H1N1 pneumonitis associated with long-term non-steroidal anti-inflammatory drug abuse

Abstract

This case series discusses two similar presentations of H1N1 influenza in young patients with a background history of long-term non-steroidal anti-inflammatory drug (NSAID) abuse. Both patients presented with type 1 respiratory failure requiring intensive care unit admission and subsequent organ support. This report reviews the immunosuppressive effects of long-term NSAID use and highlights a potential link to the significant morbidity seen.

A Scoping Review of Non-Medical and Extra-Medical Use of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

“…Across the included records, excessive use of NSAIDs amongst elite and non-elite athletes was described as a medical, such as to intoxicate) use of NSAIDs [5,8,11,12]. This inappropriate use of NSAIDs has increased in recent times, perhaps attributable to the self-care revolution [27], the increasing number and accessibility of medicines and the wide availability of online health information [13].…”

“…Current evidence as collated by this review is that nonmedical and extra-medical use of NSAIDs poses significant health risks for individuals. A range of adverse health consequences were described, including nephrotoxicity (acute renal failure and acute interstitial nephritis) [74]; damage to the renal system; asthma exacerbation; gastrointestinal problems [14,49,60,75]; hypertension and other cardiovascular diseases [38]; gastric erosions and ulceration; chronic gastritis; renal necrosis and disease; hepatocyte necrosis [54]; type 1 respiratory failure [5]; oliguria/anuria and gastric bleeds [15]; recurrent hypokalaemia episodes [57,73]; withdrawal symptoms [51]; haematuria, eosinophilia and decreased creatinine clearance [39]. The majority of NSAID overdoses are asymptomatic, which poses a serious risk to people who use NSAIDs excessively without experiencing any noticeable adverse outcomes [35].…”

“…NSAIDs are reported to be safe and effective if used within medical guidelines. However, inappropriate use has also been reported in the literature [4][5][6][7][8]. This can result in a broad spectrum of harms, including gastrotoxicity, hepatoxicity, nephrotoxicity, cardiotoxicity, overdose and even death [9,10], and increases the burden on healthcare systems.…”

“…Anecdotal reports, as well as several case reports and mini reviews, have highlighted the trend of extra-medical (using more than prescribed or recommended, for a medical reason) or non-medical (using for reasons other than medical, such as to intoxicate) use of NSAIDs [ 5 , 8 , 11 , 12 ]. This inappropriate use of NSAIDs has increased in recent times, perhaps attributable to the self-care revolution [ 27 ], the increasing number and accessibility of medicines and the wide availability of online health information [ 13 ].…”

Ibuprofen in the Management of Viral Infections: The Lesson of COVID‐19 for Its Use in a Clinical Setting

“…[58][59][60] In contrast, ibuprofen is a COX-1/2 balanced inhibitor, and several studies documented that its use is related to low gastrointestinal, cardiovascular, renal, and skin risk compared to the other NSAIDs. [61][62][63][64][65][66][67] Some authors described the development of respiratory failure 68 and empyema 69 in patients with acute viral infection exposed to NSAIDs. However, the development of respiratory adverse effects probably could be related to the effects of NSAIDs that prevent the timely recognition of respiratory diseases, leading to a delay in the diagnosis, promoting a more invasive disease.…”