cytokine release, cell-mediated lung damage, and free radical production with oxidative injury." "Some OTC cold medicines contain codeine, dihydrocodeine, and caffeine; some patients might continue taking the medicine due to the addictive effects." "We report an extremely rare case of drug-induced interstitial lung disease due to OTC cold medicine taken every day for 25 years."

Deeper Inquiries

How can regulations be improved to prevent long-term use of OTC cold medicine?

To prevent long-term use of OTC cold medicine, regulations can be enhanced in several ways. Firstly, drugstores could be mandated to inquire about the patient's medical history and current medications before selling OTC cold medicine. This would help identify individuals who may be at risk of adverse effects due to prolonged use. Additionally, stricter guidelines could be implemented regarding the sale of OTC cold medicine containing potentially harmful ingredients like codeine or caffeine. Pharmacists could also be required to provide detailed information on the effects and potential risks of these medications to patients. Moreover, implementing a system to track OTC cold medicine purchases across different stores could help identify individuals who are repeatedly buying these medications and intervene if necessary.

What are the potential risks of overlooking drug-induced interstitial lung disease in patients?

Overlooking drug-induced interstitial lung disease in patients can have serious consequences. Failure to recognize this condition can lead to delayed diagnosis and treatment, resulting in disease progression and potentially irreversible lung damage. Patients may experience worsening respiratory symptoms, such as cough, shortness of breath, and fatigue, which can significantly impact their quality of life. In severe cases, untreated drug-induced interstitial lung disease can lead to respiratory failure and even death. Additionally, misdiagnosis or failure to attribute symptoms to medication use can result in unnecessary tests, treatments, and healthcare costs for the patient.

How can healthcare providers effectively educate patients about the risks of prolonged OTC cold medicine use?

Healthcare providers can effectively educate patients about the risks of prolonged OTC cold medicine use through various strategies. Firstly, during patient consultations, providers should inquire about the patient's medication history, including the use of OTC cold medicines. By discussing the potential risks and side effects of these medications, providers can raise awareness and encourage patients to use them judiciously. Additionally, healthcare professionals can provide educational materials, such as brochures or handouts, that outline the risks of long-term OTC cold medicine use and the signs and symptoms of drug-induced interstitial lung disease. Engaging in open and honest conversations with patients about the importance of following recommended dosages and durations of OTC cold medicine can help prevent adverse outcomes. Furthermore, healthcare providers can leverage digital platforms and telehealth services to reach a wider audience and disseminate information about safe medication practices.