Druginduced pulmonary disease is lung disease brought on by a bad reaction to a medicine. 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. Druginduced pulmonary disease uf health, university of. There are no distinct physiologic, radiographic or pathologic patterns of dild, and the diagnosis is usually made when a patient with interstitial lung disease ild is exposed to a medication.
Patients with drug induced pleural disease often have dyspnea as the presenting symptom. Ingber1,2,7 preclinical drug development studies currently rely on costly and timeconsuming animal. Pathologic characteristics of druginduced lung disease. 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. Aug 31, 2004 drugassociated lung disease is common, with infiltrative lung disease comprising 70% of cases. Drug induced lung disease dild carries a significant morbidity and mortality. Considering the physiologic and metabolic capacity of the lung, it is surprising that drug induced pulmonary disease is not more common. Drug induced interstitial lung disease diild occurs as a result of numerous agents, but the risk often only becomes apparent after the marketing authorisation of such agents. More than 380 medications are now recognized as being implicated in respiratory.
Druginduced pulmonary diseases types, symptoms and. The possibility of druginduced lung disease should be considered in order to avoid potentially fatal consequences. The incidence of dild for each individual drug is variable. Druginduced lung toxicity is an increasingly frequent cause of morbidity and it is becoming more commonly diagnosed as a cause of acute and chronic lung disease. Types of lung problems or diseases that may be caused by medicines include. Information regarding onset, reversibility, fever, eosinophilia, and. Interstitial lung disease is difficult to diagnose.
Case of druginduced interstitial lung disease secondary to. Travis, mdb adepartment of pathology and laboratory medicine, new yorkpresbyterian hospital, weill cornell medical center, starr 1015, 525 east 68th street, new york, ny 10021, usa bdepartment of pulmonary and mediastinal pathology, armed forces institute of pathology, 6825 northwest 16th street. Cytotoxic lung injury may result from direct injury to. 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. A human disease model of drug toxicityinduced pulmonary. Review open access druginduced interstitial lung disease. Drug induced interstitial lung disease pubmed central pmc. Drug induced interstitial lung disease diild, defined as an interstitial abnormality secondary to administration of a drug, can be acute or chronic. Because druginduced lung disease was suspected, ldvsof administration was immediately discontinued, and the. After restarting the drug, the skin reaction did not recur, but an acute pneumonitis developed 2 mo later. Drug induced pulmonary diseases by vishwanath gouda 1st year m. Following a quality assessment, 156 fulltext papers describing more than. Druginduced pulmonary disease pulmonary disorders msd. Drug induced interstitial lung disease dild can be caused by chemotherapeutic agents, antibiotics, antiarrhythmic drugs, and immunosuppressive agents.
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. Based on the official american thoracic societyeuropean respiratory society statement and the japanese respiratory society guidelines for the management of drug. Druginduced diseases are adverse effects of drugs on different organs or parts of the body. Druginduced interstitial lung disease diild, defined as an interstitial abnormality secondary to administration of a drug, can be acute or chronic. Pathologic characteristics of druginduced lung disease douglas b.
Therefore, we need to accumulate and consider more detailed reports. Oral and parenteral administration are most often implicated as causing lung damage, with nebulized and intrathecal routes implicated to a lesser extent. Wed like to understand how you use our websites in order to improve them. Patients with druginduced pleural disease often have dyspnea as the presenting symptom. There is only one report of an unsuccessful attempt to desensitize a patient with sulfasalazine induced pulmonary disease.
Druginduced lung disease adverse effect with ledipasvir. 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. Druginduced lung disease dild carries a significant morbidity and mortality. Druginduced interstitial lung disease diild occurs when exposure to a drug causes in. It is usually impossible to predict who will develop lung disease from a medicine. 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. Case of druginduced interstitial lung disease secondary. Bioengineering a human disease model of drug toxicityinduced pulmonary edema in a lungonachip microdevice dongeun huh,1,2,3 daniel c.
A druginduced disease is the unintended effect of a drug, which results in mortality or morbidity with symptoms sufficient to prompt a patient to seek medical attention andor require hospitalization. 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. The table below lists some drugs known to cause drug induced lung disease. Druginduced lung disease radiology reference article. Druginduced interstitial lung disease dild can be caused by chemotherapeutic agents, antibiotics, antiarrhythmic drugs, and immunosuppressive agents.
The dyspnea may be secondary to the underlying lung parenchymal disease that is commonly associated with pleural disease or may be secondary to the presence of a rapidly increasing pleural effusion or fibrosis. Infections were ruled out by diagnostic imaging, bal, blood culture, and sputum examination. 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. 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. Amiodarone pulmonary toxicity apt was recognized in 1980, and remains a significant. Drugs can injure airways, lung parenchyma, mediastinum, the neuromuscular system, pleura, or pulmonary vasculature, but most often they cause druginduced interstitial lung disease dild.
