Druginduced lung disease is an increasingly common cause of morbidity and mortality. Drug induced lung disease is a major source of iatrogenic injury. If a drug has caused fibrosis, people often get better quickly if the medication is stopped before much damage is done. Oral and parenteral administration are most often implicated as causing lung damage, with nebulized and intrathecal routes implicated to a lesser extent. Differentiating connective tissue diseaseassociated interstitial lung disease from idiopathic pulmonary fibrosis jonathan h. Jul 07, 2016 the diagnosis of drug induced lung disease is often made on the basis of a history of drug exposure, histologic evidence of lung injury, and the exclusion of other causes of lung injury. Typical symptoms of these diseases include dyspnea labored breathing, chest discomfort, tachypnea rapid breathing, and hypoxemia low blood oxygen. What is drug induced pulmonary diseasecausessymptoms. In the case of drug or radiationinduced lung disease, ground glass opacity might be observed.
Druginduced lung disease radiology reference article. It is not a single disorder or disease, rather a range of problems occurring to a person, who has never had any other pulmonary diseases. Aug 22, 2000 the site, available in both english and french, was created by the department of pulmonary diseases and intensive care unit in dijon, france and offers uptodate information about a growing number of drug induced lung diseases. Pepper professor of public health and preventive medicine professor of biostatistics and epidemiology, medicine, and pharmacology vice dean for institutional affairs university of. Diagnosis and management of drugassociated interstitial lung. Some drugs or therapeutic agents cause undesirable reactions in lungs, known as druginduced pulmonary disease, which could be serious enough to cause death. Pathologic characteristics of druginduced lung disease douglas b. It is also advisable to avoid combining agents associated with ild, such. Druginduced pulmonary disease lung and airway disorders. The most common presentations of drug induced pulmonary disease are an abnormality on a chest radiograph or a symptom complex.
Many drugs have been associated with pulmonary complications of various types, including interstitial inflammation and fibrosis, bronchospasm, pulmonary edema, and pleural effusions. Oct 19, 2017 druginduced pulmonary diseases can be present in a variety of syndromes, clinical presentations and radiographic patterns. Considering the physiologic and metabolic capacity of the lung, it is surprising that drug induced pulmonary disease is not more common. Breathing problems from druginduced pulmonary fibrosis can come on suddenly or develop more slowly over time. Many types of lung injury can result from medicines. Interstitial lung disease ild, or diffuse parenchymal lung disease dpld, is a group of lung diseases affecting the interstitium the tissue and space around the alveoli air sacs of the lungs. Apr 09, 2019 drug induced pulmonary toxicity is a diagnosis of exclusion. Cytotoxic lung injury may result from direct injury to. Again, this is exemplified in the management of ipf with specific drugs and. The most common form of druginduced lung toxicity is druginduced interstitial lung disease dild. Drug induced pulmonary disease interstitial lung disease drug induced. To correct this, larry was started on ldopa also known as levodopa, a drug to treat parkinsons disease.
Interstitial lung disease 10 interstitial lung disease is a term that broadly describes a diverse collection of more than 200 lung disorders. We identified the modes of action of 200 lung toxic drugs based on their gene expression profiles and, subsequently, merged the drug specific pathways to construct a signaling network that captured the mechanisms underlying drug induced lung disease dild. Introduction currently there are no general guidelines for diagnosis or management of suspected drug induced di interstitial lung disease ild. The diagnosis of druginduced lung disease is often made on the basis of a history of drug exposure, histologic evidence of lung injury, and the exclusion of other causes of lung injury. Druginduced lung disease can result from a number of agents and may have a myriad of presentations, ranging from an adult respiratory distress syndrome type picture to established pulmonary fibrosis due to this, it can be extremely difficult to pinpoint the offending agent on imaging appearances alone and correlation with the medical history is mandatory. It gives american society of healthsystem pharmacists 7272 wisconsin avenue bethesda, md 20814 this vital subject the comprehensive coverage that it deserves.
Interstitial lung disease american thoracic society. Monitoring for druginduced liver disease must be tailored to the drug and the patients potential risk factors. The manifestations of druginduced pulmonary diseases span the entire spectrum of pathophysiologic conditions of the respiratory tract. Drug induced interstitial lung disease bentham open. Drugs can injure airways, lung parenchyma, mediastinum, the neuromuscular system, pleura, or pulmonary vasculature, but most often they cause druginduced interstitial lung disease dild. Travis, mdb adepartment of pathology and laboratory medicine, new york. Drug induced pulmonary disease is defined as any lung disease caused by a drug or medication 3. Drug induced lung disease is often a difficult diagnostic challenge for the clinician because of its diverse presentations and the increasing number of causative agents.
