English | Español
Care During Chemotherapy and Beyond
presented by Scott Hamilton
Print

Side Effects - Symptoms & Solutions

Pulmonary Toxicity & Chemotherapy

What is pulmonary toxicity and how is it related to chemotherapy?

Pulmonary (lung) toxicity occurs when you are exposed to a chemical or an agent that causes damage to your lungs. You may develop a mild or severe form of pulmonary toxicity. Pulmonary toxicity may be described as:

  • A form of lung fibrosis or pneumonitis (inflammation of the lung)
  • A form of non-heart related pulmonary edema (swelling in your lungs)
  • A sudden onset or occurrence of being overly sensitive (hypersensitive) to your chemotherapy or radiation therapy

Causes of pulmonary toxicity may include:

  • Certain chemotherapy agents
  • Antitumor antibiotics - Such as bleomycin and mitomycin are the most common drugs that cause pulmonary toxicity. Your risk may increase if you are over 70 years of age, and had prior radiation to your chest area.
  • Antimetabolites- such as methotrexate - have been known to cause pulmonary toxicity.
  • Alkylating agents - such as busulfan have been known to cause pulmonary toxicity
  • Nitrosoureas - such as BCNU or carmustine have been known to cause pulmonary toxicity
  • Vinca Alkaloids - such as vincristine sulfate - may cause pulmonary toxicity if used in combination with mitomycin
  • Lung injury - can increase your chances of pulmonary toxicity - Your lungs may be damaged from radiation therapy (usually with breast, lung, or Hodgkin's disease), or due to trauma
  • Other chemicals and occupational exposure- inhaling chemicals, pollution, and environmental irritants, over a long period of time, as a part of your profession - can lead to pulmonary toxicity
  • The shortness of breath (dyspnea) you experience from pulmonary toxicity may be mild or severe.  You may go through periods when you feel well, and then go through periods when you feel ill.
  • To diagnose pulmonary toxicity, your healthcare provider may order a chest x-ray, pulmonary (lung) function tests, and perhaps, a bronchoscopy.

What are some symptoms of pulmonary toxicity to look for?

  • You may experience no symptoms at first. However, as pulmonary toxicity progresses, you may experience increased coughing, either a dry or moist cough, and shortness of breath. 
  • Pulmonary toxicity may cause you to be overly tired, or very weak (fatigued). You may experience breathlessness. It may be hard for you to do any kind of your normal activities as pulmonary toxicity worsens. 
  • 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.
  • With severe forms of pulmonary toxicity, you may develop worsening lung function. The lining of your lungs will become less stretchy, making it harder to breathe. This could lead to pulmonary fibrosis.
  • You may have trouble lying flat in bed, and you may have to sleep on 2 or more pillows. Your shortness of breath may cause you to wake up in the middle of the night.

Things you can do to avoid/minimize pulmonary toxicity:

  • 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 and worsen your pulmonary toxicity. 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 the mainstay of therapy for those with pulmonary toxicity and pulmonary fibrosis. This includes exercise, air circulation, and oxygen therapy.
  • People with lung problems including pulmonary toxicity 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.
  • You may or may not have any secretions with your pulmonary toxicity. However, controlling secretions through coughing and deep breathing will help you to breathe easier, if they are present. Remember, if you are dehydrated, your secretions will be thicker, and harder to "bring up."
  • 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.
  • 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.
  • If you are experiencing heart failure as a result of your pulmonary toxicity, you may be told to reduce the amount of salt you are eating in a day. Many times, it may be restricted to about 2 grams of sodium per day. A diet lower in salt may decrease the amount of work that is placed on your heart. You should discuss this with your healthcare provider how you can specifically use your diet to control your symptoms.
  • 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 pulmonary toxicity 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 helping you to identify certain "triggers" of your pulmonary toxicity 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 was I doing differently?
  • With severe breathing problems, sleeping at night with your head of the bed elevated may make it easier to breathe. You may do this by sleeping on 2 or 3 extra pillows. This will help lung expansion (spreading out), as well as promote the drainage of secretions and ease your symptoms of pulmonary toxicity.
  • 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. Such techniques can lessen symptoms of pulmonary toxicity.
  • 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 your pulmonary toxicity, 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 to treat pulmonary toxicity:

  • 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 the symptoms of pulmonary toxicity.
  • Pulmonary toxicity may resolve if your symptoms are identified early, and lung rehabilitation is started.
  • If you develop pulmonary fibrosis (thickening of your lungs that restricts your breathing) following either treatment related pneumonitis or pulmonary toxicity, some of the inhalers and pills that work for other lung diseases may not be as effective. However, if you have pulmonary fibrosis in addition to bronchitis, or another type of lung disease, they may work to decrease your 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 pulmonary toxicity may include:
    • Corticosteroids - which may help with cough and pain
    • Narcotics - for the shortness of breath and discomfort
    • Non-drug techniques, such as pulmonary (lung) rehabilitation, and oxygen therapy.
    • Antibiotics - Antibiotics are usually not helpful for a diagnosis of pulmonary toxicity, 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.
    • Calcium channel blockers - These medications may be given to treat high blood pressure in your lungs (pulmonary hypertension), which may be a result of pulmonary toxicity or fibrosis. A few common drugs include Verapamil HCL (Calan®), and Diltiazem (Dilacor XR®).
    • 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 pulmonary toxicity 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.
    • Diuretics - may be known as "water pills", as they work to prevent or treat lung congestion by making you urinate out extra fluid, if your fibrosis has progressed into heart failure. . Some examples of this medication may include furosemide (Lasix®), and Hydrochlorthiazide. You may receive this medication alone or in combination with other medications.
    • Immune suppressing agents - such as cyclophosphamide (cytoxan®) and azathioprine (Imuran®), are used alone or in combination with steroids if the cause of your pulmonary fibrosis is unknown, or idiopathic.  Sometimes, your doctor or healthcare provider
    • 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.
    • Vasodilators - are drugs that work by opening up or "dilating" the vessels. These drugs may be given to you if you have developed pulmonary hypertension as a result of your fibrosis. These may include isosorbide dinitrate (Isordil®).
  • 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.

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.