pulmonary disorders
Chronic Eosinophilic Pneumonia
Treatment of Chronic Eosinophilic Pneumonia
Systemic corticosteroids Sometimes maintenance therapy with inhaled corticosteroids, oral corticosteroids, or both Patients with chronic eosinophilic pneumonia are uniformly responsive to IV or oral corticosteroids; failure to respond suggests another diagnosis. Initial treatment isprednisone40 to 60 mg once a day. Clinical improvement is frequently striking and rapid, often occurring within 48 hours. Complete resolution of symptoms and x-ray abnormalities occurs within 14 days in most patients and by 1 month in almost all. Symptoms and plain chest x-rays are both reliable and efficient guides to therapy. Although HRCT is more sensitive for the detection of imaging abnormalities, there is no benefit gained by repeating CT. Peripheral eosinophil counts, ESR, and IgE levels can also be used to follow the clinical course during treatment. However, not all patients have abnormal laboratory test results. Symptomatic or radiographic relapse occurs in many cases either after cessation of therapy or, less commonly, with tapering of the corticosteroid dose. Relapse can occur months to years after the initial episode. Thus, corticosteroid therapy may be required for long periods of time (years). Inhaled corticosteroids (eg,fluticasoneorbeclomethasone500 to 750 mcg twice a day) may be effective, especially in reducing the maintenance dose of oral corticosteroid. Relapse does not appear to indicate treatment failure, a worse prognosis, or greater morbidity. Patients continue to respond to corticosteroids as during the initial episode. Fixed airflow obstruction can occur in some patients who recover, but the abnormalities are usually of borderline clinical significance. Chronic eosinophilic pneumonia occasionally leads to physiologically important restrictive lung function abnormalities as a result of irreversible fibrosis, but abnormalities are usually mild enough that this disorder is an extremely unusual cause of morbidity or death. 