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Care During Chemotherapy and Beyond
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Side Effects - Symptoms & Solutions

Pneumonitis

What is pneumonitis?

  • Treatment-related pneumonitis is a sign of lung injury, when there is inflammation of your lungs. This may be due to chemotherapy, or radiation therapy. It is very similar to pulmonary toxicity.
  • Pneumonitis commonly occurs 2 to 3 months after radiation to the chest area. It may also develop after chemotherapy that caused lung injury, or lung (pulmonary) toxicity.
  • Pneumonitis is often diagnosed by chest x-ray, according to the symptoms you are experiencing, and the amount of time after you have completed treatment.
  • Because you have been diagnosed with pneumonitis, you may develop pulmonary fibrosis. This may occur after a period of 6 to 12 months. You may feel well after your episode of pneumonitis, before the fibrosis occurs.
  • Some people may develop pulmonary fibrosis after a full dose of radiation to treat their disease, without developing pneumonitis.

What are some symptoms to look for?

  • You may notice that you are short of breath, or have feelings of breathlessness
  • You may have fever, or chills.
  • You may be overly tired, or very weak (fatigued). It may be hard for you to do your normal activities
  • You may experience shortness of breath, either at rest or while performing any type of activity. This may include walking to the door, or climbing stairs.
  • You may have sudden onset of  coughing spells with a dry cough. You will not be able to produce any phlegm or sputum.
  • You may have pain in your muscles, or pain in your lungs when you take a deep breath, especially if you are coughing really hard, for long periods of time.

Things you can do:

  • Make sure you tell your doctor, as well as all healthcare providers, about any other medications you are taking (including over-the-counter, vitamins, or herbal remedies). 
  • Remind your doctor or healthcare provider if you have a history of diabetes, liver, kidney, or heart disease. If you have a family history of heart disease, stroke, high blood cholesterol, or high blood pressure, in a first or second-degree relative, you may be at risk for certain problems. Notify your healthcare provider if you have any of these diseases in your family.
  • If you are still smoking, you should quit. If you do not smoke, avoid smoke-filled rooms. Smoking first or second-hand can further damage lung tissue. Discuss with your healthcare provider techniques that can help you quit.
  • Avoid people who are sick. Wash your hands often, with soap and water, for at least 15 seconds at a time. Use tissues when you sneeze or cough.
  • Do not share eating or drinking utensils with anyone.
  • If you are over the age of 65 years, or have an altered immune system due to chemotherapy, chronic disease or steroid use, the Centers for Disease Control (CDC) recommends that you receive a flu vaccine every year, and a pneumonia vaccine every 5 years. Discuss this with your healthcare provider if this is right for you.
  • Pulmonary (lung) rehabilitation is important for people with pneumonitis. This includes exercise, air circulation, and oxygen therapy.
  • People with lung problems need to circulate air from the bottom of their lungs and out of your lungs (oxygenation), to prevent infection and pneumonia. Using an incentive spirometer for 15 minutes a day, twice a day, can help promote oxygenation.
  • Make sure to drink 2 to 3 liters of fluids (non-alcoholic, non-caffeinated) per day, to remain well hydrated. Taking warm showers or baths, and using a vaporizer, may help to thin out your secretions, if they are present.
  • After an initial rest period, try to exercise, as tolerated, to promote air exchange (oxygenation), and to maintain your optimal level of functioning. Walking, swimming, or light aerobic activity may also help you to lose weight, and feel better. Make sure to exercise, under the supervision of your healthcare provider, and discuss with your healthcare provider how you can create a specific exercise program to suit your needs.
  • Oxygen therapy may decrease the amount of work that you have to do to breathe. Discuss this with your healthcare provider.
  • Try to avoid "environmental allergens" (such as smoke, pollution, and common causes of seasonal allergies), as well as things that may cause allergies in your home (hair sprays, mold, dust mites, and pets). These may trigger an episode of shortness of breath, and make your symptoms worse.
  • Keep a diary of your any abnormal symptoms, such as excessive fatigue, shortness of breath or chest pain, if these are occurring regularly. Write down the foods that you have eaten, the exercise or activity you were undergoing when the symptoms occurred, and how you felt before they occurred. This diary may be valuable in identifying certain "triggers" of your symptoms.
  • Questions to ask yourself, may include:
    • Did my symptoms occur gradually, or did this episode come on all of a sudden? Was I feeling anxious? Did I perform any kind of activity, or was I resting?
    • Did I eat any different kinds of foods? Was I around any pets? Did I travel recently? What did I do differently?
  • Use relaxation techniques to decrease the amount of anxiety you have. If you feel anxious, place yourself in a quiet environment, and close your eyes. Take slow, steady, deep breaths, and try to concentrate on things that have relaxed you in the past.
  • You should restrict the amount of alcohol you take in, or avoid it all together. Alcohol may adversely interact with many medications.
  • Participating in support groups may be helpful to discuss with others what you are going through. Ask your healthcare provider if he or she is aware of any support groups that would benefit you.
  • If you are ordered a medication to treat this disorder, do not stop taking any medication unless your healthcare provider tells you to. Take the medication exactly as directed. Do not share your pills with anyone.
  • If you miss a dose of your medication, discuss with your healthcare provider what you should do.
  • If you experience symptoms or side effects, especially if severe, be sure to discuss them with your health care team.  They can prescribe medications and/or offer other suggestions that are effective in managing such problems.
  • Keep all your appointments for your treatments.

