55 y/o Native American female with complex recent history of multiple ED visits and hospitalizations for chest pain SOB respiratory failure. There is a h/o of COPD/emphysema and repeated courses of antibiotics and steroids over past two years. Pt was established with Pulmonary and ultimately diagnosed with eosinophilic pneumonitis which is currently being treated with Dupixent 300 mg q 2 weeks. PO steroids tapered. Pt continues to struggle with c/o dyspnea and chest pain. She has ruled out repeatedly for ischemia. Recent CT chest (11/07/22) consistent with interstitial pneumonia emphysema possible aspiration/bronchiectasis. Currently completing Bactrim course; using albuterol Symbicort. Pulmonologist retired and pt having difficulty establishing with new provider.
How can I best manage this patient until she establishes with Pulmonary? What is the natural course for this disease?
Those with acute eosinophilic pneumonia are treated with steroids and respond very quickly and improve. Those with chronic eosinophilic pneumonia first of all this is an advanced diagnosis that is established after careful review of the imaging by the Pulmonary doc and not the radiologist would also respond to steroids. The patient at this point needs their imaging reviewed (pre and post treatment) by an in person Pulm specialist to determine next course of action. PFTs including Spiro Lung Volumes and DLCO would also be helpful. If the patient is still dyspneic then I would also consider referral to a Pulmonary Rehab program.