Skip to main content

Main menu

  • Home
  • Current issue
  • ERJ Early View
  • Past issues
  • ERS Guidelines
  • Authors/reviewers
    • Instructions for authors
    • Submit a manuscript
    • Open access
    • Peer reviewer login
  • Alerts
  • Subscriptions
  • ERS Publications
    • European Respiratory Journal
    • ERJ Open Research
    • European Respiratory Review
    • Breathe
    • ERS Books
    • ERS publications home

User menu

  • Log in
  • Subscribe
  • Contact Us
  • My Cart

Search

  • Advanced search
  • ERS Publications
    • European Respiratory Journal
    • ERJ Open Research
    • European Respiratory Review
    • Breathe
    • ERS Books
    • ERS publications home

Login

European Respiratory Society

Advanced Search

  • Home
  • Current issue
  • ERJ Early View
  • Past issues
  • ERS Guidelines
  • Authors/reviewers
    • Instructions for authors
    • Submit a manuscript
    • Open access
    • Peer reviewer login
  • Alerts
  • Subscriptions

Cryptogenic organising pneumonia

J. A. Kastelik, M. Greenstone, D. V. McGivern, A. H. Morice
European Respiratory Journal 2006 28: 1291; DOI: 10.1183/09031936.00100106
J. A. Kastelik
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
M. Greenstone
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
D. V. McGivern
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
A. H. Morice
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Info & Metrics
  • PDF
Loading

To the Editors:

We have read with interest the paper by Cordier 1 describing the current understanding of the pathogenesis, aetiology, diagnosis and treatment of cryptogenic organising pneumonia (COP). The author acknowledged that corticosteroids remain the standard treatment of COP, usually resulting in rapid clinical, and slower radiological, improvements. Although the response to corticosteroids is generally good, a proportion of patients can experience early or late relapses. In addition, some patients may be unable to tolerate corticosteroids, or the disease may continue to deteriorate, despite therapy with corticosteroids. Therefore, there is a need for alternative therapies to treat this condition. Cordier 1 only briefly mentioned the occasional improvement of COP to treatment with antibiotics, especially macrolides 2.

Macrolides have gained increasing use in the management of diffuse panbronchiolitis, asthma and cystic fibrosis 3. It has been proposed that the activity of macrolides in these conditions is through anti-inflammatory, as well as antimicrobial, action. In vitro studies suggest that macrolides may have an immunomodulatory activity, exhibited through: 1) the inhibition of the pulmonary influx of neutrophils; 2) the reduction of inflammatory cytokines, such as interleukin-8; 3) the protection of the epithelium from bioactive phospholipids; and 4) the improvement of the transportability of airway secretions 3. Some of these activities may affect the underlying mechanisms involved in the pathogenesis of COP, therefore explaining a potential role of macrolides as therapeutic agents to treat this condition.

Recently, there has been increasing evidence of the role of macrolides in the treatment of COP. For example, Stover et al. 4 described their experience using macrolides to treat three patients with COP and three patients with radiation-induced bronchiolitis obliterans organising pneumonia. Over the last few years we have also gained experience in the use of macrolides in the treatment of COP. To date, we have treated three patients with clinical and/or histological confirmation of COP. Two of our patients presented with an acute illness and one had a more gradual presentation. All three patients received clarithromycin 500 mg b.i.d. and the duration of therapy ranged between 3–12 months. All of the patients showed improvement in their symptoms, together with the radiological resolution of pulmonary infiltrates and improvement in inflammatory markers. One of the patients was originally treated with oral corticosteroids but failed to improve, however, once macrolides were introduced his condition improved and within a few weeks the corticosteroids were able to be withdrawn.

Based on our observations, and the report by Stover et al. 4, we believe that the duration of macrolide therapy should be between 3–12 months, although caution should be exhibited. The decision to treat cryptogenic organising pneumonia patients with macrolides should, at present, be made on an individual basis with the proviso that if improvement is not observed, or if a patient's condition worsens, conventional therapy with corticosteroids should be introduced. Macrolides could be considered for use in combination with corticosteroids in patients who fail to respond to corticosteroids or as a corticosteroid sparing agent. We would suggest wider reporting of experience to gain more information on the role of macrolides in cryptogenic organising pneumonia.

