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Chapter 17. Drug-Induced Lung Diseases

David W Kamp, MD, FCCP
DOI: 10.1378/pulm.26.17
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Synopsis 

Drug-induced lung diseases have challenged clinicians since the dawn of modern medicine, in part because there are so many drugs implicated (>430) and in part because it is a diagnosis of exclusion. A patient with a drug-induced lung disease often presents with nonspecific respiratory symptoms, such as cough and dyspnea, and abnormal chest imaging. A thorough drug history is crucial in identifying the potential cause of pulmonary toxicity. With few exceptions (eg, bleomycin, amiodarone), the molecular mechanisms underlying drug-induced lung diseases are largely unknown but appear distinct depending on the drug and host genetics affecting susceptibility. In this chapter, we focus on four broad areas: (1) appreciating the diverse clinical syndromes of drug-induced pulmonary diseases; (2) understanding the general approach to the patient with suspected drug toxicity; (3) reviewing the common abnormalities associated with specific chemotherapeutic agents; and (4) comprehending the typical manifestations of pulmonary toxicity due to nonchemotherapeutic agents. Understanding the clinical manifestations of drug-induced lung diseases should facilitate early diagnosis and effective management of these patients as well as help ascertain the origin of other more common pulmonary disorders, such as idiopathic pulmonary fibrosis, noncardiogenic pulmonary edema, and hypersensitivity pneumonitis.

Objectives 
  • Appreciate the diverse clinical syndromes of drug-induced pulmonary diseases.

  • Understand the general approach to the patient with suspected drug toxicity.

  • Review the common abnormalities associated with specific chemotherapeutic agents.

  • Comprehend the typical manifestations of pulmonary toxicity due to nonchemotherapeutic agents.

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