Eosinophilic pneumonia medical therapy: Difference between revisions
Jump to navigation
Jump to search
No edit summary |
No edit summary |
||
| Line 6: | Line 6: | ||
== 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> | ||
* 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> | |||
* In the presence of severe hypoxemia or respiratory failure requiring mechanical ventilation, | * [[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. | ||
* 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> | |||
* A longer treatment course | * [[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 entertained | * 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 entertained. | |||
* 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> | * 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 | * Resolution of presenting symptoms | ||
* Decline in peripheral eosinophilia | * Decline in peripheral [[eosinophilia]] | ||
* Marked reduction | * 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== | ||
Revision as of 20:18, 13 February 2018
|
Eosinophilic pneumonia Microchapters |
|
Diagnosis |
|
Treatment |
|
Case Studies |
|
Eosinophilic pneumonia medical therapy On the Web |
|
American Roentgen Ray Society Images of Eosinophilic pneumonia medical therapy |
|
Risk calculators and risk factors for Eosinophilic pneumonia medical therapy |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohammed Abdelwahed M.D[2]
Overview
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 entertained.
- 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.