Druginduced interstitial lung disease dild can be caused by chemotherapeutic agents, antibiotics, antiarrhythmic drugs, and immunosuppressive agents. Jul 27, 2012 recognition of drug induced lung disease, however, is difficult because the clinical, radiological, and histological findings are nonspecific. The number of drugs associated with adverse reactions involving the liver is extensive, but in clinical practice is dominated by alcohol, antibiotics, and acetaminophen. Introduction currently there are no general guidelines for diagnosis or management of suspected druginduced di interstitial lung disease ild.
Identifying this problem, and stopping the drug is the key intervention. No drug produces both symptoms and antinuclear druginduced lung disease 63 antibodies in more than a small proportion of patients. Oral and parenteral routes of drug administration are most frequently cited as causing dild. Druginduced pulmonary toxicity is a diagnosis of exclusion. Interstitial lung disease induced by drugs respiration 2004. Presumably, the doctor did not realize the parkinsonism was druginduced, and the stelazine was continued. Some drugs or therapeutic agents cause undesirable reactions in the lungs known as drug induced pulmonary diseases,which sometimes could be serious enough to cause. Drug induced interstitial lung disease pubmed central pmc. More than 380 medications are known to cause druginduced respiratory diseases, the true frequency is unknown 1, 2. Their appearance can mimic other interstitial lung diseases and, for the most part, druginduced interstitial lung disease is a condition of exclusion rather than a specific entity that can be diagnosed with imaging studies or histology. Druginduced interstitial lung disease dild is not uncommon and has many clinical patterns, ranging from benign infiltrates to lifethreatening acute respiratory distress syndrome. Lungonachip microdevice a human disease model of drug toxicity. Diild is a recognised subtype of diffuse parenchymal lung diseases according to the american thoracic.
Pathologic characteristics of druginduced lung disease. Depending on the specific disease, other compartments of the lung. Causes many types of lung injury can result from medicines. Some drugs or therapeutic agents cause undesirable reactions in lungs, known as drug induced pulmonary disease, which could be serious enough to cause death. It is usually impossible to predict who will develop lung disease from a medicine. A human disease model of drug toxicityinduced pulmonary. Drug induced pulmonary disease is not a single disorder. Jul 14, 2016 adverse drug reactions adrs have been estimated to be the third leading cause of death in the united states, following heart disease and cancer. In the case of drug or radiation induced lung disease, ground glass opacity might be observed. Recognition of druginduced lung disease is difficult because the clinical, radiologic, and histologic findings are nonspecific 1, 2. Considering the physiologic and metabolic capacity of the lung, it is surprising that druginduced pulmonary disease is not more common. Recognition of druginduced lung disease, however, is difficult because the clinical, radiological, and histological findings are nonspecific. Druginduced lung disease is a major source of iatrogenic injury. Identification of drugspecific pathways based on gene.
As with most drug induced diseases, the pathological changes are nonspecific. Induced pulmonary edema in a editors summary could affect patient health. The diagnosis and management of common interstitial lung diseasesbut not rare. Druginduced pulmonary disease is not a single disorder, but rather a common clinical problem in which a patient without previous pulmonary disease develops respiratory symptoms, chest xray changes, deterioration of pulmonary function, histologic changes, or several of these findings in. Drug induced lung disease is an increasingly common cause of morbidity and mortality. Lung onachip microdevice a human disease model of drug toxicity. With the advent of new immunotherapy and evergrowing arsenal of. A type of therapy that is associated with these types of toxicity is amiodarone therapy, particularly with regard to alveolar and interstitial infiltrates. The manifestations of druginduced pulmonary diseases span the entire spectrum of. Pathologic characteristics of drug induced lung disease douglas b. This condition can be suspected if the patient has been exposed to a likely causative drug, develops new signs and symptoms, and has a remittence of these symptoms once the drug is withheld.
Hs3hs8 many drugs, including herbal products, have been implicated as the cause of pulmonary adverse events. There are two mechanisms involved in dild, which are probably interdependent. The diagnosis is based on clinical history and consistent radiologic findings. Travis, mdb adepartment of pathology and laboratory medicine, new yorkpresbyterian hospital, weill cornell medical center. Hypersensitivity reaction, particularly to methotrexate, can also result in. Drug abuse and lung disease respiratory tract disorders and. Interstitial lung disease induced by drugs and radiation.
Druginduced interstitial lung disease diild occurs as a result of numerous agents, but the risk often only becomes. For seven years, larry took both drugs until seeing a parkinsons specialist. Drugs can injure airways, lung parenchyma, mediastinum, the neuromuscular system, pleura, or pulmonary vasculature, but most often they cause drug induced interstitial lung disease dild. Prevention, detection, and management is a well organised, easy to use reference source that fills a sizeable gap in the available literature. We illustrated the utility of ilp modeling with a case study of drug induced lung injury. It concerns alveolar epithelium, pulmonary capillary endothelium, basement membrane, and perivascular and perilymphatic tissues.
