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
- 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.