PURPOSE: Although most patients show improvement upon initiation of pneumonia treatment, there are those whose primary focus of pneumonia does not improve, or stops improving after initial improvement, with the pertinent radiological lesion persisting.When clinical signs improve while pulmonary lesions persist, secondary organizing pneumonia(OP) can be taken into consideration which responds to a combined steroid therapy. However, the clinical (distinguishing) features of those patients whose pneumonia showed both clinical and radiological improvements remain unclear.
METHODS: Patients who, after about one week of antibiotic treatment for infectious pneumonias, showed clinical and laboratory improvements with no radiological changes were given 0.5mg/kg of steroid(dexamethasone/prednisone?), who were then followed prospectively. The patients in the study were divided into two groups: one group who showed no response to antibiotics, thus classified Cryptogenic OP(COP), and the other group that showed no response after initial improvement upon antibiotics therapy, thus named Secondary OP(SOP). For statistical significance, patients whose pneumonias improved after antibiotics therapy but who had never been, or is on steroid therapies, were selected as control group, Community acquired pneumonia(CAP).
RESULTS: In a total of 34 patients, antibiotics were administered from week one to four, and for those patients who were given steroid therapies, antibiotics were given, on average, for eleven days, who showed response within four days, on average. Significant factors included old age, subacute or chronic onset, unilateral or multifocal pneumonia on radiological findings, initial normal WBC count, no fluctuation of WBC count, anemia, and low protein and albumin levels in blood chemistry.
CONCLUSION: It can be speculated that a combined steroid therapy should be administered and evaluated for treatment response in patients with clinical features of organizing pneumonia that show no further improvement after more than one week of empirical therapy.
CLINICAL IMPLICATIONS: Steroid with antibiotics therapy is useful in not improved pneumonia.
DISCLOSURE: Chan Kwon Park, No Financial Disclosure Information; No Product/Research Disclosure Information