Internal Medicine

0521779407-10 CUNY1086/Karliner 0 521 77940 7 June 7, 2007 18:40

844 Interstitial Lung Diseases

■Baseline PFTs, CXR, CT

■Treat intercurrent infection

■Avoid aspiration; asymptomatic acid reflux common

specific therapy

Indications

■Presence of disease unless extremely end-stage

Treatment Options

■Antiinflammatory therapy:

➣prednisone

➣azathioprine, cyclophosphamide: usually added as second agent

to spare steroid adverse effects

➣Colchicine: may be antifibrotic; efficacy unclear

■Referral for lung transplantation

Side Effects & Contraindications

■Prednisone:

➣Systemic effects of steroids

➣If used with azathioprine or cyclophosphamide, give PCP pro-

phylaxis

➣Contraindications:

Absolute: prior severe adverse reactions

Relative: mild diabetes, past history of ulcers, anxiety and irri-

tability

■Azathioprine:

➣Side Effects: bone marrow suppression, liver toxicity, nausea,

future malignancy

➣Contraindications

Absolute: liver disease, low blood counts

Relative: mildly low blood counts

■Cyclophosphamide:

➣Side effects: bone marrow suppression, esp leukopenia (adjust

dose), bladder hemorrhage (take with large volume of water early

in day), bladder tumors, azoospermia and amenorrhea, nausea,

future malignancy

➣Contraindications

Absolute: preexisting hematologic abnormalities

Relative: mild hematologic abnormalities

■Colchicine:

➣Side effects: diarrhea, muscle weakness

➣Contraindications: