Serial lung function testing in patients treated with Amiodarone: A prospective study

Gleadhill, I.; Wise, Robert A.; Schonfeld, Steven A.; Scott, Penelope P.; Guarnieri, Thomas; Levine, Joseph; Griffith, Lawrence S.C.; Veltri, Enrico P.

doi:10.1016/0002-9343(89)90221-0

Cited by 45 publications

(27 citation statements)

References 22 publications

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“…6 Gleadhill et al also evaluated 91 patients receiving amiodarone during a mean follow-up period of 12 months, and reported that an individual decrease in %DLCO of 20% gave a sensitivity of 100% and a specificity of 83% for the diagnosis of APT. 30 In our study, the sensitivity and specificity of 15% or 20% decrease in %DLCO were lower than those in the previous reports. 6,30 This may in part be related to frequently monitoring %DLCO during the longer followup period in our study, because of the large inherent variability in this test.…”

Section: Discussioncontrasting

confidence: 90%

“…30 In our study, the sensitivity and specificity of 15% or 20% decrease in %DLCO were lower than those in the previous reports. 6,30 This may in part be related to frequently monitoring %DLCO during the longer followup period in our study, because of the large inherent variability in this test. 5 In our study, however, values of the NNS for an individual decrease in %DLCO every 3 and 6 months seem not to be high from the viewpoints of prevention and early detection of APT, because these values are lower than those for mammography in women aged 50-59.…”

Section: Discussioncontrasting

confidence: 90%

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Incidence and Predictors of Pulmonary Toxicity in Japanese Patients Receiving Low-Dose Amiodarone

Yamada

Shiga

Matsuda

et al. 2007

Circ J

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Background Amiodarone-induced pulmonary toxicity (APT) is the most serious side-effect of amiodarone, and its detection and prevention are extremely important. This study was designed to evaluate the incidence and clinical risk factors of APT, and the utility of a pulmonary function test or serum KL-6 assay to predict pulmonary toxicity in Japanese patients receiving low-dose amiodarone. Methods and ResultsFive hundred consecutive patients receiving amiodarone were retrospectively evaluated. Mean follow-up period was 48 months and mean maintenance dose was 141 mg daily. Cumulative incidence of APT was 4.2%, 7.8%, and 10.6% at 1, 3, and 5 years, respectively. On multivariate analysis, age at the start (hazard ratio (HR) =1.48, 95% confidence interval (CI) 1.13 to 1.93) was a significant pretreatment risk factor. Age (HR =1.64, 95% CI 1.29 to 2.09), maintenance dose (HR =1.90, 95% CI 1.45 to 2.49) and plasma monodesethylamiodarone concentration (HR =1.30, 95%CI 1.08 to 1.58) were risk factors. Sensitivity and specificity in screening with measurement of percent predicted diffusion capacity of carbon monoxide, ≥15% individual decrease, were 68% and 69%, and for ≥20% individual decrease, were 59% and 74%, whereas those in screening with serum KL-6 assay, ≥500 U/ml, were 25% and 91%, respectively. Conclusions Even at low dose, amiodarone shows substantial pulmonary toxicity. Higher age and higher maintenance dose are risk factors. Further decreasing the maintenance dose of amiodarone should be considered in order to reduce the incidence of pulmonary toxicity, at least in Japanese patients. (Circ J 2007; 71: 1610 -1616

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Section: Discussioncontrasting

confidence: 90%

Section: Discussioncontrasting

confidence: 90%

Incidence and Predictors of Pulmonary Toxicity in Japanese Patients Receiving Low-Dose Amiodarone

Yamada

Shiga

Matsuda

et al. 2007

Circ J

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“…Chest X-ray findings are nonspecific and include diffuse alveolar and interstitial abnormalities [6], which may be confused with other conditions, such as pul monary edema, hypersensitivity pneumonitis, or diffuse fi brosis. Changes in pulmonary function tests arc also pre sent, and among these, impairment of the diffusing capac ity for carbon monoxide, total lung capacity and forced vital capacity are the most frequent [10].…”

Section: Discussionmentioning

confidence: 99%

A Localized Pleuropulmonary Lesion Induced by Long-Term Therapy with Amiodarone

Piazza

Bizzaro²

1992

Respiration

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Pulmonary toxicity is an important adverse effect of amiodarone therapy that usually manifests as an acute or chronic diffuse lung disease; in rare cases localized lesions have also been described. We observed a solitary mass localized in the left lung base and involving the adjacent pleura in a 69-year-old man who had been treated for 1 year with amiodarone (cumulative dose 52 g). Cytological and histological examination showed that the lesion consisted of fibrotic tissue and a massive macrophagic infiltration. Following suspension of amiodarone and surgical excision, there was a complete recovery and the mass did not relapse. We confirm that respiratory complaints can occur in patients treated by long-term amiodarone therapy and that lung involvement can manifest with a solitary localized (fibrotic) lesion.

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“…20% decline in DLCO of the predicted value, or the value lower than 80% of the predicted one and reduces the total lung capacity (TLC) for more than 15% are the diagnostic criteria of APT. However, an isolated decrease in DLCO in the absence of clinical evidence of the disease is nonspecific and not diagnosed APT [8]. Fiberoptic bronchoscopy and bronchoalveolar lavage (BAL) are useful in excluding other interstitial lung problems.…”

Section: Amiodarone Pulmonary Toxicitymentioning

confidence: 99%

Drug induced lung disease - amiodarone in focus

Vasić

Milenković²,

Pešut³

et al. 2014

Med pregl

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More than 380 medications are known to cause pulmonary toxicity. Selected drugs that are important causes of pulmonary toxicity fall into the following classes: cytotoxic, cardiovascular, anti-inflammatory, antimicrobial, illicit drugs, miscellaneous. The adverse reactions can involve the pulmonary parenchyma, pleura, the airways, pulmonary vascular system, and mediastinum. Drug-induced lung diseases have no pathognomonic clinical, laboratory, physical, radiographic or histological findings. A drug-induced lung disease is usually considered a diagnosis of exclusion of other diseases. The diagnosis of drug-mediated pulmonary toxicity is usually made based on clinical findings. In general, laboratory analyses do not help in establishing the diagnosis. High-resolution computed tomography scanning is more sensitive than chest radiography for defining radiographic abnormalities. The treatment of drug-induced lung disease consists of immediate discontinuation of the offending drug and appropriate management of the pulmonary symptoms. Glucocorticoids have been associated with rapid improvement in gas exchange and reversal of radiographic abnormalities. Before starting any medication, patients should be educated about the potential adverse effects of the drug. Amiodarone is an antiarrhythmic agent used in the treatment of many types of tachyarrhythmia. Amiodarone-caused pulmonary toxicity is a well-known side effect (complication) of this medication. The incidence of amiodarone-induced lung disease is approximately 5-7%.

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Serial lung function testing in patients treated with Amiodarone: A prospective study

Cited by 45 publications

References 22 publications

Incidence and Predictors of Pulmonary Toxicity in Japanese Patients Receiving Low-Dose Amiodarone

Incidence and Predictors of Pulmonary Toxicity in Japanese Patients Receiving Low-Dose Amiodarone

A Localized Pleuropulmonary Lesion Induced by Long-Term Therapy with Amiodarone

Drug induced lung disease - amiodarone in focus

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