A1547 paclitaxelinduced acute interstitial pneumonitis a40. Interstitial lung disease induced by drugs respiration 2004. Common clinical syndromes associated with druginduced pulmonary parenchymal disease include 1 pneumonitisfibrosis, 2 hypersensitivity lung disease, and 3 noncardiogenic pulmonary edema. Bruce 1,10, colm leonard 4, stephen bianchi 11 and nazia chaudhuri 4. Recent experiences of the approval and introduction of the novel cancer therapy gefitinib iressa for the treatment of advanced nonsmallcell lung cancer nsclc have indicated international differences of occurrence of ild. It concerns alveolar epithelium, pulmonary capillary endothelium, basement membrane, and perivascular and perilymphatic tissues. The incidence of lung damage by in dividual drugs is difficult to. Swift 3, alexander oldroyd 1, christopher johns 3, conal hayton 4, alessandro giollo 5,6, james m.
Lungonachip microdevice a human disease model of drug toxicity. Some drugs or therapeutic agents cause undesirable reactions in the lungs known as druginduced pulmonary diseases,which sometimes could be serious enough to cause. The diagnosis is based on a history of drug exposure, histologic evidence of lung damage, and exclusion of other causes of lung injury. Drug induced pulmonary disease is lung disease brought on by a bad reaction to a medicine. 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. Identification of drugassociated ild is further hampered, as clinical imaging and pathological. It may occur when an injury to the lungs triggers an abnormal healing.
Recognition of drug induced lung disease is difficult because the clinical, radiologic, and histologic findings are nonspecific 1, 2. Druginduced interstitial lung disease dild is not uncommon and has many clinical patterns, ranging from benign infiltrates to lifethreatening acute respiratory distress syndrome. Because drug induced lung disease was suspected, ldvsof administration was immediately discontinued, and the. Article deciphering druginduced interstitial lung disease. Druginduced lung disease is a major source of iatrogenic injury. Pdf druginduced lung disease is a major source of iatrogenic injury.
Many types of lung injury can result from medicines. Induced pulmonary edema in a editors summary could affect patient health. Pulmonary function testing for the early detection of drug. These include both cytotoxic and noncytocytoxic drugs.
Jul 27, 2012 recognition of drug induced lung disease, however, is difficult because the clinical, radiological, and histological findings are nonspecific. The first patient developed pulmonary interstitial fibrosis after more than 4 yr of treatment for crohns disease. Pulmonary symptoms and chest roentgenographic and pulmonary function abnormalities gradually reversed after stopping the drug. Over 350 drugs may cause diild, but liability is often not recognised until late in drug development, or after launch. Druginduced lung injury may involve the airways, lung parenchyma, mediastinum, pleura, pulmonary vasculature, andor the neuromuscular. With the advent of new immunotherapy and evergrowing arsenal of. Recognition of druginduced lung disease, however, is difficult because the clinical, radiological, and histological findings are nonspecific. The diagnosis is based on a history of drug exposure, histologic evidence of lung damage, and. Considering the physiologic and metabolic capacity of the lung, it is surprising that druginduced pulmonary disease is not more common. Druginduced interstitial lung disease diild occurs as a result of numerous agents, but the risk often only becomes apparent after the marketing authorisation of such agents. Drugs which induce lung disease are categorized according to the radiographic pattern of the disease.
Less common patterns of pulmonary parenchymal injury by drugs include bronchiolitis obliterans and a pulmonary renal syndrome. Dild, drug induced interstitial lung disease, dpt, drug provocation test, dlst, drug induced lymphocyte stimulation test, lmt, leukocyte migration test introduction several types of drugs can cause drug induced interstitial lung disease dild. Pulmonary function tests pft are sometimes monitored during treatment with known pulmonary toxic drugs to detect asymptomatic drug induced interstitial lung disease dild. Indirect effects include drug induced thrombocytopenia, central ner. The incidence is increasing with approximately 400 drugs known to potentially cause dild. Common clinical syndromes associated with drug induced pulmonary parenchymal disease include 1 pneumonitisfibrosis, 2 hypersensitivity lung disease, and 3 noncardiogenic pulmonary edema. Clinical scenarios relevant to the surgical pathologist pulmonary drug reactions result from either direct or indirect effects of a drug. Drug induced pulmonary diseases linkedin slideshare. The lung is the only organ of the body that receives the entire circulation. We report the findings in two patients with sulfasalazineinduced pulmonary disease. Druginduced lung disease drugs lung toxicity patients registry web technology in the relatively recent past, conventional i.
Adverse drug reactions are an important cause of morbidity and mortality, accounting for an estimated 5% of all hospitalizations and 0. There have been no reports of severe asthma or respiratory failure similar to that reported with the beta blockers, casting doubt on the role of bronchial. There have been no reports of severe asthma or respiratory failure similar to that reported with the beta blockers, casting doubt on the role of bronchial hyperreactivity in ace inhibitorrelated lung disease. There are two mechanisms involved in dild, which are probably interdependent. Recognition of druginduced lung disease is difficult because the clinical, radiologic, and histologic findings are nonspecific 1, 2. Interstitial lung disease associated with drug therapy. Dild, druginduced interstitial lung disease, dpt, drug provocation test, dlst, druginduced lymphocyte stimulation test, lmt, leukocyte migration test introduction several types of drugs can cause druginduced interstitial lung disease dild. 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. However, this condition is on the increase again, as the drug regains popularity as a urinary antiseptic. The latter consequence is most important because many of the histologic patterns that are seen in druginduced pulmonary disease also are seen in bacterial.