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Drug-induced interstitial lung disease (DI-ILD) is a very challenging topic both clinically and academically. With the advent of new immunotherapy and ever-growing arsenal of chemotherapeutic and biologic agents for a variety of conditions, it is paramount for the clinician to assess for the development of pulmonary toxicity before irreversible lung damage occurs. In this review, we have summarized the literature and describe the most commonly implicated agents and also describe new and rare causes of DI-ILD. Bleomycin and amiodarone remain the most frequent culprits of DI-ILD. Proteasome inhibitors have been observed to cause pulmonary toxicity in some patients. GM-CSF has also emerged as a cause of DI-ILD in recent years. Nitrofurantoin is commonly associated with DI-ILD in the class of antimicrobial agents, with both acute and chronic toxicity described. Anti-TNF drugs, in particular, etanercept and infliximab, are the overwhelming offenders among the biologic agents. In addition, methotrexate has been widely associated with lung injury, especially in those with underlying rheumatoid arthritis. Over 300 drugs are known to be associated with DI-ILD, and risk factors for the development of DI-ILD are not well understood. Radiographic patterns and histological patterns do not correlate well, and the data on treatment response to glucocorticoid therapy remains variable. Early identification, removal of the offending agent, and elimination of other causes of lung injury remain paramount in the approach to DI-ILD.

The impact of hospitalization on patient outcomes is increasingly recognized and considered in the prognostication of many pulmonary disorders. We sought to evaluate the impact of hospitalization on survival in connective tissue disease-interstitial lung disease (CTD-ILD) patients.A chart review of patients with CTD-ILD followed at a tertiary care center was performed. Patients were stratified into two groups based on hospitalization status. Outcomes of the groups were compared using Kaplan-Meier survival analyses as well as multivariate competing risk analysis.There were 137 patients identified with confirmed CTD-ILD. Patients who underwent hospitalization for any reason had a significant decrease in transplant-free survival compared to the never hospitalized cohort (3-year survival 60% vs. 94%; p = 0.0001). Hospitalization for ≥7 days was associated with worse outcomes than those hospitalized for7 days (median survival 1.59 years vs. 7.17 years, p = 0.0012). Based on multivariate competing risk analysis, factors associated with death, with lung transplantation as a competing risk, were age (HR = 1.05 [95% 1.01-1.09]; P = 0.0443), male gender (HR = 4.94 [95% CI: 1.58-15.41]; P = 0.006), and all cause hospitalization (HR = 11.97 [95% CI: 1.36-105.49]; P = 0.0253).This study highlights the impact of hospitalization on subsequent outcomes in the CTD-ILD population with a significantly reduced transplant-free survival demonstrated, especially after cardiopulmonary hospitalization events.