P Plleeuurraall d diisseeaassee d duurriinngg ttrreeaattmmeenntt w wiitthh b brroommooccrriippttiinnee iinn p paattiieennttss p prreevviioouussllyy e exxppoosseedd ttoo a assbbeessttooss

Pleural disease during treatment with bromocriptine in patients previously exposed to asbestos. G. Hillerdal, J. Lee, A. Blomkvist, A. Rask-Andersen, M. Uddenfeldt, H. Koyi, E. Rasmussen. ©ERS Journals Ltd 1997. ABSTRACT: Bromocriptine, which is used in the treatment of Parkinson''s dis- ease, can cause adverse pleuropulmonary reactions. Exposure to asbestos can result in similar lesions. Fifteen patients with former exposure to asbestos, who developed pleural fibro- sis after treatment with bromocriptine, were observed independently in Sweden (11 patients) and Australia (four patients). The patients complained of malaise, often associated with weight loss, dyspnoea, and a disturbing cough. Laboratory values included increased erythrocyte sedi- mentation rate and a low haemoglobin level. Lung function tests showed a restric- tive lung function defect. Chest radiographs showed bilateral pleural fibrosis, with small amounts of fluid in some cases. Soon after bromocriptine was withdrawn, the patients improved clinically, and the laboratory values returned to normal. However, in most cases, pleural fibrosis and a restrictive lung function defect per- sisted to some extent. In conclusion, in patients who develop pleuropulmonary fibrosis whilst being treated with bromocriptine, former exposure to asbestos should be investigated. Conversely, when pleural changes develop in a patient on bromocriptine and with prior exposure to asbestos, the possible causative role of the drug should be dis- cussed. Special follow-up may be indicated when bromocriptine is planned in a patient with previous asbestos exposure, and if symptoms or signs of pleural fibro- sis develop, bromocriptine withdrawal should be considered. Eur Respir J 1997; 10: 2711-2715.