drug induced pulmonary disease

this is a diagnosis of

exclusion

what is it?

when a pt has no hx of pulmonary disease develops respiratory sx, chest xray changes, or detorioration of pulmonary function, histo changes, or other findings due to drug therapy

clinical presentation

• pts may complain of pleuritic chest pain, dyspnea, cough, wheezing, fever

• sx can be present during rest or activity

• when it affects the vasculature, it can present with hematoma, alveolarl hemorrhage…

drug interstitial lung disease (DILD)

• interstitial pneumonitis and fibrosis

• organizing pneumonia

• eosinophilic pneumonia

• hypersensitivity oneumonitis

• others

interstitial pneumonitis and fibrosis

• nonproductive cough, expiratory cackles, sudden dyspnea

• may include fever, rash, or eosinophilia

• can progress to fibrosis, pulmonary htn, OR CYANOSIS

• probs caused by oxidative stress and direct cell injury

interstitial pneumonitis and fibrosis causative agents

• amiodarone

  • can be due to daily dose is >400 mg, long term use, improvement following d/c

• chemotherapy like bleomycin

• antimicrobials like nitrufurantoin and dapto

• transplant meds like everlimus and temsirolimus

interstitial pneumonitis and fibrosis monitoring

• baseline spirometry

• amiodarone - baseline chest radiography, PFT, chest radiogram, sx every 3-6 month son therapy

interstitial pneumonitis and fibrosis management and tx

• stop offending agent

• sometimes start corticosteroids

• supplemental o2

• mechanical ventilation

• severe cases —> lung transplant

organizing pneumonia

• can be from an inflammatory response in th elung parenchyma

• presents with

  • non productive cough

  • dyspnea

  • bilateral cackles

  • rarely have eosinophilia

  • occasional fever/rash

• generally reversed with d/c or corticosteroids

organizing pneumonia causative agents

• antimicrobials - minocycline and nitrofurantoin

• chemotherapy agents - bleomycin

• cardio - amiodarone

• anti-inflammatory - sulfasalazine

eosinophilic pneumonia

• cause is probs due to drug chemoattractants through 5ht2a (APs and antiepileptics) or oxidant injury (nitrofurantoin and dapto)

• can be managed with corticosteroids - taper over 2-3 months and it is used specifically for chronic

• presentation can be BAL >25% eosinophils ; dry cough; dyspnea; chest pain; fever

hypersensitivity pneumonia

• s/sx - bronchospasm, conjuctivitis, rhinitis, angioedema, dyspnea, swollen eyes

• can be acute or chronic

hypersensitivity pneumonia causative agents and how to manage it

• NSAIDs or methotrexate

• d/c the drug or supportive care with corticosteroids and AHs

conditions with indirect effect on the lung function

• drug induced cough

• respiratory depression

drug induced cough

• due to ACEi and sometimes can be caused by CCB, fentanyl iv bolus, or latanoprost

• accumulation of bradykinin or substance P

• manage it with d/c drug

• improvement after d/c should be seen within 1-4 weeks

• usually switch to ARB

respiratory depression

• occurs through CNS depression —> hypoventilation or neuromuscular blockage which bluts pt initiated reso

• common meds that may cause it are opioids