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Amiodarone pulmonary toxicity: prospective evaluation of serial pulmonary function tests
S A Magro1, E C Lawrence, S H Wheeler
1Department of Medicine, Baylor College of Medicine, Houston, Texas.
Journal of the American College of Cardiology
|September 1, 1988
Summary
Amiodarone can cause pulmonary toxicity in 17% of patients. A 15% decrease in diffusing capacity for carbon monoxide (DLCO) indicates toxicity but doesn't require treatment changes in asymptomatic individuals.
Area of Science:
- Pulmonology
- Cardiology
- Pharmacology
Background:
- Amiodarone is an effective antiarrhythmic drug.
- Pulmonary toxicity is a known adverse effect of amiodarone therapy.
- Early detection and management of amiodarone-induced pulmonary toxicity are crucial.
Purpose of the Study:
- To evaluate the incidence and diagnostic utility of pulmonary function tests in patients treated with amiodarone.
- To identify predictors of amiodarone-induced pulmonary toxicity.
- To assess the clinical significance of changes in diffusing capacity for carbon monoxide (DLCO).
Main Methods:
- Prospective evaluation of 89 patients treated with amiodarone.
- Serial pulmonary function tests (PFTs) in 67 patients.
- Analysis of PFT variables, including DLCO, in relation to amiodarone-induced pulmonary toxicity.
Main Results:
- Pulmonary toxicity occurred in 17% of patients.
- A significant decrease in DLCO was observed in patients with toxicity.
- A decrease in DLCO >= 15% showed high sensitivity (100%) and specificity (89%) for diagnosing pulmonary toxicity.
- Higher amiodarone doses were associated with toxicity.
- Abnormal baseline DLCO or chest X-ray did not predict toxicity.
Conclusions:
- Serial PFTs, particularly DLCO, are valuable in diagnosing amiodarone-induced pulmonary toxicity.
- A 15% decrease in DLCO is a sensitive and specific indicator of toxicity.
- Asymptomatic patients with a DLCO decrease require careful monitoring but not immediate treatment changes.
- Higher amiodarone doses increase the risk of pulmonary toxicity.
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