Drugs that may be prescribed by your doctor:

  • Depending on your lung function, and your overall health status, your doctor may recommend that certain drugs be used to help your lungs function more effectively, and decrease symptoms.
  • Treatment is aimed at preventing pneumonitis and pulmonary toxicity to those that are high risk. It is important to identify symptoms of lung damage early in treatment.
  • Treatment for pneumonitis includes:
    • Corticosteroids - which may help with cough and pain
    • Narcotics- to help relieve shortness of breath and discomfort
    • Non-drug techniques, such as pulmonary (lung) rehabilitation, and oxygen therapy.
    • Antibiotics - Antibiotics are usually not helpful for a true diagnosis of pneumonitis, because there is usually not an infection present. However, your doctor or healthcare provider may order antibiotic pills or intravenous (IV), depending on how severe your illness is, if he or she suspects a bacteria infection, and your overall health status. Commonly prescribed antibiotics for bronchitis, pneumonia and respiratory (breathing) problems include azithromycin (Zithromax®), and levofloxacin (Levaquin®). If you are prescribed antibiotics, take the full prescription. Do not stop taking pills once you feel better.
    • Corticosteroids: Steroids work by decreasing inflammation and swelling, which may be present with certain lung disorders, such as pulmonary toxicity, pneumonitis, and pulmonary fibrosis. People may benefit from steroids, either inhaled, by pill form, or in the vein (IV).
    • People who have an outbreak of severe shortness of breath and airway inflammation may be ordered a steroid pill, such as prednisone, for a short period of time. This may help with your shortness of breath, and chest discomfort, if any is present.
    • Patients with severe pneumonitis and shortness of breath may require IV administration of another steroid, methylprednisolone.
    • Cough medications/Decongestants - may help you to be more comfortable if you are coughing a lot. Guaifenesin is an active ingredient in many cough medications, may be given alone, but is often combined with other drugs, such as codeine, to help your cough.  Guaifenesin may also be combined with pseudoephedrine (Sudafed®) as a decongestant, or any one of many medications, depending on your symptoms.  Another common medication you may receive is Hydrocodone Bitartrate-Homatropine Methylbromide (Hycodan®). This is a narcotic antitussive (anti-cough medication), which will help relieve your cough.
    • Narcotics - Such as morphine sulfate may be useful, in certain cases of shortness of breath, to relieve your body's need to breathe. Morphine is called an opiate. Opiates tell your breathing center in your main brain stem not to breathe so hard. This might make you more comfortable. If you are taking morphine, though, make sure you discuss with your healthcare provider common side effects, such as constipation, drowsiness, nausea and vomiting, and how to control these side effects.
    • Oxygen therapy - If you are experiencing shortness of breath at rest, or on exertion, your healthcare provider may see if oxygen therapy is right for you. You may take oxygen when your symptoms are at their worst. For example, some people are only on oxygen at nighttime, and not during the day. Some take oxygen when they are performing activities, but not all the time.
  • Your healthcare provider will discuss with you which treatments are helpful to you.
  • Do not stop any medications abruptly, as serious side effects may occur

When to call your doctor or health care provider:

  • Fever of 100.5º F (38º C), chills, sore throat (possible signs of infection if you are receiving chemotherapy).
  • If you cough up blood
  • Shortness of breath, chest pain or discomfort; swelling of your lips or throat should be evaluated immediately
  • Feeling your heart beat rapidly (palpitations)
  • Any new rashes on your skin
  • Any unusual swelling in your feet and legs
  • Weight gain of greater than 3 to 5 pounds in 1 week.
  • If your symptoms become worse, or do not improve within 3 days of treatment

Note:  We strongly encourage you to talk with your health care professional about your specific medical condition and treatments. The information contained in this website is meant to be helpful and educational, but is not a substitute for medical advice.