Eosinophilic pneumonia medical therapy: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Eosinophilic pneumonia}} | {{Eosinophilic pneumonia}} | ||
{{CMG}} {{AE}} | {{CMG}}; {{AE}} {{MAD}} | ||
==Overview== | ==Overview== | ||
Medical treatment of eosinophilic pneumonia include supportive care with supplemental [[oxygen]], [[Empiric therapy|empiric antibiotics]] until culture results are available, and systemic [[Glucocorticoid|glucocorticoid therapy]], [[Glucocorticoids|systemic glucocorticoids]] for almost all patients except those with clear evidence of an improving course. [[Prednisone]] is the preferred drug of choice. Dose of 40 to 60 mg daily is reasonable. [[Glucocorticoid]] tapering over 7 to 14 days may be an acceptable for patients who present with initial [[eosinophilia]]. If a patient fails to respond to [[glucocorticoids]], an alternative diagnosis should be used such as subcutaneous [[interferon]], high-dose intravenous [[immunoglobulins]], plasma exchange. [[Relapse]] can be treated with a dose of 20 mg per day of [[prednisone]]. | |||
== Medical Therapy == | == Medical Therapy == | ||
* Initial management of acute eosinophilic pneumonia (AEP) usually includes | * Initial management of acute eosinophilic pneumonia (AEP) usually includes: | ||
* | * Supportive care with supplemental oxygen | ||
* | * [[Empiric therapy|Empiric antibiotics]] until culture results are available, and systemic glucocorticoid therapy<ref name="pmid8181338">{{cite journal| author=Hayakawa H, Sato A, Toyoshima M, Imokawa S, Taniguchi M| title=A clinical study of idiopathic eosinophilic pneumonia. | journal=Chest | year= 1994 | volume= 105 | issue= 5 | pages= 1462-6 | pmid=8181338 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8181338 }}</ref> | ||
* In the presence of severe hypoxemia or respiratory failure requiring mechanical ventilation, | * Most patients with AEP experience progressive respiratory failure without systemic glucocorticoid therapy, but improve rapidly (within 12 to 48 hours) in response to intravenous or oral glucocorticoid therapy.<ref name="pmid10508792">{{cite journal| author=Jantz MA, Sahn SA| title=Corticosteroids in acute respiratory failure. | journal=Am J Respir Crit Care Med | year= 1999 | volume= 160 | issue= 4 | pages= 1079-100 | pmid=10508792 | doi=10.1164/ajrccm.160.4.9901075 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10508792 }}</ref> | ||
* [[Glucocorticoid|Systemic glucocorticoids]] for almost all patients except those with clear evidence of an improving course. | |||
* | * [[Prednisone]] is the preferred drug of choice. Dose of 40 to 60 mg daily is reasonable. | ||
* A longer treatment course | * In the presence of severe [[hypoxemia]] or [[respiratory failure]] requiring mechanical ventilation, [[methylprednisolone]] (60 to 125 mg every six hours) is given until respiratory failure resolves.<ref name="pmid26333129">{{cite journal| author=Jhun BW, Kim SJ, Kim K, Lee JE| title=Outcomes of rapid corticosteroid tapering in acute eosinophilic pneumonia patients with initial eosinophilia. | journal=Respirology | year= 2015 | volume= 20 | issue= 8 | pages= 1241-7 | pmid=26333129 | doi=10.1111/resp.12639 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26333129 }}</ref> | ||
* If a patient fails to respond to glucocorticoids, an alternative diagnosis should be | * [[Glucocorticoid]] tapering over 7 to 14 days may be an acceptable for patients who present with initial [[eosinophilia]]. | ||
* A favorable response to glucocorticoid therapy is typically defined by | * A longer treatment course up to four weeks of [[prednisone]] may occasionally be required in patients who experienced severe [[respiratory failure]] with delayed resolution of symptoms. | ||
* Resolution of presenting symptoms | * If a patient fails to respond to [[glucocorticoids]], an alternative diagnosis should be used: | ||
* Decline in peripheral eosinophilia | * Subcutaneous [[interferon]] | ||
* Marked reduction | * High-dose intravenous [[immunoglobulins]] | ||
* Plasma exchange | |||
* [[Cyclosporine]] | |||
* [[Rituximab]] | |||
* [[Relapse]] can be treated with a dose of 20 mg per day of [[prednisone]]. | |||
