Pneumotoxicity

The term pneumotoxicity stands for the toxic effects of various influences on the lungs . These are not only substances that get into the lungs through inhalation , but also, for example, those that act on and damage the lungs as part of radiation or systemic therapy . The main symptoms are shortness of breath or shortness of breath and a dry, unproductive cough. The pneumotoxicity must be differentiated from lung diseases such as infections and pulmonary embolism .

In the context of chemotherapy , pneumotoxicity is an undesirable effect . Clinically, it can occur as (chronic) pneumonitis and fibrosis , as pulmonary edema (not caused by cardiac disease ) and as hypersensitivity pneumonitis , which is also known as exogenous allergic alveolitis .

introduction

All harmful influences on the lung parenchyma are considered to be pneumotoxic . This includes not only drugs and toxins, but also high-energy radiation. The effects of each factor can result in different types of lung damage. Conversely, based on the existing damage, it is not necessarily possible to infer a specific cause.

One of the most common effects is pneumonitis, an inflammatory change in the lung tissue. Your clinical signs can be quite unspecific. Even with modern ( in vivo ) diagnostics, this pneumonitis can only be detected when the CO diffusion capacity of the lungs is measurably reduced. Corticosteroids are usually recommended therapeutically.

In the medium or long term, pneumotoxic substances can cause morphological changes in the lungs, which lead to an increase in resistance in the pulmonary circulation and thus to pulmonary hypertension . As a result, the right heart ventricle is overloaded with pressure and the cor pulmonale occurs .

Effects of pneumotoxicity by cause

Medication

More than 350 drugs are known to have adverse effects on the lungs. The clinical manifestations can be completely different, so in suspected cases further diagnostics ( lung function test with determination of diffusion capacity , x-ray of the lungs , computed tomogram and bronchoscopy with bronchoalveolar lavage) are indicated. Since one drug can lead to various changes in the lungs and, conversely, specific changes can also be traced back to several drugs, the explicit, reliable assignment of pathological processes to a specific substance is usually difficult. Therefore, in addition to the administration of corticosteroids (if necessary), it is recommended to stop all pneumotoxic agents (if at all possible).

chemotherapy

Pneumotoxicity is a well-known problem in the treatment of tumor diseases by means of chemotherapy. Its effects often do not become apparent immediately during treatment, but also up to a year later.

Many cytostatic agents used in chemotherapy lead to chronic pneumonitis , which clinically looks like a general infection with an unproductive cough and shortness of breath during exercise . The x-ray of the lungs shows alveolar or reticular infiltrates . Hypersensitivity pneumonitis (e.g. due to methotrexate or bleomycin ) also has a rather unspecific clinical appearance with muscle pain , unproductive cough, fever and shortness of breath, with pleural effusions and infiltration of both lung roots and eosinophilia in the blood count being typical. In both cases, the latency period between therapy and the appearance of the phenomenon is short. After administration of methotrexate, pulmonary edema without cardiac cause and after administration of bleomycin a respiratory distress syndrome can typically be observed.

radiotherapy

The pneumotoxicity resulting from radiation therapy is also known as radiogenic pneumopathy . It is a direct reaction of the lung tissue to the radiation. In the classic case, it begins with pneumonitis, which later develops into pulmonary fibrosis, or (more rarely) completely regresses. Hypersensitivity pneumonitis, bronchial stenosis or bronchiolitis obliterans with organizing pneumonia and, in extreme cases, life-threatening respiratory distress syndrome or right heart failure occur less frequently .

Pneumonitis occurs up to twelve weeks after treatment, accompanied by unspecific symptoms such as dry cough, malaise, and shortness of breath. In the case of superinfections in particular , pronounced fever attacks can occur. Even if the clinical pulmonary findings are normal, the first sign of the CO diffusion capacity may be reduced ( lung function test ). X-rays of the lungs , computed tomography and bronchoscopy (with bronchoalveolar lavage) can be indicated as further examinations . Typical are radiological changes in the radiation area (radiation dose over 40 Gy ). Histologically, this pneumonitis shows the picture of an interstitial pneumonia , which it develops from direct damage to the endothelial cells and pneumocytes II.

Plant poisons

In veterinary medicine , the pneumotoxicity of plant toxins also plays a role, especially in re-animals. The black nettle has a pneumotoxic effect and sometimes leads to death in grazing cattle.

inhalation

The inhalation of certain substances can also have a pneumotoxic effect. For example, the toxic effects of certain fluorocarbon compounds in leather and textile impregnation sprays are known. Metal dust containing cobalt or tungsten from grinding processes can also lead to pneumonitis , fibrosis and shortness of breath.

Individual evidence

1. ↑ ^{a b c} Herbert Rübben (Ed.): Uroonkologie. 3rd, completely revised Springer, Berlin a. a. 2001, ISBN 3-540-67310-5 , pp. 698 ff. ( Preview in Google book search).
2. ↑ D. Ukena: Drug-Induced Lung Diseases. In: The pulmonologist. Volume 4, May 2007, Issue 3, ISSN  1613-5636 , pp. 201-212, doi: 10.1007 / s10405-007-0149-9 .
3. ↑ ^{a b} Ulrike Höller, Petra Feyer: Management and prophylaxis of organ-related toxicities - pneumotoxicity under radiation therapy. In: Focus oncology. 2007, No. 9, pp. 61-67. Urban & Vogel Media and Medicine; online ( memento of September 3, 2013 in the Internet Archive ) in: onkosupport.de, accessed on March 1, 2017 (PDF; 213 kB).
4. ↑ Gernot Katzer: Perilla (Perilla frutescens [L.] Britton). In: gernot-katzers-spice-pages.com, accessed on March 1, 2017.
5. ↑ M. Guirgius et al. a .: Tox-Zentrum: Brennpunkte 2002. In: Schweizer Ärztezeitung. Volume 84, 2003, No. 45, pp. 2353-2356 (PDF; 380 kB), doi : 10.4414 / saez.2003.10073 .
6. ↑ M. Goldoni, S. Catalani, G. De Palma, P. Manini, O. Acampa, M. Corradi, R. Bergonzi, P. Apostoli, A. Mutti: Exhaled breath condensate as a suitable matrix to assess lung dose and effects in workers exposed to cobalt and tungsten. In: Environmental health perspectives. Volume 112, Number 13, September 2004, pp. 1293-1298, PMID 15345342 , PMC 1247519 (free full text).

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