Correct!
3. Standard treatment is with oral corticosteroids
The standard treatment of CEP is with oral corticosteroids, although spontaneous remission may occur in 10% of patients (3). CEP usually responds rapidly and dramatically to corticosteroids. Failure to respond to corticosteroids suggest the diagnosis of CEP may be wrong. Inhaled steroid treatment in CEP has not been studied prospectively but one brief report of the use of inhaled steroids alone in CEP suggests it may be ineffective.
Relapses occur in up to 83% of patients (3). Symptoms and radiologic opacities often reappear when the corticosteroid dose is lowered or stopped, and patients usually require a maintenance dose equivalent to or greater than 15 mg of prednisone per day to remain symptom free and without radiographic opacities. Addition of inhaled steroids to the oral corticosteroid regimen may allow a reduction in the oral corticosteroid maintenance dose.
Our patient was treated with an initial dose of 125 mg of methylprednisolone twice a day, and after a rapid clinical response, switched to high dose oral corticosteroids. His dyspnea, wheezing, hypoxia and chest x-ray opacities rapidly resolved. His absolute eosinophil count decreased to 20 eosinophils/ɥL. He was discharged from the hospital after 5 days with a planned slow taper of his oral prednisone dose.
References