Chest
Volume 93, Issue 5, May 1988, Pages 1067-1075
Journal home page for Chest

Today's Practice of Cardiopulmonary Medicine
Amiodarone Pulmonary Toxicity: Recognition and Pathogenesis (Part I)

https://doi.org/10.1378/chest.93.5.1067Get rights and content

Section snippets

CLINICAL PRESENTATION

In many cases, there appear to be two separate types of presentation of patients with APT,16,18,22,23 which has been recognized by very few authors. One is the more common variety of an insidious onset of nonproductive cough, dyspnea, weight loss, and occasionally fever associated with parenchymal infiltrates, predominantly a diffuse interstitial pattern. The chest x-ray almost always correlates with the clinical symptoms, meaning that the symptoms usually do not precede the change in the chest

RISK FACTORS FOR TOXICITY

There are several reports suggesting that preexisting lung disease—ie, abnormal chest roentgenogram findings and/or pulmonary function status prior to the initiation of therapy—predisposes to APT.8,9,15, 16, 17, 18, 19,22,28 Kudenchuk et al15 prospectively studied 69 patients before and during amiodarone therapy and found that 28 percent with a pretreatment Dsb of less than 80 percent predicted eventually showed changes consistent with APT compared to only 5 percent if the pretreatment Dsb was

METHOD OF DIAGNOSIS

There are no laboratory or clinical data currently available that alone unequivocally establish the diagnosis of APT. To make a “clinical” diagnosis of APT requires the exclusion of other diagnostic possibilities (especially occult congestive heart failure) together with a reasonable constellation of symptoms or findings consistent with the diagnosis. Kudenchuk et al15 defined APT as any two of the following findings: (1) new or worsening symptoms; (2) new abnormalities on, or worsening of

THERAPEUTIC OPTIONS

Once the clinical diagnosis of APT has been made, a limited number of therapeutic options are available to the clinician. First, the most frequently used option is simply to discontinue amiodarone. In most cases, symptoms and findings will begin to resolve within a few days, although near-complete resolution may require several months. In general, the more insidious the onset of the disease, the slower the resolution. Clearly, the unusual occurrence of progressive pulmonary toxicity is possible

SUMMARY

Amiodarone represents an important new approach in the treatment of serious cardiac rhythm disturbances and is associated with significant pulmonary toxicity in approximately 5 to 10 percent of patients. The recognition of APT in patients receiving the drug early in the course of the disease will likely preclude the development of a permanent loss of pulmonary function in these patients. It is important for the clinician to individualize both the diagnostic and therapeutic approach to the

First page preview

First page preview
Click to open first page preview

REFERENCES (49)

  • Gonzalez-RothiRJ et al.

    Amiodarone pulmonary toxicity presenting as bilateral exudative pleural effusions

    Chest

    (1987)
  • DakeMD et al.

    Gallium-67 lung uptake associated with amiodarone pulmonary toxicity

    Am Heart J

    (1985)
  • MartinWJ et al.

    Amiodarone pulmonary toxicity: assessment by bronchoalveolar lavage

    Chest

    (1985)
  • Israel-BietD et al.

    Bronchoalveolar lavage in amiodarone pneumonitis. Cellular abnormalities and their relevance to pathogenesis

    Chest

    (1987)
  • AkounGM et al.

    Amiodarone-induced hypersensitivity pneumonitis: evidence of an immunological cell-mediated mechanism

    Chest

    (1984)
  • CostabelU et al.

    T-lymphocytosis in bronchoalveolar lavage fluid of hypersensitivity pneumonitis: changes in profile of T-cell subsets during the course of disease

    Chest

    (1984)
  • AkounGM et al.

    Drug-related pneumonitis and drug-induced hypersensitivity pneumonitis [Letter]

    Lancet

    (1984)
  • EttensohnDB et al.

    Bronchoalveolar lavage in gold lung

    Chest

    (1984)
  • WoodDL et al.

    Amiodarone pulmonary toxicity report of two cases associated with rapidly progressive fatal adult respiratory distress syndrome after pulmonary angiography

    Mayo Clin Proc

    (1985)
  • HarrisL et al.

    Side effects of long-term amiodarone therapy

    Circulation

    (1983)
  • FogorosRN et al.

    Amiodarone: clinical efficacy and toxicity in 96 patients with recurrent drug-refractory arrhythmias

    Circulation

    (1983)
  • RotmenschHH et al.

    Steady-state serum amiodarone concentrations: relationships with antiarrhythmic efficacy and toxicity

    Ann Intern Med

    (1984)
  • RaederEA et al.

    Side effects and complications of amiodarone therapy

    Am Heart J

    (1983)
  • Amiodarone. Med Lett

    (1986)
  • Cited by (252)

    • Acute Lung Injury Associated With Perioperative Amiodarone Therapy—Navigating the Challenges in Diagnosis and Management

      2022, Journal of Cardiothoracic and Vascular Anesthesia
      Citation Excerpt :

      Older patients and those with prior pulmonary disease may be at elevated risk.49 Further possible risk factors include male sex, delivery of high oxygen levels, and previous cardiac or thoracic surgery.10,28-31,49 The daily and cumulative treatment doses, as well as treatment duration, also may play a role.20,32-38

    • Chronic diffuse lung diseases

      2022, Practical Pulmonary Pathology: A Diagnostic Approach
    • Acute lung injury

      2022, Practical Pulmonary Pathology: A Diagnostic Approach
    View all citing articles on Scopus

    Supported in part by NIH grant HL36124.

    Part 2 will appear in the next issue of Chest.

    View full text