Medicinal lung lesions

Medicinal lesions of the lungs are not an independent nosological unit, but represent a common clinical problem when a patient who has not previously suffered from lung disease begins to detect clinical manifestations from these organs, or he has changes in the chest radiograph, pulmonary function impairment and / or histological changes in the background of drug therapy.

[1], [2], [3], [4], [5],

What causes lung damage?

More than 150 individual drugs or their classes are known to cause lung damage; The mechanism of lesion is rarely known, but many drugs probably cause a hypersensitivity reaction.

Bronchial asthma	Aspirin, beta-blockers (timolol), cocaine, dipyridamole, hydrocortisone, IL-2, methylphenidate, nitrofurantoin, protamine, sulfasalazine, vinca alkaloids pink (in combination with mitomycin)
Obliterating bronchiolitis with organizing pneumonia	Amiodarone, bleomycin, cocaine, cyclophosphamide, methotrexate, minocycline, mitomycin C, penicillamine, sulfasalazine, tetracycline
Pneumonitis of hypersensitivity	Azathioprine in combination with 6-mercaptopurine, busulfan, fluoxetine, irradiation
Interstitial pneumonia or fibrosis	Amphotericin B, bleomycin, busulfan, carbamazepine, chlorambucil, cocaine, cyclophosphamide, phenytoin, flecainide, heroin, melphalan, methadone, methotrexate, methylphenidate, methylside, mineral oil, nitrofurantoin, nitrates, procarbazine, silicone, tokainide, vinca alkaloids pink (in combination with mitomycin)
Noncardiogenic pulmonary edema	Terbutaline, ritodrin, chlordiazepoxide, cocaine, cytarabine, ethylated oils, gemcitabine, heroin, hydrochlorothiazide, methadone, mitomycin C, phenothiazines, protamine, sulfasalazine, tocolytics, tricyclic antidepressants, tumor necrosis factor, vinca alkaloids pink (in combination with mitomycin)
Parenchymal hemorrhage	Anticoagulants, azathioprine in combination with 6-mercaptopurine, cocaine, mineral oils, nitrofurantoin, irradiation
Pleural effusion	Amiodarone, anticoagulants, bleomycin, bromocriptine, busulfan, colony-stimulating factor of granulocytes and macrophages, IL-2, methotrexate, methylsigide, mitomycin C, nitrofurantoin, paraaminosalicylic acid, procarbazine, radiation, tocolytic agents
Pulmonary eosinophilic infiltrate	Amiodarone, amphotericin B, bleomycin, carbamazepine, phenytoin, ethambutol, etoposide, colony-stimulating factor of granulocytes and macrophages, isoniazid, methotrexate, minocycline, mitomycin C, nitrofurantoin, paraaminosalicylic acid, procarbazine, radiation, sulfasalazine, sulfonamides, tetracycline, trazodone
Pulmonary vasculitis	Anorectics (dexfenfluramine, fenfluramine, phentermine), busulfan, cocaine, heroin, methadone, methylphenidate, nitrates, irradiation

Symptoms of medicinal lesions of the lungs

Depending on the type of drug, pulmonary medications may resemble interstitial fibrosis, obliterating bronchiolitis with arranging pneumonia, bronchial asthma, noncardiogenic pulmonary edema, pleural effusion, eosinophilic pulmonary infiltration, pulmonary hemorrhage, or veno-occlusive disease with appropriate changes in the chest radiograph or CT and results lung function tests.

Diagnosis of medicinal lesions of the lungs

The diagnosis is based on observation of the response to the withdrawal of the drug and, if practical from a practical point of view, the re-appointment of a suspected drug.

[6], [7], [8], [9]

Treatment of medicinal lesions of the lungs

Treatment of medicinal lesions of the lung consists in stopping the medication. Screening of pulmonary function is usually performed in patients before or at the time of therapy with drugs that can cause pulmonary toxicity, but the effectiveness of screening in predicting or early detection of toxicity has not been proven.