Does drug-induced emphysema exist?

Pulmonary physicians are well aware of drug-induced acute and chronic pulmonary toxicities; inhaled or systemically administered drugs can affect airway tone and cause cough, dyspnoea due to airspace disease, diffuse alveolar damage, pulmonary capillaritis or interstitial lung fibrosis, to name a few presentations and tissue manifestations. Well-studied drugs that cause pulmonary toxicity include methotrexate [1], bleomycin [2] and amiodarone [3], all of which can cause interstitial lung disease, platinum compounds which can generate pulmonary hypersensitivity reactions [4], or propylthiouracil which can cause antineutrophil cytoplasmic antibody positive vasculitis and nonspecific interstitial pneumonitis [5, 6]. Over the years a catalogue of drug-induced pulmonary toxicities has been assembled [7] and, more recently, druginduced respiratory disease in patients with haematological disorders [8] and toxicity related to the systemic treatment of nonsmall cell lung cancer [9] have been reviewed.