eMedicine Specialties > Pulmonology > Eosinophilic Lung Diseases

Pulmonary Eosinophilia: Treatment & Medication

Author: Jussi J Saukkonen, MD, Associate Professor, Department of Internal Medicine, Division of Pulmonary/Critical Care Medicine, Boston University School of Medicine, Boston Medical Center
Contributor Information and Disclosures

Updated: Nov 20, 2009

Treatment

Medical Care

Give general supportive care by treating hypoxemia with supplemental oxygen. Treat bronchospasm with inhaled or nebulized bronchodilators. Inhaled corticosteroids may also be used when appropriate for persistent wheezing. Administer systemic steroids judiciously because they may worsen some infections.

  • Extrinsic syndromes
    • Medication-induced syndromes: These respond to the withdrawal of the offending agents, with few, if any, residual effects.
    • Loeffler syndrome: Remove any potentially offending medications or ingested substances. Loeffler syndrome is mild and self-limited. Patients rarely require systemic corticosteroids.
    • AEP: Patients with AEP respond rapidly to high doses of systemic corticosteroids and do not tend to relapse.
    • Parasitic infections: Once a diagnosis of parasitic infection is established, initiate therapy with appropriate antibiotics. Patients who are immunocompromised or patients taking systemic steroids with strongyloidiasis may develop hyperinfection syndrome,20 often associated with gram-negative septicemia and adult respiratory distress syndrome. They may require empiric antibiotic coverage and respiratory and hemodynamic support.
    • Fungal causes: For allergic bronchopulmonary aspergillosis (ABPA), administer systemic steroids and inhaled bronchodilators. Short-term itraconazole may be used in the treatment of ABPA, as data suggest that it causes reductions in inflammatory markers and may have steroid-sparing effects. For coccidioidomycosis, the use of steroids early in infection may result in dissemination and death.
  • Intrinsic syndromes
    • Chronic eosinophilic pneumonia (CEP): Patients with CEP respond rapidly to prednisone at a dose of 30-40 mg/d, with significant symptom improvement occurring within 48 hours and radiographic clearing occurring within 10 days. Relapse is common if steroids are discontinued in the first 6 months of therapy. Continue therapy with lower doses of prednisone for several additional months. Patients rarely require permanent steroid therapy.
    • Idiopathic hypereosinophilic syndrome (IHES): Half the patients respond to corticosteroids, but others require more aggressive therapy with busulfan, cyclophosphamide, cyclosporin-A, etoposide, azathioprine, hydroxyurea, vincristine, or interferon alfa. Imatinib is used in myeloproliferative IHES.
    • Churg-Strauss syndrome (CSS): Prednisone administered at a dose of 40-60 mg/d for several weeks, followed by lower-dose therapy for a total of 1 year, generally provides efficacious therapy. High doses of intravenous methylprednisolone, cyclophosphamide, and azathioprine have been used to treat patients whose conditions are refractory. In refractory cases, high-dose intravenous immunoglobulin has been reported to be helpful.21 Interferon-alpha and tumor necrosis factor inhibitors, such as infliximab and etanercept, have also been used.22
    • Eosinophilic granuloma (EG): Smoking cessation is essential. Corticosteroids are generally not beneficial.

Also see the following clinical guideline summaries:

Surgical Care

Surgical intervention is rarely necessary for patients with these syndromes. The need for open lung biopsy is rare (see Procedures).

  • Parasitic diseases
    • Echinococcal cystectomy or lung resection is the preferred treatment for this disease. Right hepatic echinococcal cysts may be removed during the echinococcal cystectomy. Often, adjuvant medical therapy is administered.
    • Dirofilariasis may be difficult to distinguish from malignancy and may require transthoracic needle aspiration or resection.
  • Malignancy
    • Lung resection may be necessary if a solitary pulmonary nodule is present or if malignancy is in the forefront diagnostically.
    • Mediastinoscopy may be necessary if lymphadenopathy, possibly representing lymphoma, is significant.
  • Pneumothorax with obstructive lung disease
    • This may require tube thoracostomy.
    • If recurrent, such as with EG, pleurodesis may be required.

Consultations

Often, the complexity of these patients' presentations and treatment warrants subspecialty consultation. This may facilitate diagnosis and treatment.

  • Pulmonologists provide expertise in the diagnostic approach, optimize the management of respiratory symptoms, may perform flexible bronchoscopy when indicated, and assist in the long-term management of the disease.
  • Infectious disease specialists provide diagnostic and therapeutic expertise and assistance, especially with unusual pathogens.
  • Radiologists who have good knowledge of chest radiography and tomography findings can be invaluable. A radiologist may be needed in the rare instance that a radiologically guided biopsy is warranted.
  • Consult a thoracic surgeon when an open lung biopsy is indicated.
  • Consult a hematologist for management of IHES.

Diet

Patients who have ingested food, supplements, or medication to which the syndrome is attributed should subsequently avoid reexposure.

  • Chemically related medications should be avoided.
  • Measures should be taken to avoid ingestion of contaminated water or food.
  • Patients should avoid incompletely cooked seafood and crustaceans.
  • Patients should avoid incompletely cooked pork.

Activity

Discourage the patient from engaging in activities linked to the syndrome or encourage the patient to take measures to avoid recurrence of the syndrome.

  • Patients should avoid contaminated water or soil known to harbor parasites or fungi.
  • Patients should avoid close contact with animals known to harbor parasites until these animals have been decontaminated.

