Chronic eosinophilic pneumonia: treatment with inhaled corticosteroids.
BACKGROUND
Chronic eosinophilic pneumonia (CEP) is highly sensitive to systemic corticosteroids, but frequently relapses if the dose is tapered or treatment discontinued. Long-term usage of systemic corticosteroids may cause side effects. Alternative treatments are therefore desired.


OBJECTIVE
We evaluated the response of CEP to monotherapy with inhaled corticosteroids (ICS).


METHODS
Four patients who had CEP without spontaneous resolution were studied. Patients received inhaled beclomethasone dipropionate (BDP) at a dose of 0.8 mg/day in 1 patient and 1.6 mg/day in 3 patients for 2 weeks. Treatment was continued if a patient showed improvement in at least 1 of the following indices: radiological findings, symptoms, and blood eosinophilia.


RESULTS
After the initial 2 weeks of treatment with BDP, the blood eosinophil count increased in 2 patients and decreased in 2. Symptoms worsened in 2 and improved in 2. Infiltrates on chest radiography increased in 3 and showed little change in 1. In the 2 patients with worsening of all 3 outcome indices, oral prednisolone was started; the indices improved. In the remaining 2 patients, BDP alone was continued. One patient had worsening of CEP after 2 months of treatment, and another had relapse of CEP at 3.5 years while receiving 1.6 mg/day of BDP. All patients thus finally had worsening or relapse of CEP during treatment with BDP.


CONCLUSIONS
ICS may not be effective when given as monotherapy in patients with CEP.
D000280:Administration, Inhalation; D000284:Administration, Oral; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001249:Asthma / Q000150:complications; D001507:Beclomethasone / Q000008:administration & dosage* / Q000009:adverse effects; D001773:Blood Cells / Q000473:pathology; D002908:Chronic Disease; D004804:Eosinophils / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D007958:Leukocyte Count; D008875:Middle Aged; D011239:Prednisolone / Q000008:administration & dosage; D011657:Pulmonary Eosinophilia / Q000150:complications / Q000188:drug therapy* / Q000473:pathology / Q000503:physiopathology; D012129:Respiratory Function Tests; D013997:Time Factors; D017211:Treatment Failure
D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids; D011239:Prednisolone; D001507:Beclomethasone