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Pulmonary reactions to chemotherapeutic agents: the ‘chemotherapy lung’
Published in Philippe Camus, Edward C Rosenow, Drug-induced and Iatrogenic Respiratory Disease, 2010
Fabien Maldonado, Andrew H Limper
Clinically, busulfan-induced pulmonary toxicity results in the subacute onset of cough, fever, weight loss and dyspnoea on exertion. These symptoms typically occur more than four years after initiation of chemotherapy. Occasionally, these symptoms may occur within a few months, and some cases have been reported as late as 10 years after initiation of treatment. The chest X-ray generally shows characteristic alveolar and interstitial infiltrates which should suggest the diagnosis and prompt the clinician to discontinue the drug. Pulmonary function studies are frequently abnormal with evidence of a restrictive pattern and a decreased DLCO. Bronchoscopic examination may be of importance in ruling out alternative diagnoses, in particular infectious or neoplastic processes. Histologically, atypical type 2 pneumocytes are present with a relatively decreased number of type 1 pneumocytes. In addition, lymphocytic and plasma cell infiltration can be observed in lavage. Discontinuation of the offending agent is mandatory. Corticosteroids may also be used, although their efficacy remains unclear at best. Unfortunately, the majority of patients progress to respiratory failure and death.
Potential for occupational exposures to pathogens during bronchoscopy procedures
Published in Journal of Occupational and Environmental Hygiene, 2019
Maryshe Zietsman, Linh T. Phan, Rachael M. Jones
Bronchoscopy is one of several respiratory procedures classified as an aerosol-generating procedure (AGP). AGPs are procedures thought to generate respirable aerosols and have been associated with increased risk of occupationally acquired infection among healthcare personnel.[1,2] During a bronchoscopy procedure, a bronchoscope is inserted through the nose or mouth of a sedated patient to visualize the respiratory tract and diagnose or treat medical problems. The procedure may involve administration of nebulized medication. The procedure can induce coughing, particularly during removal of the bronchoscope.