Bronchoalveolar T-cell subsets in gold lung. Evidence for a hypersensitivity reaction.

one is faced with a serious problem with few drugs left to use prior to the use of a paralysant in conjunction with artificial respiration. If there is no significant tachyarrhythmia, one can try atropine solution by inhalation. Unfortunately, most patients have tachyarrhythmia precluding further use of sympathomimetic drugs or recently advocated atropine solution inhalation. During the past 8 years one ofus (TKS) has been using ACTH, 40 units IV, continuously every 8 hours in addition to therapy including high dosage ofcorticosteroids and aminophylline in these patients. After 48 to 72 hours’ administration patients start to respond, thereby avoiding enotracheal intubation, muscle paralysant, artificial ventilation, and in rare instances, bronchial lavage. Once their respiratory status stabilizes, we discontinue ACTH altogether and start weaning from corticosteroids over a period of days. We do not know how the addition ofACTH benefits these patients, but most likely through its pharmacologic effect as the adrenal cortex is most likely suppressed by the time of its use.