Amiodarone Pulmonary Toxicity: Clinical and Subclinical Features

In a prospective study of lung function of 34 patients takingamiodarone, 24 showed no functional changes but 10 developeda sustained fall in CO transfer factor (T_LCO)exceeding 15 percent. These patients had on average received a higher dose ofdrug in the first three months of treatment. Seven showed noclinical or radiographic changes and T_LCO improved with reductionm drug dose. The other three patients developed florid clinicaland radiographic features of amiodarone pulmonary toxicity.All three had impaired T_LCO before receiving amiodarone. During the course of the prospective study amiodarone pulmonarytoxicity was diagnosed In four other patients. Lung tissue wasexamined in five of the seven patients with clinical toxicityand showed alveolar wall thickening, exudation and interstitialand intra-alveolar fibrosis with prominent ‘foamy’macrophages. Electron microscopy of macrophages showed numerouslysosomal multilainellar bodies, which were demonstrated byenergy dispersive X-ray analysis to contain iodine, a constituentof the amiodarone molecule. Two of the patients with clinicaltoxicity died of respiratory failure; the other five showedgradual Improvement on withdrawal of the drug and treatmentwith corticosteroids. Subsequent withdrawal of steroids wasassociated with clinical and/or functional deterioration infive patients. A separate autopsy study of the lungs of eight patients dyingduring treatment with amiodarone, but without clinically-recognisedtoxicity, showed that an alveolitis had been present in twoand prominent ‘foamy’ macrophages were seen in thelungs of six patients. We conclude that clinical and subclinical effects of amiodaroneon the lung are common. The clinical syndrome may be easilymisdiagnosed as pulmonary oedema. Subclinical changes in lungfunction are usually reversible, but whether they herald clinicaltoxicity if treatment is continued without modification is notestablished. The presence of ‘foamy’ macrophagesmay simply reflect exposure to the drug rather than clinically-importanttoxicity.     

WELL BABY CLINIC: ITS ORGANLZATION AND AIM

Tho Aim of Well Baby Oinic work is to direct the hygiene, feeding, pm- phyIactic inoculations and training nf an infant so as to giw him opportunity for normal development during the first years of life. It is the almost universar practice in United States hospitals and is becoming more generally practiscd in England and Europe to have a pediatrician talie charge of the infant at birth. This assures early examination hy a physician trained for the care of infants and gives the mother the advantage of startiuS from the beginning with the physician who is to belr, her with the care of her infant. The Child Health lVurse should visit the mother while she is still in hospital. Before lee\ving hospital, each mother should. receive cxplicit directions for feeding lwr infant, for his daily routine and for the care of his skin and clothmg. Appointment should be made for the mother and infant to returu to Well Babi t:linic the, first week after leaving hospital.