Original article
Factors associated with the relapse of cryptogenic and secondary organizing pneumonia

https://doi.org/10.1016/j.resinv.2016.09.001Get rights and content

Abstract

Background

Organizing pneumonia (OP) is a histopathological response pattern to lung inflammation. It is clinically classified into cryptogenic OP and secondary OP, which is associated with various clinical conditions. Rapid resolution with corticosteroids and frequent relapses are common in OP. However, few studies have investigated the factors associated with OP relapse.

Methods

The medical records of 75 patients with biopsy-proven OP, diagnosed between January 2010 and August 2015, who underwent corticosteroid therapy were retrospectively reviewed. Initially, the patients were all treated successfully; however, 31 patients experienced relapse thereafter (R group), whereas the others did not (NR group; 44 patients). The clinical, radiological, and pathological characteristics and administered corticosteroid doses were compared between the two groups.

Results

The neutrophil percentage in the bronchoalveolar lavage (BAL) fluid and the level of fibrin deposition in lung biopsy specimens were higher in the R group than in the NR group (P=0.01 and P=0.002, respectively). The multivariate analysis demonstrated that both factors were statistically significant predictors of OP relapse.

Conclusions

A high neutrophil percentage in the BAL and the level of fibrin deposition in lung biopsy specimens are considered predictive factors of OP relapse during the tapering or after the cessation of steroid therapy. Patients without these findings may be treated with low-dose corticosteroids.

Introduction

Organizing pneumonia (OP) is a nonspecific response to various stimuli or injuries that can be cryptogenic or secondary to several causes, such as collagen vascular diseases, infections, radiation therapy, drugs, and hematological malignancies. Cryptogenic OP (COP) is classified as idiopathic interstitial pneumonia because of its idiopathic nature and associated parenchymal inflammation and fibrosis [1], [2]. Regardless of whether the patients have COP or secondary OP (SOP), almost all of them experience a subacute onset and show good response to corticosteroid therapy; however, relapses are frequently seen when corticosteroids are tapered or discontinued [3]. Lazor et al. reported that 58% of patients with COP experienced relapse and 27% had two or more relapses [4]. Previous studies have shown several possible factors related to OP relapse, but few studies have comprehensively investigated these factors. The aim of this study was to identify the factors related to relapse in patients with OP.

Section snippets

Patients

Patients with biopsy-proven OP diagnosed at the National Hospital Organization Himeji Medical Center between January 2010 and August 2015 were selected as candidates for our study. The histological diagnosis of OP was based on the presence of intraluminal organization in the alveolar ducts or alveoli. Among the candidates, patients who showed spontaneous remission were excluded; the remaining patients were selected as our subjects, and their medical records were retrospectively reviewed. The

Results

Of the 101 patients with biopsy-proven OP identified for the study, 26 were excluded because their disease resolved without corticosteroid therapy. The remaining 75 patients who underwent steroid therapy (43 men and 32 women) were studied. Their mean age was 69.9±10.3 years. Of these patients, 40 were diagnosed with COP, and 35 with SOP (associated with autoimmune disease in 18, infectious disease in 6, and other diseases in 11 patients).

Biopsy specimens were obtained by transbronchial biopsy

Discussion

We comprehensively reviewed the clinical, radiological, and pathological factors associated with relapse in patients with OP. This study included not only patients with COP but also patients with SOP, and there may be some bias based on OP etiology. However, Drakopanagiotakis reported that the clinical and radiological features did not differ between COP and SOP, with treatment response, relapse rates, and mortality being similar. Moreover, we excluded subjects with OP who had spontaneous

Conclusions

We found BAL neutrophilia and a high level of fibrin deposition to be associated with OP relapse. Patients without these findings would benefit from the reduction of the initial and total corticosteroid doses to reduce the incidence of adverse effects.

Conflict of interest

We have no conflict of interest, financial or otherwise, that exists with regard to this research.

Acknowledgements

We express our thanks to Dr. Rokuro Mimura for his assistance in the histopathological analysis and Dr. Takanori Higashino for his assistance in the radiological analysis.

References (24)

  • M. Hotta

    Neutrophil chemotactic activity in cryptogenic organizing pneumonia and the response to erythromycin

    Kurume Med J

    (1996)
  • E. Barroso et al.

    Idiopathic organizing pneumonia: a relapsing disease

    Respiration

    (2007)
  • Cited by (17)

    • Systematic Review of Systemic Corticosteroids for Treatment of Organizing Pneumonia

      2022, Open Respiratory Archives
      Citation Excerpt :

      Of these, 13 were not included in the study because either the full text was unavailable or they were unrelated to the aim of the review. Then 122 articles were selected for reading.2,4–8,12–126 The most frequent exclusion criterion was sample size, as most publications were case reports.

    View all citing articles on Scopus
    View full text