The treatment of drug-induced lung disease consists of immediately discontinuing the offending drug and appropriately managing the pulmonary symptoms. Acute episodes of drug-induced pulmonary disease usually disappear 24-48 hours after the drug has been discontinued, but chronic syndromes may take longer to resolve.
General supportive measures include the following:
Control of underlying lung disease
Prompt treatment of concomitant respiratory infections
Anecdotal reports indicate that glucocorticoid therapy has been associated with rapid improvement in gas exchange and reversal of radiographic abnormalities. If cytotoxic drug-induced disease is severe or appears to progress despite elimination of further drug exposure, an empirical course of glucocorticoids is advisable. Conditions that have favorable corticosteroid responses are cryptogenic organizing pneumonia (COP) and drug-induced eosinophilic pneumonia.
In cases of severe lung toxicity and irreversible fibrosis, patients may be considered for lung transplantation. According to the registry of the International Society of Heart and Lung Transplantation, 1-, 3-, and 5-year actuarial survival rates after lung transplantation are 70.7%, 54.8%, and 42.6%, respectively.
Complications of drug-induced lung toxicity, such as hypoxia, pulmonary thromboembolic disease, and pneumothorax, may require hospital admission. Consultation with a pulmonologist may be helpful.
Most patients with drug-induced lung toxicity can be treated in community settings. Transfer to a tertiary care center is indicated when the diagnosis is in doubt or when treatment is ineffective. Patients with drug-mediated interstitial lung disease are generally treated in an outpatient setting.
For long-term follow-up, patients are seen monthly at first. Subsequently, patients are seen every 3-6 months. Pulmonary function tests (especially diffusing capacity of the lungs for carbon monoxide [DLCO]), the 6-minute walk test, and chest radiographs are usually needed to monitor the course of the disease.
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