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 x-ray changes, deterioration of pulmonary function, histologic changes, or several of these findings in association with medication therapy or illicit drug use. Here we use the term "drug" to include medications and illicit drugs that can cause the disorder. Over 150 drugs or categories of drugs have been reported to cause pulmonary disease; the mechanism is rarely known, but many drugs are thought to provoke a hypersensitivity response
Depending on the drug, drug-induced syndromes can cause interstitial fibrosis, organizing pneumonia, asthma, noncardiogenic pulmonary edema, pleural effusions, pulmonary eosinophilia, pulmonary hemorrhage, or veno-occlusive disease (see table Substances With Toxic Pulmonary Effects).
(See also Overview of Interstitial Lung Disease.)
Substances With Toxic Pulmonary Effects
Condition | Drug or Agent |
|---|---|
aspirin | |
Organizing pneumonia | |
Interstitial pneumonia or fibrosis | cocaineheroin |
Noncardiac pulmonary edema | heroin |
Parenchymal hemorrhage | |
cocaine | |
Pulmonary vascular disease | cocaine, heroin |
Diagnosis is based on observation of responses to withdrawal from and, if practical, reintroduction to the suspected drug.
Treatment of Drug-Induced Pulmonary Disease
Stopping the drug
Treatment is stopping the drug that is causing pulmonary disease.
Prevention of Drug-Induced Pulmonary Disease
A screening pulmonary function test is commonly done in patients about to begin or already taking drugs with pulmonary toxicities, but the benefits of screening for prediction or early detection of toxicity are unproved.