    • © ERS Journals Ltd

    References

    1. ↵
      Cordier J-F. Cryptogenic organising pneumonia. Eur Respir J 2006;28:422–446.
      OpenUrlAbstract/FREE Full Text
    2. ↵
      Epler GR, Colby TV, McLoud TC, Carrington CB, Gaensler FA. Bronchiolitis obliterans organizing pneumonia. N Engl J Med 1985;312:152–158.
      OpenUrlPubMedWeb of Science
    3. ↵
      Rubin BK, Henke MO. Immunomodulatory activity and effectiveness of macrolides in chronic airway disease. Chest 2004;125: Suppl. 2 70S–78S.
    4. ↵
      Stover DE, Mangino D. Macrolides: a treatment alternative for bronchiolitis obliterans organizing pneumonia? Chest 2005;128:3611–3617.
    View Abstract
    PreviousNext
    Back to top
    View this article with LENS
    Vol 28 Issue 6 Table of Contents
    European Respiratory Journal: 28 (6)
    • Table of Contents
    • Index by author
    Email

    Thank you for your interest in spreading the word on European Respiratory Society .

    NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

    Enter multiple addresses on separate lines or separate them with commas.
    Cryptogenic organising pneumonia
    (Your Name) has sent you a message from European Respiratory Society
    (Your Name) thought you would like to see the European Respiratory Society web site.
    CAPTCHA
    This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
    Print
    Citation Tools
    Cryptogenic organising pneumonia
    J. A. Kastelik, M. Greenstone, D. V. McGivern, A. H. Morice
    European Respiratory Journal Dec 2006, 28 (6) 1291; DOI: 10.1183/09031936.00100106

    Citation Manager Formats

    • BibTeX
    • Bookends
    • EasyBib
    • EndNote (tagged)
    • EndNote 8 (xml)
    • Medlars
    • Mendeley
    • Papers
    • RefWorks Tagged
    • Ref Manager
    • RIS
    • Zotero

    Share
    Cryptogenic organising pneumonia
    J. A. Kastelik, M. Greenstone, D. V. McGivern, A. H. Morice
    European Respiratory Journal Dec 2006, 28 (6) 1291; DOI: 10.1183/09031936.00100106
    del.icio.us logo Digg logo Reddit logo Technorati logo Twitter logo CiteULike logo Connotea logo Facebook logo Google logo Mendeley logo
    Full Text (PDF)

    Jump To

    • Article
      • References
    • Info & Metrics
    • PDF
    • Tweet Widget
    • Facebook Like
    • Google Plus One

    More in this TOC Section

    • Transitioning endothelial cells contribute to pulmonary fibrosis
    • Endothelial to mesenchymal transition as novel feature of pulmonary fibrosis
    • Treatable traits in ILD: why not consider acute exacerbations?
    Show more Correspondence

    Related Articles

    Navigate

    • Home
    • Current issue
    • Archive

    About the ERJ

    • Journal information
    • Editorial board
    • Press
    • Permissions and reprints
    • Advertising

    The European Respiratory Society

    • Society home
    • myERS
    • Privacy policy
    • Accessibility

    ERS publications

    • European Respiratory Journal
    • ERJ Open Research
    • European Respiratory Review
    • Breathe
    • ERS books online
    • ERS Bookshop

    Help

    • Feedback

    For authors

    • Instructions for authors
    • Publication ethics and malpractice
    • Submit a manuscript

    For readers

    • Alerts
    • Subjects
    • Podcasts
    • RSS

    Subscriptions

    • Accessing the ERS publications

    Contact us

    European Respiratory Society
    442 Glossop Road
    Sheffield S10 2PX
    United Kingdom
    Tel: +44 114 2672860
    Email: journals@ersnet.org

    ISSN

    Print ISSN:  0903-1936
    Online ISSN: 1399-3003

    Copyright © 2023 by the European Respiratory Society