From the Guidelines
The immediate treatment for pneumonitis should involve removing the offending agent, providing supplemental oxygen, and administering corticosteroids, with antimicrobial treatment initiated as soon as possible if the cause is infectious, as guided by the most recent and highest quality evidence 1. When managing pneumonitis, it is crucial to consider the underlying cause, as this will significantly influence the treatment approach.
- For infectious pneumonitis, antimicrobial treatment should be empirical and based on the individual risk of mortality, severity of pneumonia, and local patterns of microbial resistance, as recommended by guidelines for the management of adult lower respiratory tract infections 1.
- For non-infectious causes, such as drug-induced pneumonitis, the offending medication must be discontinued immediately.
- Supportive care is also essential and includes oxygen therapy to maintain saturation above 92%, bronchodilators like albuterol for bronchospasm, and in severe cases, mechanical ventilation may be necessary.
- Corticosteroids, such as prednisone 40-60mg daily, are effective in reducing inflammation in the lung tissue and are often prescribed for moderate to severe cases, with a gradual taper over 4-6 weeks as symptoms improve.
- Patients should be monitored closely for improvement, with follow-up imaging and pulmonary function tests to assess response to treatment, and in cases of hypersensitivity pneumonitis, complete avoidance of the triggering antigen is essential for long-term management.
From the Research
Immediate Treatment for Pneumonitis
The immediate treatment for a patient diagnosed with pneumonitis depends on the underlying cause and severity of the condition.
- For drug-induced hypersensitivity pneumonitis, changing the offending medication is crucial, as seen in a patient who developed hypersensitivity pneumonitis caused by cephalosporins with identical R1 side chains 2.
- In cases of occupational hypersensitivity pneumonitis, removal from the exposure and treatment with corticosteroids may be effective, such as the use of an extra-fine aerosol corticosteroid for a patient with hypersensitivity pneumonitis caused by Grifola frondosa (Maitake) mushroom spore 3.
- For community-acquired pneumonia, antibiotics such as levofloxacin, ceftriaxone, or azithromycin may be used, depending on the severity and suspected causative pathogens 4, 5.
- In immune-related pneumonitis, glucocorticoids are the first line of treatment, and low-dose maintenance therapy may be necessary to prevent recurrence, as reported in a patient with durable complete response 6.