ABSTRACT
With an increasing number of therapeutic drugs, the list of drugs that is responsible for severe pulmonary disease also grows. Many drugs have been associated with pulmonary complications of various types, including interstitial inflammation and fibrosis, bronchospasm, pulmonary edema, and pleural effusions. Drug-induced interstitial lung disease (DILD) can be caused by chemotherapeutic agents, antibiotics, antiarrhythmic drugs, and immunosuppressive agents. There are no distinct physiologic, radiographic or pathologic patterns of DILD, and the diagnosis is usually made when a patient with interstitial lung disease (ILD) is exposed to a medication known to result in lung disease. Other causes of ILD must be excluded. Treatment is avoidance of further exposure and systemic corticosteroids in patients with progressive or disabling disease.
ABSTRACT
INTRODUCTION: With an increasing number of therapeutic drugs available for use, the list of drugs that are responsible for severe pulmonary disease also grows. Genetic polymorphism of drug-metabolizing enzymes, particularly of the cytochrome P450 superfamily of enzymes, influences individual drug efficacy and safety through the alteration of pharmacokinetics and disposition of drugs. AREAS COVERED: This review focuses on drug-induced interstitial lung disease, describes common patterns of pulmonary injury, discusses diagnosis and treatment, and details the prevalence and clinical significance of cytochrome P450 polymorphisms. EXPERT OPINION: Polymorphisms of cytochrome P450 genes can influence the metabolic activity of the subsequent enzymes, which in turn may lead to localized reactions and tissue damage, for example, in lung tissue. Pharmacogenomic techniques allow efficient analysis of risk factors and genotyping tests have the potential to optimize drug therapy. In the future, genotyping should be considered to identify patients who are at high risk of severe toxic responses in order to guide appropriate individual dosage.
