Cryptogenic organizing pneumonia medical therapy

Cryptogenic Organizing Pneumonia Microchapters
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Manpreet Kaur, MD [2]

Medical Therapy

• The mainstay of the therapy is pharmacotherapy.
• Corticosteroids are used as first-line treatment for patients with the symptomatic and progressive disease.
• For asymptomatic mass lesions or nonprogressive disease, treatment is not required, observation is required till they become symptomatic.

Factors deciding to initiate medical therapy

• Severity of symptoms.
• Pulmonary function test.
• The extent of disease on imaging.
• The rapidity of progression of symptoms.

Standardized regimens of corticosteroids for the symptomatic and progressive disease are:

• Preferred regimen (1) Prednisone 0.75 mg/kg PO q24h for 4 weeks.
  • Followed by (2) Prednisolone 0.5 mg/kg PO q24h for 4 weeks.
  • Followed by (3) Prednisolone 20mg PO q24h for 4 weeks.
  • Followed by (4) Prednisolone 10mg PO q24h for 6 weeks.
  • Followed by (5) Prednisolone 5mg PO q24h for 6 weeks before they were stopped.

Severe cases:

• Preferred regimen (1)Prednisolone 2mg/kg IV q24h for first 3-5 days.

Followed by the same regimen discussed above.

Relapses:

• Relapses are very common with corticosteroids therapy.
• The predictors of relapses are:
  • Delayed treatment.
  • Increased gamma-glutamyltransferase levels.
  • Increased alkaline phosphatase levels.
• Relapses occur while receiving prednisone at 20 mg daily; treat with increasing the dose and decreased as discussed above.