What is a major pulmonary toxicity associated with bleomycin, and what monitoring is recommended?

• A. Pulmonary fibrosis with baseline and periodic pulmonary function testing to monitor cough, dyspnea and oxygenation.
• B. Pulmonary edema monitored with daily chest X-rays.
• C. Pneumonitis monitored by spirometry weekly.
• D. Bronchospasm managed with inhaled beta-agonists and no imaging.

Answer: (A)

Bleomycin can cause lung toxicity that presents as pneumonitis and can progress to pulmonary fibrosis. To catch this early, the key monitoring approach is baseline pulmonary function testing and regular follow-up tests during treatment, focusing on diffusion capacity (DLCO) and standard spirometry measures like FVC. This helps detect declines in lung function even before severe symptoms appear. Clinically, watching for cough, shortness of breath, and changes in oxygenation complements the objective tests. Imaging isn’t used as a daily monitoring tool; if toxicity is suspected, imaging may be used to evaluate the lungs, and bleomycin is often discontinued if toxicity is suspected. The option describing baseline and periodic pulmonary function testing to monitor cough, dyspnea and oxygenation best matches how this toxicity is detected and tracked.