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Drug-induced pulmonary disease

Definition

Drug-induced pulmonary disease is lung disease brought on by a bad 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 that may result from medications include:

• Allergic reactions -- asthma, hypersensitivity pneumonitis, or eosinophilic pneumonia
• Alveolar hemorrhage (bleeding into the lung air sacks)
• Bronchitis
• Drug-induced lupus erythematosus
• Granulomatous lung disease -- a type of tumor in the lungs
• Inflammation of the lung air sacks (pneumonitis or infiltration)
• Interstitial fibrosis
• Lung failure
• Lung vasculitis (inflammation of lung blood vessels)
• Mediastinitis
• Pulmonary edema
• Pleural effusion
• Swollen lymph nodes

Many drugs are known to cause lung disease in some people, including those used during chemotherapy and to treat certain heart conditions. Other drugs known to cause lung disease in some people include certain antibiotics and illicit drugs.

Symptoms

• Bloody sputum
• Chest pain
• Cough
• Fever
• Shortness of breath
• Wheezing

Note: Symptoms may vary from person to person.

Signs and tests

The doctor will perform a physical exam and listen to your chest and lungs with a stethoscope. Abnormal breath sounds may be heard.

Tests that may be done include:

• Bronchoscopy
• Complete blood count with blood differential
• Chest CT scan
• Chest x-ray
• Lung biopsy (in rare cases)
• Thoracentesis (if pleural effusion is present)

Treatment

The first step is to stop the drug that is causing the problem. Other treatments depend on your specific symptoms. For instance, you may need oxygen until the drug-induced lung disease improves. Powerful anti-inflammatory medicines called steroids are sometimes used and may quickly reverse the lung inflammation.

Support Groups

Expectations (prognosis)

Acute episodes usually go away within 48 - 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 may never go away.

Complications

• Diffuse interstitial pulmonary fibrosis
• Hypoxemia (low blood oxygen)
• Respiratory failure

Calling your health care provider

Call your health care provider if you develop symptoms of this disorder.

Prevention

Any previous reaction to a medication should be noted, so that you can avoid the medication in the future. Wear a medical allergy bracelet if you have known drug reactions. Avoid the abuse of illicit drugs, as this will prevent many drug-induced lung diseases.

References

Mason RJ, Murray JF, Broaddus VC, Nadel JA, eds. Textbook of Respiratory Medicine. 4th ed. Philadelphia, Pa: Saunders Elsevier; 2005.

Noble J, ed. Primary Care Medicine. 3rd ed. Philadelphia, Pa: Mosby Elsevier; 2001.