Do we need annual PFTs on every patient taking amiodarone?
My practice pattern has been to get annual TSH/LFTs/PFTs + CXR/ophtho exam. The ACC agrees with watching the lungs. But, the best evidence I found says the sensitivity for evaluating for diffuse interstitial lung disease using a decrease in DLCO is only 68%, with a specificity of 69% - not fantastic. The bottom line from this paper (attached) is that routine use of PFTs is not supported. Similarly, UpToDate recommends an annual CXR for everyone but says PFTs can be deferred/individualized. I’m processing all of this information as enough to be practice-changing for me; I’ll save PFTs for patients who have underlying lung disease, are at high risk, and/or with symptoms.
Figure 3.
Amiodarone (Cordarone, Pacerone) Considerations for Use* US/FDA Approved Indications: Heart Rate Control and Heart Rhythm Control for Atrial Fibrillation. https://www.acc.org/~/media/Non-Clinical/Files-PDFs-Excel-MS-Word-etc/Tools%20and%20Practice%20Support/Quality%20and%20Clinical%20Toolkits/AFib%20Toolkit/Amiodarone.pdf?la=en
Bui A, Han S, Alexander M, Toner G, Irving L, Manser R. Pulmonary function testing for the early detection of drug induced lung disease: a systematic review in adults treated with drugs associated with pulmonary toxicity. Internal Medicine Journal. Published online October 7, 2019. doi:https://doi.org/10.1111/imj.14647
UpToDate. www.uptodate.com. https://www.uptodate.com/contents/amiodarone-clinical-uses
