To minimize the risk of pulmonary toxicity from bleomycin, what is the recommended approach to oxygen exposure?

• A. Always use 100% oxygen
• B. Oxygen not used
• C. High oxygen increases risk
• D. Limit oxygen exposure

Answer: (D)

Minimizing oxygen exposure helps protect the lungs from bleomycin-induced injury. Bleomycin can cause pulmonary toxicity, and higher oxygen levels worsen that damage because oxygen promotes reactive oxygen species that injure alveolar cells. The lungs have a limited ability to inactivate bleomycin, so the drug can stay active longer there, making damage more likely when oxygen is abundant. Therefore use the lowest FiO2 that safely maintains oxygenation, avoid unnecessary exposure to 100% oxygen, and carefully titrate oxygen during treatment and any anesthesia or recovery periods. Keeping oxygen exposure as low as possible reduces oxidative stress in the lungs and lowers the risk of pneumonitis and fibrosis.