Effect of intermittent high dose parenteral corticosteroids on the alveolitis of idiopathic pulmonary fibrosis

B. A. Keogh, J. Bernardo, G. W. Hunninghake, B. R. Line, D. L. Price, R. G. Crystal

Research output: Contribution to journalArticle

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Abstract

Idiopathic pulmonary fibrosis (IPF) is a progressive, fatal disorder in which chronic accumulation of neutrophils within the alveolar structures occurs. These cells with their large stores of preformed mediators likely play a major role in subsequent lung derangement. To evaluate the adjunctive use of intermittent high dose 'pulse' corticosteroid therapy as a means of inhibiting neutrophil accumulation in the IPF lung, 5 patients were treated in a single blind random fashion with 'high dose' corticosteroids (2 g methylprednisolone given intravenously once a week plus 0.25 mg/kg prednisone given orally daily) and 8 patients were treated with 'low dose' corticosteroids only (0.25 mg/kg prednisone given orally daily). All patients had biopsy-proved disease in midcourse, and the 2 groups were matched for clinical and physiologic criteria. To evaluate the effect of these therapies on the quantity of neutrophils in the lungs of these patients, both groups underwent bronchoalveolar lavage and 67Ga scanning at the beginning and end of the 6-month study period; both methods gave an estimate of the intensity of the neutrophil alveolitis in these patients. Low dose corticosteroids had little effect on neutrophil accumulation (% neutrophils in lavage, -5 ± 8% change from baseline; 67Ga uptake, +27 ± 14% change from baseline), whereas high dose corticosteroids significantly reduced neutrophil accumulation (% neutrophils in lavage, -46 ± 8% change from baseline, p < 0.02 compared with that in the low dose group; 67Ga uptake, -23 ± 11% change from baseline, p < 0.05 compared with that in the low dose group). In addition, 2 patients in the high dose group were reevaluated 6 months after cessation of the intermittent high dose pulse corticosteroids. Both had marked increases in lavage neutrophils compared with when they were receiving the high dose therapy (10 to 22% and 18 to 52%, respectively). These findings suggest that massive doses of intermittent intravenously administered corticosteroids may help to suppress the neutrophil component of the alveolitis of IPF.

Original languageEnglish
Pages (from-to)18-22
Number of pages5
JournalAmerican Review of Respiratory Disease
Volume127
Issue number1
Publication statusPublished - 25 Feb 1983
Externally publishedYes

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Idiopathic Pulmonary Fibrosis
Adrenal Cortex Hormones
Neutrophils
Therapeutic Irrigation
Prednisone
Lung
Methylprednisolone
Bronchoalveolar Lavage
Research Design
Therapeutics
Biopsy

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Effect of intermittent high dose parenteral corticosteroids on the alveolitis of idiopathic pulmonary fibrosis. / Keogh, B. A.; Bernardo, J.; Hunninghake, G. W.; Line, B. R.; Price, D. L.; Crystal, R. G.

In: American Review of Respiratory Disease, Vol. 127, No. 1, 25.02.1983, p. 18-22.

Research output: Contribution to journalArticle

Keogh, B. A. ; Bernardo, J. ; Hunninghake, G. W. ; Line, B. R. ; Price, D. L. ; Crystal, R. G. / Effect of intermittent high dose parenteral corticosteroids on the alveolitis of idiopathic pulmonary fibrosis. In: American Review of Respiratory Disease. 1983 ; Vol. 127, No. 1. pp. 18-22.
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abstract = "Idiopathic pulmonary fibrosis (IPF) is a progressive, fatal disorder in which chronic accumulation of neutrophils within the alveolar structures occurs. These cells with their large stores of preformed mediators likely play a major role in subsequent lung derangement. To evaluate the adjunctive use of intermittent high dose 'pulse' corticosteroid therapy as a means of inhibiting neutrophil accumulation in the IPF lung, 5 patients were treated in a single blind random fashion with 'high dose' corticosteroids (2 g methylprednisolone given intravenously once a week plus 0.25 mg/kg prednisone given orally daily) and 8 patients were treated with 'low dose' corticosteroids only (0.25 mg/kg prednisone given orally daily). All patients had biopsy-proved disease in midcourse, and the 2 groups were matched for clinical and physiologic criteria. To evaluate the effect of these therapies on the quantity of neutrophils in the lungs of these patients, both groups underwent bronchoalveolar lavage and 67Ga scanning at the beginning and end of the 6-month study period; both methods gave an estimate of the intensity of the neutrophil alveolitis in these patients. Low dose corticosteroids had little effect on neutrophil accumulation ({\%} neutrophils in lavage, -5 ± 8{\%} change from baseline; 67Ga uptake, +27 ± 14{\%} change from baseline), whereas high dose corticosteroids significantly reduced neutrophil accumulation ({\%} neutrophils in lavage, -46 ± 8{\%} change from baseline, p < 0.02 compared with that in the low dose group; 67Ga uptake, -23 ± 11{\%} change from baseline, p < 0.05 compared with that in the low dose group). In addition, 2 patients in the high dose group were reevaluated 6 months after cessation of the intermittent high dose pulse corticosteroids. Both had marked increases in lavage neutrophils compared with when they were receiving the high dose therapy (10 to 22{\%} and 18 to 52{\%}, respectively). These findings suggest that massive doses of intermittent intravenously administered corticosteroids may help to suppress the neutrophil component of the alveolitis of IPF.",
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