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• W2109706231 abstract "I read with interest the article by Lomia and colleagues wherein they have described the use of carbamazepine for treatment of moderate and severe persistent asthma.1Lomia M. Tchelidze T. Pruidze M. Bronchial asthma as neurogenic paroxysmal inflammatory disease: a randomized trial with carbamazepine.Respir Med. 2006; 100: 1988-1996Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar However, there are two points regarding the study which need careful attention. Firstly, patients with persistent asthma are often receiving treatment with theophylline or its analogs. In the current study also, more than two thirds of patients in each group were on oral theophylline. Carbamazepine has been shown to interact with theophylline and reduce the half life of the latter.2Mitchell E.A. Dower J.C. Green R.J. Interaction between carbamazepine and theophylline.N Z Med J. 1986; 99: 69-70PubMed Google Scholar, 3Rosenberry K.R. Defusco C.J. Mansmann Jr., H.C. McGeady S.J. Reduced theophylline half-life induced by carbamazepine therapy.J Pediatr. 1983; 102: 472-474Abstract Full Text PDF PubMed Scopus (30) Google Scholar In patients with moderate-to-severe persistent asthma, such an effect can not only result in worsening of asthma control but also increase the risk of serious exacerbations, hospitalization and thus an increase in the morbidity (and possibly mortality) associated with asthma. Secondly, carbamazepine itself has been associated with the development of a wide range of pulmonary disorders including pulmonary eosinophilia, diffuse parenchymal lung disease and even respiratory failure.4Orliaguet O. Langin T. Gavazzi G. Brambilla C. Acute eosinophilic pneumonia due to hypersensitivity to carbamazepine.Rev Mal Respir. 1998; 15: 797-799PubMed Google Scholar, 5Uji M. Sugama Y. Matsushita H. Carbamazepine-induced pneumonitis definitively diagnosed by accidental readministration.Nihon Kokyuki Gakkai Zasshi. 2005; 43: 150-154PubMed Google Scholar, 6Milesi-Lecat A.M. Schmidt J. Aumaitre O. Kemeny J.L. Moinard J. Piette J.C. Lupus and pulmonary nodules consistent with bronchiolitis obliterans organizing pneumonia induced by carbamazepine.Mayo Clin Proc. 1997; 72: 1145-1147Abstract Full Text Full Text PDF PubMed Scopus (27) Google Scholar, 7Ben Jemaa M. Kammoun S. Kanoun F. Zghal K.M. Ben Hamed S. Respiratory manifestations of carbamazepine. Apropos of a case.Rev Pneumol Clin. 1997; 53: 351-354PubMed Google Scholar Occurrence of asthma has also been reported with the use of carbamazepine.8Lewis I.J. Rosenbloom L. Glandular fever-like syndrome, pulmonary eosinophilia and asthma associated with carbamazepine.Postgrad Med J. 1982; 58: 100-101Crossref PubMed Scopus (21) Google Scholar, 9Lee T. Cochrane G.M. Amlot P. Pulmonary eosinophilia and asthma associated with carbamazepine.Br Med J (Clin Res Ed). 1981; 282: 440Crossref PubMed Scopus (13) Google Scholar Since drug hypersensitivity has been the postulated underlying mechanism, patients have usually been managed with withdrawal of the drug and administration of corticosteroids, although severe cases, wherein administration of carbamazepine was associated with the development of respiratory failure, have required mechanical ventilatory support in addition to other measures.10Wilschut F.A. Cobben N.A. Thunnissen F.B. Lamers R.J. Wouters E.F. Drent M. Recurrent respiratory distress associated with carbamazepine overdose.Eur Respir J. 1997; 10: 2163-2165Crossref PubMed Scopus (27) Google Scholar The authors’ recommendation for the routine use of carbamazepine in persistent asthma on the basis of a single trial involving small number of patients in each group is at present, premature and unwarranted. It would be prudent to first evaluate the potential adverse effects associated with the use of carbamazepine in patients with persistent asthma by conducting randomized clinical trials (involving larger patient numbers) that are designed to test the safety profile of the drug rather than its efficacy. After all, in the practice of medicine, non maleficence precedes beneficence." @default.
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• W2109706231 date "2007-03-01" @default.
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• W2109706231 title "Carbamazepine in asthma: First do no harm!" @default.
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