Drugs acting on the respiratory tract

This chapter discusses several drugs acting on the respiratory tract. Many different agents have been used intrapleurally to produce pleurodesis, both in patients with pleural effusion and in patients with pneumothorax. Some of these agents, talc in particular, have been associated with potentially serious adverse events. Talc is a magnesium sheet silicate and is produced in an asbestos-free form for use in pleurodesis. The most serious adverse effect of talc is a possible association between talc pleurodesis and the development of acute respiratory failure. The intravenous formulation of tetracycline was instilled intrapleurally to produce chemical pleurodesis, with good effect. The adverse effect most commonly seen with tetracycline was chest pain, which was often severe. Several antineoplastic agents have been introduced into the pleural space to achieve pleurodesis, but the greatest reported experience is with bleomycin, Intrapleural bleomycin has an efficacy similar to that of tetracycline and doxycycline. β-adrenoceptor agonists can produce or worsen hypoxia acutely in patients with asthma by increasing ventilation-perfusion inequality. It is not known whether this effect is clinically important in patients with asthma not severe enough to require hospital treatment.