Dyspnea or difficulty breathing is the primary sign of chemotherapy induced pulmonary toxicity. Other symptoms include fever, dry cough, tachypnea or increased respiratory rate and rales.

Management strategies for pulmonary toxicity include:

a. Obtaining a baseline assessment of pulmonary function, including chest x-ray, pulmonary function tests, and arterial blood gas analysis.
b. Observing the patient’s respiratory rate and breathing pattern and noting any changes with position and exertion.
c. Assessing the patient for signs of pulmonary toxicity, including a dry persistent cough, dyspnea, tachypnea, cyanosis or rales.
d. Preventing respiratory infection by promoting exercise, coughing and deep breathing, and humidification of air.
e. Teaching the patient to recognize signs and symptoms of pulmonary toxicity.
f. Instructing the patient to avoid smoking and exposure to respiratory irritants such as noxious gases and aerosol sprays.
g. Monitoring the cumulative dose of bleomycin, which should not exceed 450 units.
h. Avoiding giving high doses of inspired oxygen to prevent further lung damage.
i. Providing supportive therapy such as loop diuretics to decrease pulmonary congestion or giving bronchodilating drugs as needed.