Table 14. Pulmonary Late Effects
| Predisposing Therapy | Pulmonary Effects | Health Screening/Interventions |
| DLCO = diffusing capacity of the lung for carbon monoxide; GVHD = graft-versus-host disease. | ||
| Busulfan; carmustine (BCNU)/lomustine (CCNU); bleomycin; radiation impacting lungs; surgery impacting pulmonary function (lobectomy, metastasectomy, wedge resection) | Subclinical pulmonary dysfunction; interstitial pneumonitis; pulmonary fibrosis; restrictive lung disease; obstructive lung disease | History: cough, shortness of breath, dyspnea on exertion, wheezing |
| Pulmonary exam | ||
| Pulmonary function tests (including DLCO and spirometry) | ||
| Chest x-ray | ||
| Counsel regarding tobacco avoidance/smoking cessation | ||
| In patients with abnormal pulmonary function tests and/or chest x-ray, consider repeat evaluation prior to general anesthesia | ||
| Pulmonary consultation for patients with symptomatic pulmonary dysfunction | ||
| Influenza and pneumococcal vaccinations | ||
| Hematopoietic cell transplantation with any history of chronic GVHD | Pulmonary toxicity (bronchiolitis obliterans, chronic bronchitis, bronchiectasis) | History: cough, shortness of breath, dyspnea on exertion, wheezing |
| Pulmonary exam | ||
| Pulmonary function tests (including DLCO and spirometry) | ||
| Chest x-ray | ||
| Counsel regarding tobacco avoidance/smoking cessation | ||
| In patients with abnormal pulmonary function tests and/or chest x-ray, consider repeat evaluation prior to general anesthesia | ||
| Pulmonary consultation for patients with symptomatic pulmonary dysfunction | ||
| Influenza and pneumococcal vaccinations | ||
