[Early diagnosis of amiodarone-induced pulmonary toxicity: are repeated lung function tests of any value?]

Amiodarone therapy for certain life-threatening cardiac arrhythmias is associated with numerous side and adverse effects, of which pulmonary toxicity is one of the most serious adverse reactions. It appears to be generally accepted that amiodarone-induced pulmonary toxicity (APT) is associated with considerable morbidity and mortality. Based on the assumption that detection of APT in an asymptomatic phase would improve the prognosis for these patients, the value of monitoring for toxic effects with various paraclinical tests has been extensively studied. This article summarizes current knowledge of the pulmonary complications of amiodarone therapy with emphasis on the usefulness of pulmonary function tests in the detection of APT. Based on the findings in the published studies, it appears that changes in pulmonary function, including diffusion capacity, over time do not identify patients at risk for development of APT. It is suggested that it is worthwhile to obtain two or three measurements of pulmonary function, including diffusion capacity, within the first few months of therapy in order to establish the variation in the individual patient. When a stable maintenance dose has been reached, subsequent testing should be reserved for patients who develop new or progressive pulmonary symptoms or radiographic infiltrates.