What is the treatment for eosinophilic pneumonitis?

Treatment for Eosinophilic Pneumonitis

Systemic corticosteroids are the first-line treatment for eosinophilic pneumonitis, with oral prednisolone at a dose of 0.5-1 mg/kg/day recommended as the initial therapy. 1

Treatment Algorithm

First-Line Therapy

• Systemic corticosteroids:
  • Oral prednisolone 0.5-1 mg/kg/day 1
  • Continue until clinical and radiological resolution (typically 2-4 weeks)
  • Then taper gradually over several months to prevent relapse 2, 3

For Refractory Cases or Severe Disease

• High-dose systemic corticosteroids:
  • Consider increasing to higher doses if inadequate response 4
  • For persistently troublesome symptoms, oral corticosteroids should be given 4

Maintenance Therapy

• Tapering schedule:
  • Slow taper is essential as relapses are common 3, 5
  • Long-term low-dose maintenance may be required for patients with frequent relapses 5

Adjunctive Therapies

• Inhaled corticosteroids:
  • Not effective as monotherapy for eosinophilic pneumonitis 6
  • May be used as adjunctive therapy during systemic steroid tapering 4
  • Options include budesonide (400 μg twice daily) or fluticasone (440-880 μg twice daily) 1

For Specific Etiologies

• If occupational or allergen exposure identified:

  • Avoidance is the best treatment 4
  • Remove the patient from exposure to the causative agent 4, 7

• If medication-induced:

  • Discontinue the offending medication (e.g., NSAIDs) 7
  • Systemic corticosteroids for symptomatic treatment 7

Monitoring and Follow-up

• Regular monitoring of:
  • Clinical symptoms
  • Chest radiography
  • Blood eosinophil counts 1
• Follow-up should continue for at least 1 year after treatment, as relapses are common 5

Important Considerations

Diagnostic Confirmation

• Diagnosis should be confirmed by:
  • Presence of airway eosinophilia (via sputum induction or bronchial wash)
  • Improvement following corticosteroid therapy 4

Treatment Response

• Complete radiographic clearing occurs in approximately 65% of cases with corticosteroid treatment 5
• Blood eosinophil counts normalize in about 72% of treated episodes 5

Pitfalls to Avoid

1. Monotherapy with inhaled corticosteroids is ineffective - A study of four patients with chronic eosinophilic pneumonia treated with inhaled beclomethasone dipropionate showed that all patients eventually experienced worsening or relapse 6

2. Inadequate duration of therapy - Premature discontinuation of corticosteroids often leads to relapse 3, 5

3. Failure to identify underlying causes - Always investigate for potential triggers such as medications, occupational exposures, or parasitic infections 1, 7

4. Inadequate monitoring - Regular assessment of eosinophil counts and organ function is essential 1

Systemic corticosteroids remain the cornerstone of therapy for eosinophilic pneumonitis, with excellent prognosis when treatment is initiated promptly and continued for an adequate duration.