Eosinophilic pneumonia natural history, complications, and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Priyamvada Singh, M.D. [2]
Overview
Natural History
Complications
Prognosis
Eosinophilic pneumonia due to cancer or parasitic infection carries a prognosis related to the underlying illness. AEP and CEP, however, have very little associated mortality as long as intensive care is available and treatment with corticosteroids is given. CEP often relapses when prednisone is discontinued; therefore, some people with CEP require lifelong therapy. Chronic prednisone is associated with many side effects, including increased infections, weakened bones, stomach ulcers, and changes in appearance.[3]
Symptomatic and radiographic improvement is usually rapid and progressive with complete radiographic clearing over one to two months after initiation of systemic glucocorticoids [8].
Similarly, pulmonary function tests return to normal after recovery from the illness [8].
Relapse is uncommon and is usually associated with resumption of cigarette smoking after initial cessation [14,18-20].
The pleural effusions may resolve more slowly than the pulmonary parenchymal opacities [9].
Although response to corticosteroid treatment is dramatic
and treatment always leads to complete resolution,
relapses of ICEP are observed in up to 50% of patients [3].
These relapses occur while tapering the dose of corticosteroids
or after weaning. Relapses remain as responsive to
corticosteroids as the inaugural episode. Inhaled corticosteroids
have been proposed in order to prevent relapses
[7]. This is supported by a lower rate of ICEP relapse in
asthmatics treated with inhaled corticosteroids [8].
The development of asthma in the follow-up of ICEP
patients is a common finding [8]. Up to one third of the
patients have asthma requiring long-term corticosteroid
therapy after a diagnosis of ICEP has been made, and
some patients develop a fixed obstructive pattern on pulmonary
function tests [8]. Overall, more than half of
patients affected by ICEP may require long-term oral corticosteroid
therapy due to either multiple relapses or
severe asthma [8]. It is thus advisable to recommend
measures to prevent corticosteroid-induced osteoporosis
from the start of the treatment.