* A favorable response to glucocorticoid therapy is typically defined by:<ref name="pmid3285120">{{cite journal| author=Jederlinic PJ, Sicilian L, Gaensler EA| title=Chronic eosinophilic pneumonia. A report of 19 cases and a review of the literature. | journal=Medicine (Baltimore) | year= 1988 | volume= 67 | issue= 3 | pages= 154-62 | pmid=3285120 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3285120 }}</ref> | |||
* Resolution of presenting symptoms | |||
* Decline in peripheral [[eosinophilia]] | |||
* Marked reduction of radiographic abnormalities | |||
* Improved [[pulmonary function tests]] evidenced by [[forced vital capacity]] (FVC), [[total lung capacity]] (TLC), [[diffusing capacity]] (DLCO), and [[Pulse oximetry|pulse oxygen saturation]]. | |||
==References== | ==References== | ||
{{Reflist|2}} | |||
{{WH}} | |||
{{WS}} | |||
Latest revision as of 04:58, 2 March 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohammed Abdelwahed M.D[2]
Overview
Medical treatment of eosinophilic pneumonia include supportive care with supplemental oxygen, empiric antibiotics until culture results are available, and systemic glucocorticoid therapy, systemic glucocorticoids for almost all patients except those with clear evidence of an improving course. Prednisone is the preferred drug of choice. Dose of 40 to 60 mg daily is reasonable. Glucocorticoid tapering over 7 to 14 days may be an acceptable for patients who present with initial eosinophilia. If a patient fails to respond to glucocorticoids, an alternative diagnosis should be used such as subcutaneous interferon, high-dose intravenous immunoglobulins, plasma exchange. Relapse can be treated with a dose of 20 mg per day of prednisone.
Medical Therapy
- Initial management of acute eosinophilic pneumonia (AEP) usually includes:
- Supportive care with supplemental oxygen
- Empiric antibiotics until culture results are available, and systemic glucocorticoid therapy[1]
- Most patients with AEP experience progressive respiratory failure without systemic glucocorticoid therapy, but improve rapidly (within 12 to 48 hours) in response to intravenous or oral glucocorticoid therapy.[2]
- Systemic glucocorticoids for almost all patients except those with clear evidence of an improving course.
- Prednisone is the preferred drug of choice. Dose of 40 to 60 mg daily is reasonable.
- In the presence of severe hypoxemia or respiratory failure requiring mechanical ventilation, methylprednisolone (60 to 125 mg every six hours) is given until respiratory failure resolves.[3]
- Glucocorticoid tapering over 7 to 14 days may be an acceptable for patients who present with initial eosinophilia.
- A longer treatment course up to four weeks of prednisone may occasionally be required in patients who experienced severe respiratory failure with delayed resolution of symptoms.
- If a patient fails to respond to glucocorticoids, an alternative diagnosis should be used:
- Subcutaneous interferon
- High-dose intravenous immunoglobulins
- Plasma exchange
- Cyclosporine
- Rituximab
- Relapse can be treated with a dose of 20 mg per day of prednisone.
- A favorable response to glucocorticoid therapy is typically defined by:[4]
- Resolution of presenting symptoms
- Decline in peripheral eosinophilia
- Marked reduction of radiographic abnormalities
- Improved pulmonary function tests evidenced by forced vital capacity (FVC), total lung capacity (TLC), diffusing capacity (DLCO), and pulse oxygen saturation.
References
- ↑ Hayakawa H, Sato A, Toyoshima M, Imokawa S, Taniguchi M (1994). "A clinical study of idiopathic eosinophilic pneumonia". Chest. 105 (5): 1462–6. PMID 8181338.
- ↑ Jantz MA, Sahn SA (1999). "Corticosteroids in acute respiratory failure". Am J Respir Crit Care Med. 160 (4): 1079–100. doi:10.1164/ajrccm.160.4.9901075. PMID 10508792.
- ↑ Jhun BW, Kim SJ, Kim K, Lee JE (2015). "Outcomes of rapid corticosteroid tapering in acute eosinophilic pneumonia patients with initial eosinophilia". Respirology. 20 (8): 1241–7. doi:10.1111/resp.12639. PMID 26333129.
- ↑ Jederlinic PJ, Sicilian L, Gaensler EA (1988). "Chronic eosinophilic pneumonia. A report of 19 cases and a review of the literature". Medicine (Baltimore). 67 (3): 154–62. PMID 3285120.