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Drug-Induced Pulmonary Toxicity Treatment & Management

  • Author: Ryland P Byrd, Jr, MD; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
Updated: Dec 31, 2015

Approach Considerations

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 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.

Contributor Information and Disclosures

Ryland P Byrd, Jr, MD Professor of Medicine, Division of Pulmonary Disease and Critical Care Medicine, James H Quillen College of Medicine, East Tennessee State University

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

Disclosure: Nothing to disclose.


Thomas M Roy, MD Chief, Division of Pulmonary Disease and Critical Care Medicine, Quillen Mountain Home Veterans Affairs Medical Center; Professor of Medicine, Division of Pulmonary Disease and Critical Care Medicine, Fellowship Program Director, James H Quillen College of Medicine, East Tennessee State University

Thomas M Roy, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Medical Association, American Thoracic Society, Southern Medical Association, Wilderness Medical Society

Disclosure: Nothing to disclose.

Chief Editor

Zab Mosenifar, MD, FACP, FCCP Geri and Richard Brawerman Chair in Pulmonary and Critical Care Medicine, Professor and Executive Vice Chairman, Department of Medicine, Medical Director, Women's Guild Lung Institute, Cedars Sinai Medical Center, University of California, Los Angeles, David Geffen School of Medicine

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

Disclosure: Nothing to disclose.


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

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. 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.

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

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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 cryptogenic 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.
Cryptogenic organizing pneumonia (also called bronchiolitis obliterans-organizing pneumonia or BOOP) 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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