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Asthma Unmasked With Tumor Necrosis Factor-α-Blocking DrugsTumor Necrosis Factor-α-Blocking Drugs and Asthma

Laurent Guilleminault, MD; Philippe Carré, MD; Frédérique Beau-Salinas, MD; Camille Taillé, MD, PhD; Philippe Dieudé, MD; Bruno Crestani, MD, PhD; Patrice Diot, MD, PhD; Sylvain Marchand-Adam, MD, PhD
Author and Funding Information

From the Service de pneumologie et exploration fonctionnelle respiratoire (Drs Guilleminault, Carré, Diot, and Marchand-Adam), Hôpital Bretonneau, and the Department of Clinical Pharmacology/Regional Centre of Pharmacovigilance (Dr Beau-Salinas), CHRU Tours, Tours; Unité INSERM U618, Faculté de médecine (Drs Guilleminault, Diot, and Marchand-Adam), Université François Rabelais, Tours; the Service de Pneumologie (Drs Taillé and Crestani), and the Service de rhumatologie (Dr Dieudé), APHP, Hôpital Bichat-Claude-Bernard, Paris; and Unité INSERM U700, Faculté de X. Bichat (Drs Taillé and Crestani), Université René Descartes, Paris, France.

Correspondence to: Laurent Guilleminault, MD, CHRU Tours, Hôpital Bretonneau, Service de pneumologie et exploration fonctionnelle respiratoire, 2 Boulevard Tonnelle, 37032 Tours, France; e-mail: guillel@free.fr


Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;140(4):1068-1071. doi:10.1378/chest.10-2350
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We report five cases of asthma unmasked by anti-tumor necrosis factor (TNF)-α-blocking drugs. Asthma symptoms appeared within an average of 4 months (range 1-24 months) after starting the anti-TNF-α treatment for inflammatory disease. The patients did not appear to be predisposed to asthma except for one patient who had asthma during childhood. Four patients stopped anti-TNF-α-blocking drugs with an improvement of symptoms within 1 to 5 months. In the patient with a history of childhood asthma, respiratory symptoms recurred when another anti-TNF-α therapy was started. Asthma control was achieved with inhaled steroids, allowing anti-TNF-α treatment to continue. The biotherapy was maintained for the fifth patient in association with inhaled steroids. The pathophysiologic mechanisms are unknown but are probably more complex than the T helper 1/ T helper 2 imbalance suggested in the literature, and further studies are required.


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