Drug induced pulmonary disease is an umbrella term that refers to a number of clinical problems associated with the lungs. Investigation of a case of suspected druginduced lung disease begins with a high index of clinical suspicion and thereafter involves demonstration of the operation of one or more of the basic mechanisms described above. Many drugs can cause lung problems in people who have no other lung disorders. The diagnosis is based on a history of drug exposure, histologic evidence of lung damage, and exclusion of other causes of lung injury. Druginduced lung disease is often a difficult diagnostic challenge for the clinician because of its diverse presentations and the increasing number of causative agents. No drug produces both symptoms and antinuclear drug induced lung disease 63 antibodies in more than a small proportion of patients. Druginduced pulmonary disease pulmonary disorders merck. Drug induced interstitial lung disease dild can be caused by chemotherapeutic agents, antibiotics, antiarrhythmic drugs, and immunosuppressive agents. Drug induced pulmonary diseases linkedin slideshare. However, this condition is on the increase again, as the drug regains popularity as a urinary antiseptic. Chair and professor, department of biostatistics and epidemiology director, center for clinical epidemiology and biostatistics george s. Consequently, the diagnosis of druginduced lung disease is based on a combination of radiologic, clinical, and histologic when imperative findings in a patient who has received a drug known to cause the abnormalities.
Drug induced pulmonary disease is not a single disorder, but rather a common clinical problem in which a patient without previous pulmonary disease develops respiratory symptoms, chest xray changes, deterioration of pulmonary function, histologic changes, or several of these findings in association with drug therapy. The type of problem depends on the drug involved, but many of the drugs are thought to cause an allergictype reaction. Adverse drug reactions adrs have been estimated to be the third leading cause of death in the united states, following heart disease and cancer. Breathing problems from drug induced pulmonary fibrosis can come on suddenly or develop more slowly over time. Oct 23, 2012 investigation of a case of suspected drug induced lung disease begins with a high index of clinical suspicion and thereafter involves demonstration of the operation of one or more of the basic mechanisms described above. Druginduced pulmonary disease msd manual professional edition. Drugs can have multiple different adverse effects on the lungs, airways, pleura, mediastinum, and the interstitium. Drug induced interstitial lung disease dild is not uncommon and has many clinical patterns, ranging from benign infiltrates to lifethreatening acute respiratory distress syndrome. Drug induced pulmonary diseases by vishwanath gouda 1st year m. Types of lung problems or diseases that may be caused by medicines include. Druginduced pulmonary disease interstitial lung disease drug induced.
These diseases are classified together because they all affect the tissue and space around the alveoli air sacs, called the interstitium. None of these histologic patterns is specific for either drug reaction in general or the reaction to a particular drug. Amiodarone pulmonary toxicity apt was recognized in 1980, and remains a significant. Ct features of the usual interstitial pneumonia pattern. The site, available in both english and french, was created by the department of pulmonary diseases and intensive care unit in dijon, france and offers uptodate information about a growing number of druginduced lung diseases.
Druginduced pulmonary disease is not a single disorder. The main value of hrct is in the depiction of parenchymal abnormalities in symptomatic patients who have normal or questionable findings on chest radiography. Drug induced lung disease can result from a number of agents and may have a myriad of presentations, ranging from an adult respiratory distress syndrome type picture to established pulmonary fibrosis. Therapeutic update on druginduced pulmonary disorders. Druginduced pulmonary diseases types, symptoms and treatment. Common clinical presentations include interstitial pneumonitisfibrosis, hypersensitivity pneumonitis, noncardiogenic pulmonary edema, and airways dysfunction. Druginduced pulmonary disease is lung disease brought on by a bad reaction to a medicine. Among the more common clinical manifestations of druginduced lung disease are noncardiogenic pulmonary edema npe and acute respiratory distress syndrome ards.
Drug induced pulmonary disease is lung disease brought on by a bad reaction to a medicine. Evaluation of epidemiologic studies on adverse drug reactions provides a perspective on the importance of druginduced pulmonary disease. Druginduced lung disease can result from a number of agents and may have a myriad of presentations, ranging from an adult respiratory distress syndrome type picture to established pulmonary fibrosis. The connection with drug use and the development of related inflammatory damage or idiosyncratic toxicities is hard to recognize and objectify, especially in those cases using multiple drugs. Druginduced pulmonary fibrosis british lung foundation. Like other interstitial lung diseases, there is a restrictive ventilatory impairment with diminished. Therefore, the diagnosis is often difficult and, in most cases, is based on exclusion of all other possible causes. Druginduced pulmonary diseases types, symptoms and. May 31, 2012 drug induced interstitial lung disease dild is not uncommon and has many clinical patterns, ranging from benign infiltrates to lifethreatening acute respiratory distress syndrome.
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