Drug Induced Pulmonary Disease

Background for drug induced pulmonary disease

typically a diagnosis of exclusion, often preventable

pathogenesis

-cytotoxic effects on alveolar capillary endothelial cells

-direct oxidative injury

-amphiphilic medications causing deposition of phospholipid within the cells

-immune mediated lung injury

apnea

temporary cessation of breathing, especially during sleep

apnea is induced by the

central nervous system depression or respiratory neuromuscular blockade

Sedatives and hypnotic commonly involved in apnea

phenothiazines, barbiturates, benzodiazepines, general anesthetics

Bronchospasms

spasm of bronchial smooth muscle producing narrowing of the bronchi

most common drug induced respiratory problem

bronchospasm

Bronchospasm Types

IgE mediated, ASA induced, Beta Blockers, Contrast Media

AIA Clinical trial: Samter’s Triad

asthma, chronic rhinosinusitis, aspirin intolerance

AIA is most common in what gender

females

Symptoms of AIA include

rhinorrhea, flushing, loss of consciousness, asthma like reaction

AIA treatment

manage underlying asthma, aspirin avoidance, aspirin desensitization

Beta Blockers

Beta blockers have potential for causing fatal bronchospasm in patients with asthma/COPD

management of beta-blockers

use cardioselective agents. start low and monitor for symptoms.

Pathophysiology ACEI-Induced Cough

ACEI prevents the breakdown of bradykinin and substance P.

ACEI Induced Cough is more common in

women, nonsmokers, patients of Chinese origins

Treatment of ace

discontinue medication and unresponsive to cough suppressants

Bleomycin

glycopeptide antibiotic used for various types of cancers

Boxed warning for bleomycin

pulmonary fibrosis

Bleomycin Acute Bronchospasm

• Less common

• Acute (1-24 hours)

• S/S: Cough and Dyspnea

• Management:Premedication

Bleomycin Pulmonary Fibrosis

• More common

• Chronic,progressive

• S/S: cough, dyspnea, B/L interstitial infiltrates

• Management: baseline and periodic LFTs; transfer capacity CO

Presentation Methotrexate

Progressive respiratory complaints within 1 year of starting MTX therapy. Dry cough. Dyspnea.

Diagnosis based on exclusion MTX Induced Pneumonitis

chest x ray, CT, PFT, lung biopsy

Methotrexate Induced Pneumonitis Treatment

• Monitoring:annual chest x ray

• Discontinuation of MTX therapy

• If persists start corticosteroids

Amiodarone Induced Pulmonary Toxicity Risk Factor

men, increasing age, pre existing lung disease

Presentation of Amiodarone Induced Pulmonary Toxicity

progressive, dyspnea, nonproductive cough, malaise, fever, pleuritic chest pain

Diagnosis Amiodarone Induced Pulmonary Toxicity

chest x ray and pulmonary function test

Treatment of Amiodarone Induced Pulmonary Toxicity

discontinue amiodarone and systemic corticosteroids