Pulmonary fibrosis is a condition in which progressive scarring of lung tissue develops and permanently impairs lung function. It is currently thought that chronic damage to the lung tissue (such as from smoking) results in the formation of the scar tissue that can stiffen the lungs and impair breathing. Patients typically suffer from a dry cough and shortness of breath, also known as dyspnea. There are various medications currently used to treat patients with pulmonary fibrosis, each with its own side effects.
Glucocorticoids
These are widely used medications in the treatment of various diseases and conditions, and are used in the treatment of pulmonary fibrosis. They can cause muscle weakness/pain, impaired wound healing, risk of osteoporosis, and bone fracture due to their effects on protein and calcium metabolism. They also can increase the risk of infection due to their suppressive effects on the body's immune system. Other side effects include psychiatric effects such as unstable mood and psychosis, increased risk of diabetes, menstrual irregularity, increased risk of glaucoma and visual impairment, and increased risk of atherosclerotic heart disease.
Azathioprine
This is an immunosuppressant medication that is used in various diseases, pulmonary fibrosis included. One of the primary side effects is increased risk of infection from the suppressive effects on the body's immune system. It can also be toxic to the liver, and can manifest with jaundice and elevated liver enzymes on laboratory examination. If this is suspected, therapy must be ceased. Other symptoms include nausea and vomiting, diarrhea, muscle and joint pain, and abdominal pain.
Cyclophosphamide
This is another medication that works by suppressing immune system function. It can severely damage blood components such as the red blood cells, platelet cells (assist in clotting), and white blood cells (immune function). Another condition known as hemorrhagic cystitis, which is basically bloody inflammation of the urinary bladder, can result. This can manifest with blood in the urine and is the result of a toxic metabolite buildup in the bladder. Cyclophosphamide also interferes with reproductive function and can result in infertility in both men and women in addition to altered menstrual cycles. It can also be directly toxic to the developing fetus and as a result is not recommended for pregnant patients. It has also been linked to increased cancer risk (such as cancers of the bladder and blood cells), heart disease (such as heart failure), hair loss/thinning, nausea and vomiting.
Colchicine
Colchicine is an anti-inflammatory agent and also is used in the treatment of various diseases. Gastrointestinal disturbances such as nausea and vomiting, diarrhea, and abdominal discomfort can occur and can usually be alleviated by decreasing dosage. It can also suppress bone marrow function, with resulting decreases in the numbers of blood component cells such as white blood cells, platelet cells and red blood cells. In addition, damage to the muscle and nerve tissues have been reported, manifesting with muscle weakness. Toxicity to the kidney can also result with effects such as blood in the urine, protein in the urine, and decrease in urine output.
Interferon Gamma-1b
This medication is known as a biologic response modifier and stimulates the human immune system. Side effects include flu-like symptoms such as fever, headache, chills, joint pain and fatigue. Administration of ibuprofen can alleviate the above symptoms. Gastrointestinal symptoms such as nausea, vomiting, and diarrhea have also been reported. Rash can also develop and if it becomes severe and affects body function, drug should be discontinued. Decreased number of white blood cells and platelet cells can also occur, and can resolve with drug cessation.
References
- "Murray and Nadel's Textbook of Respiratory Medicine, 4th Edition;" Mason; 2005
- Chest. "Interferon-gamma1b therapy in idiopathic pulmonary fibrosis: A meta-analysis." Bajwa EK, Ayas NT, Schulzer M, et al. Volume 128, 2005
- Cochrane Database Sytematic Review. "Immunomodulatory agents for idiopathic pulmonary fibrosis." Davies HR, Richeldi L, Walters EH. 2003, CD003134
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