Bronchospasm associated with anti-TNF treatment

The aetiology of breathing difficulties in patients with inflammatory arthritis being treated with anti-TNF agents can be multi-factorial. Exacerbation of fibrosing alveolitis in patients recently commencing Infliximab has been previously described. Bronchospasm, although reported in some study patients, has not been formally investigated so far. The objective of this study is to define the incidence of bronchospasm in patients treated with anti-TNF agents and investigate details of their respiratory problems. We retrospectively reviewed the notes for 421 patients with inflammatory arthritis being treated with anti-TNF agents at our centre to identify patients who had developed respiratory symptoms during the course of this treatment (cardiac or pleural disease, thromboembolic phenomena or infection were excluded). We identified 7 patients where bronchospasm was thought to be due to treatment with anti-TNF drugs (1.7%). Four of these had to discontinue anti-TNF treatment; two of these needed oral corticosteroid therapy. Two patients were stabilised with increased inhaled beta-2 agonist and steroid, while one patient did not need treatment. All patients had significant exposure to smoking. Bronchospasm is not an uncommon side-effect of anti-TNF treatment. The aetiology of this is probably multi-factorial, but current or previous smoking appears to be a predisposing factor. The frequency and severity of bronchospasm appears to be greater than previously anticipated, all three anti-TNF agents appear to be implicated.