Pneumonitis

Pneumonitis is inflammation of the lung tissue that is not caused by an infection. In people treated for asbestos-related cancers, it most often follows radiation therapy or immunotherapy, and it can cause cough, shortness of breath and low oxygen levels. Most cases improve with treatment, but severe cases can be dangerous or leave lasting scarring.

Origin

The word combines the Greek pneumon, lung, with -itis, inflammation. Radiation pneumonitis was recognized early in the history of chest radiotherapy, and pneumonitis from checkpoint inhibitors became a recognized complication in the 2010s.

Significance in Asbestos Context

Radiation pneumonitis usually appears one to six months after radiation to the chest and can be followed by permanent radiation fibrosis. Immunotherapy pneumonitis can appear at any time during treatment and is one of the more dangerous immune-related side effects; it is treated by stopping the drug and giving steroids. Both cause symptoms similar to the cancer itself, an infection or worsening asbestosis, and on a CT scan they can look alike, so doctors may need scans, tests for infection and sometimes bronchoscopy to sort them out. That overlap matters in the records: a later doctor or expert may confuse treatment-related scarring with asbestosis, or the reverse. Hypersensitivity pneumonitis, caused by inhaled organic dusts or molds, is a different condition. For a patient already short of breath from asbestosis or pleural disease, even a moderate pneumonitis can mean hospital care or supplemental oxygen, which should be recorded as part of the illness's course.

Example Sentence

Two months after radiation to the chest wall, his new dry cough and patchy CT changes were diagnosed as radiation pneumonitis and treated with a tapering course of steroids.

Related Terms

Immune-Related Adverse Events, Intensity-Modulated Radiation Therapy (IMRT), Interstitial Lung Disease, Pulmonary Fibrosis, Asbestosis, Supplemental Oxygen, CT Scan, Non-Productive Cough

Notes

• Report a new or worsening cough, fever or breathlessness promptly after radiation or during immunotherapy.
• Ask that the record say clearly what caused any new lung inflammation or scarring.
• Do not stop or restart steroids without your doctor's direction.