Synopsis
Recognise eosinophilic pulmonary syndromes, distinguish isolated pneumonia from systemic vasculitis or secondary causes, and escalate hypoxaemia and organ-threatening disease safely.
- Pulmonary eosinophilia means eosinophils are implicated in lung disease; the task is to identify whether disease is primary, vasculitic, allergic, parasitic or drug induced.
- Acute eosinophilic pneumonia presents over days with fever, diffuse infiltrates and hypoxaemia; blood eosinophilia may be absent initially.
- Chronic eosinophilic pneumonia usually evolves over weeks with cough, breathlessness, constitutional symptoms, asthma and peripheral-predominant air-space opacity.
Key red flags
Days of febrile respiratory illness, diffuse bilateral opacity, severe hypoxaemia and often pleural fluid occur in a previously healthy person; recent smoking or inhalational change may be reported.
Investigation priorities
Quantify eosinophilia and observe its trajectory before treatment.
Management branches
Pulmonary infiltrates coexist with blood or lavage eosinophilia, or acute disease remains strongly suspected.
- Assess respiratory severity and systemic organ danger first, obtaining urgent cardiac, neurological or renal input when features suggest EGPA rather than isolated pneumonia.
- Map onset against asthma, sinonasal disease, new smoking, medicines, travel, parasites, fungal sensitisation and systemic symptoms; repeat the eosinophil count if initially normal.
Key medicines
PrednisoloneDose depends on acute respiratory severity, chronic eosinophilic pneumonia relapse risk or EGPA organ threat; use a specialist daily induction and taper specified by the local respiratory or vasculitis protocol.
Benralizumab for eligible adult EGPAThe licensed EGPA dose is 30 mg by subcutaneous injection every four weeks, initiated by an experienced specialist; follow the current SmPC and NICE commissioning conditions.