Ask An Expert: Organizing Pneumonia

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Ask An Expert: Organizing Pneumonia

Question:

I have a relatively rare lung condition called organizing pneumonia. I understand the treatment will be large doses of corticosteroids. How are they administered for this condition?

Answer:

Organizing pneumonia is an uncommon lung condition. The term is used to describe a particular type of reaction that causes white blood cells and fibroblasts (cells that produce scar tissue) to congregate around newly formed tiny blood vessels. When the reaction involves just the air spaces, it is called "organizing pneumonia." When it involves both the air spaces and the insides of bronchial tubes it is called "bronchiolitis obliterans organizing pneumonia," or BOOP.

The symptoms of organizing pneumonia vary, but often include a persistent dry cough, shortness of breath, fatigue, low-grade fever, and weight loss. Chest X-ray is abnormal, showing patchy shadows in the lungs, usually more prominent in the lower half of the lung. Diagnosis is confirmed with biopsy of lung tissue.

BOOP can occur without any identifying cause, or it may be associated with an infection, a drug reaction, some diseases or radiation therapy.

If an underlying or associated cause is found, treating the cause may be enough. However, a corticosteroid medication, such as prednisone, is usually prescribed. This is an oral medication. The starting dose is around 60 milligrams once per day, and the dose is tapered down depending upon the response. More severe disease may require higher doses, potentially using intravenous methyl prednisolone (Solu-Medrol). With milder cases, the initial dose of oral prednisone may be lower.

High-dose corticosteroids depress the immune system. I recommend that patients who will need prednisone daily for more than one month have a skin test for TB done prior to starting prednisone. If you already know that you test positive for TB, the doctor needs to know.

In addition, people who require high doses of prednisone or other corticosteroids for long periods of time need to take medication to prevent the lung infection Pneumocystis carinii pneumonia.

Howard LeWine, M.D., is chief editor of Internet Publishing at Harvard Health Publications. He is recognized as an outstanding clinician and teacher and is a recipient of the Internal Medicine Teacher of the Year award at Brigham and Women's Hospital. Dr. LeWine continues to practice Internal Medicine; most recently he became a hospitalist after practicing primary care for over 20 years.

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Last updated:	January 24, 2007