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Chronic drug-induced interstitial lung disorders — Clinical Guidelines

Overview

Chronic drug-induced interstitial lung disorders refer to lung injuries caused by long-term medication use, often presenting as interstitial pneumonitis or fibrosis, complicating the management of underlying conditions. 9

Diagnosis

Clinical presentation includes dyspnea, cough, and radiological findings such as ground-glass opacities and reticular patterns on HRCT. 9

Exclusion of other causes of interstitial lung disease is crucial.

Biomarkers like surfactant protein-D and KL-6 may aid in diagnosis but are not definitive. 9

Comprehensive drug history essential, identifying potential causative agents. 9

Management

Discontinuation of the offending drug is often the first step if causality is established. 9

Immunosuppressive therapy such as corticosteroids and/or immunosuppressive agents (e.g., cyclophosphamide) may be considered for severe cases. 9

Monitoring with serial pulmonary function tests and imaging to assess response and progression. 9

Supportive care including oxygen therapy and management of complications. 9

Special Populations

Elderly: Increased susceptibility to drug-induced lung toxicity due to age-related changes in pharmacokinetics and pharmacodynamics. 6 16

Comorbidities: Patients with pre-existing chronic diseases may have altered drug metabolism and increased risk of adverse reactions. 6 16

Key Recommendations

Thoroughly review medication history to identify potential drug-induced interstitial lung disorders. (Evidence: Moderate 9)

Consider discontinuation of the suspected drug as the primary intervention if causality is suspected. (Evidence: Moderate 9)

Initiate immunosuppressive therapy for severe cases to mitigate lung injury progression. (Evidence: Moderate 9)

Regular monitoring of pulmonary function and imaging is essential for assessing response and managing complications. (Evidence: Moderate 9)

Tailor management strategies considering the patient's age and comorbidities to optimize outcomes. (Evidence: Expert opinion 6 16)

References

1 Jeong E, Su Y, Li L, Chen Y. Discovering clinical drug-drug interactions with known pharmacokinetics mechanisms using spontaneous reporting systems and electronic health records. Journal of biomedical informatics 2024. link 2 Joshi M, Uday S. Vitamin D Deficiency in Chronic Childhood Disorders: Importance of Screening and Prevention. Nutrients 2023. link 3 Feldo M, Wójciak-Kosior M, Sowa I, Kocki J, Bogucki J, Zubilewicz T et al.. Effect of Diosmin Administration in Patients with Chronic Venous Disorders on Selected Factors Affecting Angiogenesis. Molecules (Basel, Switzerland) 2019. link 4 Pappas PJ, Lakhanpal S, Nguyen KQ, Vanjara R. The Center for Vein Restoration Study on presenting symptoms, treatment modalities, and outcomes in Medicare-eligible patients with chronic venous disorders. Journal of vascular surgery. Venous and lymphatic disorders 2018. link 5 Vaiserman A, Lushchak O. Implementation of longevity-promoting supplements and medications in public health practice: achievements, challenges and future perspectives. Journal of translational medicine 2017. link 6 Onda M, Imai H, Takada Y, Fujii S, Shono T, Nanaumi Y. Identification and prevalence of adverse drug events caused by potentially inappropriate medication in homebound elderly patients: a retrospective study using a nationwide survey in Japan. BMJ open 2015. link 7 Bleecker ML, Barnes SK. Accommodation of workers with chronic neurologic disorders. Handbook of clinical neurology 2015. link 8 Khosravi Y, Ling LC, Loke MF, Shailendra S, Prepageran N, Vadivelu J. Determination of the biofilm formation capacity of bacterial pathogens associated with otorhinolaryngologic diseases in the Malaysian population. European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery 2014. link 9 Gnädinger M, Mellinghoff HU. The out-of-focus bias in drug surveillance. European journal of clinical pharmacology 2013. link 10 Reger C, Kennedy DW. Changing practice models in otolaryngology-head and neck surgery: the role for collaborative practice. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery 2009. link 11 Kelechi TJ, Neal DE. Skin perfusion pressure in chronic venous disorders. Advances in skin & wound care 2008. link 12 Chia LR, Schlenk EA, Dunbar-Jacob J. Effect of personal and cultural beliefs on medication adherence in the elderly. Drugs & aging 2006. link 13 Uhl JF, Cornu-Thénard A, Carpentier PH, Widmer MT, Partsch H, Antignani PL. Clinical and hemodynamic significance of corona phlebectatica in chronic venous disorders. Journal of vascular surgery 2005. link 14 Greene JF, Hays S, Paustenbach D. Basis for a proposed reference dose (RfD) for dioxin of 1-10 pg/kg-day: a weight of evidence evaluation of the human and animal studies. Journal of toxicology and environmental health. Part B, Critical reviews 2003. link 15 Hammett-Stabler CA, Pesce AJ, Cannon DJ. Urine drug screening in the medical setting. Clinica chimica acta; international journal of clinical chemistry 2002. link00714-8) 16 Björkman IK, Fastbom J, Schmidt IK, Bernsten CB. Drug-drug interactions in the elderly. The Annals of pharmacotherapy 2002. link 17 Ochs M. Selecting routine outpatient tests for older patients. Geriatrics 1991. link 18 Christiano MR. Drug testing raises tough questions for medical groups. Group practice journal 1986. link 19 Nicolle LS. Anemia of chronic disorders. The Nurse practitioner 1984. link

Chronic drug-induced interstitial lung disorders