Drug-induced pulmonary disease
Key points
- Drug-induced pulmonary disease is a lung disease caused by an adverse reaction to a medication.
- Many types of lung injury can result from medications, and it is often impossible to predict who will develop lung disease resulting from a medication or drug.
- Challenge tests (reintroducing the suspected medication to see if symptoms recur) are rarely performed.
- Acute episodes usually resolve within 48 to 72 hours after the medication has been discontinued, but chronic syndromes may take longer to resolve.
Definition
Drug-induced pulmonary disease is a lung disease caused by an adverse reaction to a medication.
Causes, incidence, and risk factors
Many types of lung injury can result from medications, and it is often impossible to predict who will develop lung disease resulting from a medication or drug. The types of lung diseases which can result from medications include: allergic reactions (asthma, hypersensitivity pneumonitis, or eosinophilic pneumonia), an undesirable side effect such as coughing or bronchitis, inflammation of the lung air sacks (pneumonitis or infiltration), interstitial fibrosis (scarring), pulmonary edema, alveolar hemorrhage (bleeding into the lung air sacks), pleural effusion, lung vasculitis, mediastinal inflammation, swollen lymph nodes (lymphadenopathy), respiratory failure, granulomatous lung disease, and drug induced systemic lupus erythematosus.
Numerous drugs are known to cause lung (pulmonary) disease in some people including chemotherapy agents, certain antibiotics, illicit drugs, certain cardiovascular drugs, and many others.
Symptoms
- cough
- wheezing
- shortness of breath
- chest pain
- bloody sputum
- fever
Note: Symptoms may be varied.
Signs and tests
- abnormal breath sounds revealed by a physical examination with a stethoscope
- chest X-ray
- chest CT scan
- CBC with differential
- bronchoscopy
- thoracentesis if pleural effusion is present
- rarely, difficult to diagnose cases may require lung biopsy
Treatment
Treatment consists mainly of discontinuing the offending drug immediately, and supportive management of the pulmonary symptoms (e.g., inhaler therapy and oxygen if required until the drug-induced lung disease improves.) Challenge tests (reintroducing the suspected medication to see if symptoms recur) are rarely performed. Steroid therapy (such as prednisone) to quickly reverse the lung inflammation caused by the offending drug is sometimes used.
Expectations (prognosis)
Acute episodes usually resolve within 48 to 72 hours after the medication has been discontinued, but chronic syndromes may take longer to resolve. Some drug-induced lung diseases such as pulmonary fibrosis (scarring) may never resolve.
Written and revised by
Gerald Hurowitz, M.D.
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