Drug-Induced Pulmonary Toxicity Treatment & Management

  • Author: Arshad Ali, MD; Chief Editor: Zab Mosenifar, MD   more...
 
Updated: Feb 11, 2011
 

Medical Care

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:

  • Smoking cessation
  • 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 chest radiograph abnormalities. If the 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 BOOP and drug-induced eosinophilic pneumonia.

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Consultations

Consultation with a pulmonologist may be helpful in the management of the drug-induced pulmonary diseases.

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Contributor Information and Disclosures
Author

Arshad Ali, MD  Attending Physician, Department of Pulmonary and Critical Care Medicine, Mercy General Hospital, Sacramento, California

Arshad Ali, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and American Thoracic Society

Disclosure: Nothing to disclose.

Coauthor(s)

M Frances J Schmidt, MD  Chief of Pulmonary Medicine, Pulmonary Fellowship Program, Teaching Attending Physician, Department of Medicine, Interfaith Medical Center

M Frances J Schmidt, MD is a member of the following medical societies: American College of Chest Physicians and American College of Physicians

Disclosure: Nothing to disclose.

Specialty Editor Board

Ryland P Byrd Jr, MD  Professor, Department of Internal Medicine, Division of Pulmonary Medicine and Critical Care Medicine, Program Director of Pulmonary Diseases and Critical Care Medicine Fellowship, East Tennessee State University, James H Quillen College of Medicine; Medical Director of Respiratory Therapy, James H Quillen Veterans Affairs Medical Center

Ryland P Byrd Jr, MD is a member of the following medical societies: American College of Chest Physicians and American Thoracic Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Om Prakash Sharma, MD, FRCP, FCCP, DTM&H  Professor, Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Southern California Keck School of Medicine

Om Prakash Sharma, MD, FRCP, FCCP, DTM&H is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American College of Chest Physicians, American College of Physicians, American Federation for Medical Research, American Osler Society, American Thoracic Society, New York Academy of Medicine, and Royal Society of Medicine

Disclosure: Nothing to disclose.

Timothy D Rice, MD  Associate Professor, Departments of Internal Medicine and Pediatrics and Adolescent Medicine, St Louis University School of Medicine

Timothy D Rice, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Physicians

Disclosure: Nothing to disclose.

Chief Editor

Zab Mosenifar, MD  Director, Division of Pulmonary and Critical Care Medicine, Director, Women's Guild Pulmonary Disease Institute, Professor and Executive Vice Chair, Department of Medicine, Cedars Sinai Medical Center, University of California, Los Angeles, David Geffen School of Medicine

Zab Mosenifar, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Federation for Medical Research, and American Thoracic Society

Disclosure: Nothing to disclose.

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Standard nonenhanced axial thoracic CT scan shows left lower lobe consolidation with some loss of volume and an air bronchogram. Transbronchial lung biopsy confirmed the diagnosis of bronchiolitis obliterans-organizing pneumonia.
CT scan of a patient with sarcoidosis illustrating multiple nodules. This pattern can manifest in patients taking medications that can cause granulomatous reactions.
Histologic section of the lung showing diffuse alveolar damage in a patient with adult respiratory distress syndrome.
In usual interstitial pneumonitis or idiopathic pulmonary fibrosis, subpleural and paraseptal inflammation is present, with an appearance of temporal heterogeneity. Patchy scarring of the lung parenchyma and normal, or nearly normal, alveoli interspersed between fibrotic areas are the hallmarks of this disease. In addition, the lung architecture is completely destroyed.
Bronchiolitis obliterans-organizing pneumonia (also called proliferative bronchiolitis) is often patchy and peribronchiolar. The proliferation of granulation tissue within small airways and alveolar ducts is excessive and is associated with chronic inflammation of surrounding alveoli.
Lung biopsy specimen from the patient with sarcoidosis (see CT scan illustrating multiple nodules). Multiple areas of noncaseating granulomas are present. Drugs such as methotrexate, nitrofurantoin, procarbazine, and pentazocine can cause granulomatous lung disease.
Close-up view of a noncaseating granuloma with a giant cell.
 
 
 
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