Drug-Induced Interstitial Lung Disease Essay
Drug-Induced Interstitial Lung Disease Essay
Drug-Induced Interstitial Lung Disease Essay
what is Drug-Induced Interstitial Lung Disease
Drug-Induced Interstitial Lung Disease
Drug-Induced Interstitial Lung Disease (DIILD) is a lung disease caused by exposure to a drug that causes inflammation and, ultimately, fibrosis of the lung interstitium. DIILD manifests with diverse clinical patterns, ranging from mild respiratory symptoms to rapidly progressive respiratory failure and death (Spagnolo et al., 2022). Most patients do not present with pathognomonic clinical, laboratory, radiological, or pathological features. Skeoch et al. (2018) explain that the clinical phenotype, imaging, and histopathology patterns differ significantly between drugs and between patients on the same drug. Thus, DIILD is a diagnosis of exclusion, which poses unique challenges for the treating physician. DIILD is usually suspected when there is exposure to a drug known to cause lung toxicity and after exclusion of alternative causes of Interstitial lung disease.
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DIILD is graded using the National Cancer Institute Common Terminology Criteria for Adverse Events. Grade 1 (mild) is asymptomatic and only has radiographic findings. Grade 2 (moderate) is symptomatic but does not interfere with activities of daily living (Skeoch et al., 2018). Grade 3 (severe) is symptomatic and interferes with activities of daily living or oxygen indicated. Grade 4 is life-threatening or disabling and requires ventilator support, while grade 5 is fatal.
Patients likely to develop DILD include those receiving chemotherapy, those with rheumatoid arthritis and inflammatory bowel disease, and those receiving concurrent multiple toxic agents. The identified risk factors are: Age (extremes of age), sex (elderly females), dose, drug interaction, radiation, and underlying drug disease (Spagnolo et al., 2022). The drugs mostly associated with DILD include cytotoxic, anti-inflammatory, cardiovascular, antimicrobial, biological agents, and miscellaneous drugs.
References
Skeoch, S., Weatherley, N., Swift, A. J., Oldroyd, A., Johns, C., Hayton, C., Giollo, A., Wild, J. M., Waterton, J. C., Buch, M., Linton, K., Bruce, I. N., Leonard, C., Bianchi, S., & Chaudhuri, N. (2018). Drug-Induced Interstitial Lung Disease: A Systematic Review. Journal of clinical medicine, 7(10), 356. https://doi.org/10.3390/jcm7100356
Spagnolo, P., Bonniaud, P., Rossi, G., Sverzellati, N., & Cottin, V. (2022). Drug-induced interstitial lung disease. European Respiratory Journal, 60(4). DOI: 10.1183/13993003.02776-2021