Abstract
Pulmonary function, chest radiographic appearances, and the cellular composition of bronchoalveolar lavage fluid were assessed in 13 patients who were receiving amiodarone treatment. Eight of the patients had developed clinical and radiological evidence of lung disease and five were symptom free. The proportions of lymphocytes (mean 8.6 (SD 6.9)) and neutrophils (mean 3.4 (3.3)) obtained by bronchoalveolar lavage were similar in patients with and without lung complications. Electron microscopic examination of alveolar macrophages showed intralysosomal inclusion bodies in all subjects, regardless of clinical state. There was no significant difference in the mean number of inclusion bodies per macrophage transection between those with and those without lung disease. The differential cell count in bronchoalveolar lavage fluid and the presence of macrophage inclusion bodies were therefore not useful as markers of disease activity. Among those who developed clinical and radiological evidence of lung disease, the cumulative drug dose per kilogram of body weight and the duration of treatment (mean 16.5 (SD 9.0) months) were significantly correlated with the degree of lung restriction as measured by total lung capacity and forced vital capacity. It is concluded that, while the severity of the restrictive pulmonary defect that is induced by amiodarone is largely dose related, the development of lung toxicity is to some extent idiosyncratic.
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- Akoun G. M., Gauthier-Rahman S., Milleron B. J., Perrot J. Y., Mayaud C. M. Amiodarone-induced hypersensitivity pneumonitis. Evidence of an immunological cell-mediated mechanism. Chest. 1984 Jan;85(1):133–135. doi: 10.1378/chest.85.1.133. [DOI] [PubMed] [Google Scholar]
- Braude A. C., Chamberlain D. W., Rebuck A. S. Proportional analysis of respiratory cells obtained by bronchoalveolar lavage. Can Med Assoc J. 1982 Jun 15;126(12):1401–1403. [PMC free article] [PubMed] [Google Scholar]
- Colgan T., Simon G. T., Kay J. M., Pugsley S. O., Eydt J. Amiodarone pulmonary toxicity. Ultrastruct Pathol. 1984;6(2-3):199–207. doi: 10.3109/01913128409018574. [DOI] [PubMed] [Google Scholar]
- Darmanata J. I., van Zandwijk N., Düren D. R., van Royen E. A., Mooi W. J., Plomp T. A., Jansen H. M., Durrer D. Amiodarone pneumonitis: three further cases with a review of published reports. Thorax. 1984 Jan;39(1):57–64. doi: 10.1136/thx.39.1.57. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Fogoros R. N., Anderson K. P., Winkle R. A., Swerdlow C. D., Mason J. W. Amiodarone: clinical efficacy and toxicity in 96 patients with recurrent, drug-refractory arrhythmias. Circulation. 1983 Jul;68(1):88–94. doi: 10.1161/01.cir.68.1.88. [DOI] [PubMed] [Google Scholar]
- Harris L., McKenna W. J., Rowland E., Krikler D. M. Side effects and possible contraindications of amiodarone use. Am Heart J. 1983 Oct;106(4 Pt 2):916–923. doi: 10.1016/0002-8703(83)90016-9. [DOI] [PubMed] [Google Scholar]
- Heger J. J., Prystowsky E. N., Jackman W. M., Naccarelli G. V., Warfel K. A., Rinkenberger R. L., Zipes D. P. Clinical efficacy and electrophysiology during long-term therapy for recurrent ventricular tachycardia or ventricular fibrillation. N Engl J Med. 1981 Sep 3;305(10):539–545. doi: 10.1056/NEJM198109033051002. [DOI] [PubMed] [Google Scholar]
- Kudenchuk P. J., Pierson D. J., Greene H. L., Graham E. L., Sears G. K., Trobaugh G. B. Prospective evaluation of amiodarone pulmonary toxicity. Chest. 1984 Oct;86(4):541–548. doi: 10.1378/chest.86.4.541. [DOI] [PubMed] [Google Scholar]
- Manresa F., Cequier A., Escarrabill J., Pérez Ayuso M. J., Sabater X., Gausi C. Amiodarone and lung function. Lancet. 1983 Dec 10;2(8363):1367–1367. doi: 10.1016/s0140-6736(83)91127-3. [DOI] [PubMed] [Google Scholar]
- Marchlinski F. E., Gansler T. S., Waxman H. L., Josephson M. E. Amiodarone pulmonary toxicity. Ann Intern Med. 1982 Dec;97(6):839–845. doi: 10.7326/0003-4819-97-6-839. [DOI] [PubMed] [Google Scholar]
- McGovern B., Garan H., Kelly E., Ruskin J. N. Adverse reactions during treatment with amiodarone hydrochloride. Br Med J (Clin Res Ed) 1983 Jul 16;287(6386):175–180. doi: 10.1136/bmj.287.6386.175. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Pollak P. T., Sami M. Acute necrotizing pneumonitis and hyperglycemia after amiodarone therapy. Case report and review of amiodarone-associated pulmonary disease. Am J Med. 1984 May;76(5):935–939. doi: 10.1016/0002-9343(84)91014-3. [DOI] [PubMed] [Google Scholar]
- Rakita L., Sobol S. M., Mostow N., Vrobel T. Amiodarone pulmonary toxicity. Am Heart J. 1983 Oct;106(4 Pt 2):906–916. doi: 10.1016/0002-8703(83)90015-7. [DOI] [PubMed] [Google Scholar]
- Riley S. A., Williams S. E., Cooke N. J. Alveolitis after treatment with amiodarone. Br Med J (Clin Res Ed) 1982 Jan 16;284(6310):161–162. doi: 10.1136/bmj.284.6310.161. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Sobol S. M., Rakita L. Pneumonitis and pulmonary fibrosis associated with amiodarone treatment: a possible complication of a new antiarrhythmic drug. Circulation. 1982 Apr;65(4):819–824. doi: 10.1161/01.cir.65.4.819. [DOI] [PubMed] [Google Scholar]

