Eosinophilic pneumonia medical therapy
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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 Therapy
- Initial management of acute eosinophilic pneumonia (AEP) usually includes supportive care with supplemental oxygen and possibly mechanical ventilation, 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]
- Occasional patients with milder initial disease have experienced spontaneous improvement following smoking cessation and without glucocorticoid therapy.
- Thus, we recommend treatment with systemic glucocorticoids for almost all patients with AEP (after exclusion of infectious causes), except those with clear evidence of an improving 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 (usually within one to three days).[3]
- In the absence of respiratory failure (eg, pulse oxygen saturation >92 percent on low-flow supplemental oxygen), initial treatment with oral prednisone (40 to 60 mg daily) is reasonable.
- If the patient shows clinical stabilization with rapid resolution of all symptoms, then earlier glucocorticoid tapering (over 7 to 14 days) may be an acceptable treatment strategy especially for AEP patients who present with initial eosinophilia.
- A longer treatment course (up to four weeks) with tapering and discontinuing of prednisone over the subsequent two to four weeks may occasionally be required in patients who experienced severe respiratory failure with delayed resolution of symptoms and radiographic abnormalities.
- If a patient fails to respond to glucocorticoids, an alternative diagnosis should be entertained. There are no data on treatments other than glucocorticoids.
- A favorable response to glucocorticoid therapy is typically defined by:[4]
- Resolution of presenting symptoms, especially dyspnea, cough, and fever.
- Decline in peripheral eosinophilia.
- Marked reduction or clearing (in most cases) of radiographic abnormalities, although radiographic abnormalities may persist on computed tomography scan for several weeks to months after clearing of the chest x–ray [25].
- Physiologic improvement as measured by forced vital capacity (FVC), total lung capacity (TLC), diffusing capacity (DLCO), and pulse oxygen saturation (SpO2).
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.