Medication

For extrinsic diseases, remove any offending agent. Treat parasitic infections with the appropriate antibiotics. ABPA and other diseases with prominent wheezing are managed with bronchodilators, inhaled corticosteroids, and, for exacerbations, systemic corticosteroids. Use systemic corticosteroids judiciously in individuals with parasitic infection.

Intrinsic diseases are generally managed with oral or intravenous corticosteroids. CSS is also occasionally treated with cyclophosphamide or azathioprine. IHES is usually initially treated with systemic corticosteroids, with half the patients responding. Other treatments for IHES include cyclophosphamide, azathioprine, busulfan, and others.

Take care to establish a diagnosis or to at least rule out parasitic or cryptococcal infection before treating the patient with steroids because of the risk of dissemination.

Corticosteroids

Eosinophils are exquisitely sensitive to steroids. These medications inhibit eosinophil egress from the vascular compartment, inhibit their chemotaxis, and decrease eosinophil survival.


Prednisone (Sterapred)

May decrease inflammation by reversing increased capillary permeability and suppressing PMN activity. May be used in both extrinsic diseases (eg, ABPA, trichinosis, TPE, toxocariasis) and intrinsic diseases. Doses vary depending on disease and severity. Low-dose suppression may be needed in some cases.

Adult

ABPA: 0.5 mg/kg/d PO for 2 wk, then qod for 3 mo, then taper, if possible; repeat prn
CEP: 30-40 mg/d PO for several days to 1 wk, followed by low-dose suppression qd or qod for at least 6 mo
IHES (end organ dysfunction): 60 mg/d PO for 1 wk, then qod for 3 mo
CSS: 40-60 mg/d PO for several weeks until symptoms improve, followed by low-dose therapy qd or qod for as long as 1 y

Pediatric

Not established

Coadministration with estrogens may decrease clearance; concurrent use with digoxin may cause digitalis toxicity secondary to hypokalemia; phenobarbital, phenytoin, and rifampin may increase metabolism of glucocorticoids (consider increasing maintenance dose); monitor for hypokalemia with coadministration of diuretics

Documented hypersensitivity; viral infection; peptic ulcer disease; hepatic dysfunction; connective tissue infections; fungal or tubercular skin infections; GI disease; early cryptococcosis or strongyloidiasis

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Abrupt discontinuation of glucocorticoids may cause adrenal crisis; hyperglycemia, edema, osteonecrosis, myopathy, peptic ulcer disease, hypokalemia, osteoporosis, euphoria, psychosis, myasthenia gravis, and growth suppression; infections may occur with glucocorticoid use


Methylprednisolone (Solu-Medrol, Medrol)

Decreases inflammation by suppressing migration of PMN leukocytes and reversing increased capillary permeability. Administered IV for severe disease. Doses vary depending on disease and severity.

Adult

AEP: 60-125 mg/d PO q6h until symptoms are controlled; taper gradually

Pediatric

Not established

Coadministration with digoxin may increase digitalis toxicity secondary to hypokalemia; estrogens may increase levels; phenobarbital, phenytoin, and rifampin may decrease levels (adjust dose); monitor patients for hypokalemia when taking concurrently with diuretics

Documented hypersensitivity; viral, fungal, or tubercular skin infections

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Hyperglycemia, edema, osteonecrosis, peptic ulcer disease, hypokalemia, osteoporosis, euphoria, psychosis, growth suppression, myopathy, and infections are possible complications of glucocorticoid use

Bronchodilators

Provide symptomatic relief of dyspnea from bronchospasm. Do not use as sole management of these diseases.


Albuterol (Proventil, Ventolin)

Relaxes bronchial smooth muscle by action on beta-2 receptors, with little effect on cardiac muscle contractility.

Adult

MDI: 1-2 puffs as often as q4h prn, with or without spacer
Nebulizer: 0.25-0.5 mL of 5% solution in 2.5 mL NS q4h prn

Pediatric

<12 years: 1-2 puffs MDI as often as q6h prn
>12 years: Administer as in adults

Beta-adrenergic blockers antagonize effects; inhaled ipratropium may increase duration of bronchodilatation by albuterol; cardiovascular effects may increase with MAOIs, inhaled anesthetics, TCAs, and sympathomimetic agents

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Caution in hyperthyroidism, diabetes mellitus, and cardiovascular disorders; monitor for bronchospasm, tachycardia, hypertension, headache, hypokalemia, and hyperglycemia

Antifungals

Most of the fungal diseases discussed do not require specific antifungal treatment. For disseminated, severe, or invasive fungal infection, amphotericin B is administered IV. Short-term itraconazole can improve symptoms in ABPA and may have a steroid-sparing effect. Itraconazole is generally reserved for steroid-refractory cases.25 Fluconazole and other azoles have been used in the treatment of patients who are stabilized with progressive or disseminated coccidioidomycosis. Various agents are available for treatment of P carinii pneumonia.

Coccidioidomycosis does not usually require treatment, but treatment is required for immunocompromise or progressive or disseminated disease. Itraconazole can be used for mild-to-moderate disease, and it is also used for treatment of blastomycosis.


Itraconazole (Sporanox)

Synthetic triazole antifungal agent that slows fungal cell growth by inhibiting cytochrome P-450–dependent synthesis of ergosterol, a vital component of fungal cell membranes. Used anecdotally, with steroid-sparing effects, in several patients with ABPA or aspergilloma, but benefit has not been proven.
Available as tab, PO, and IV solutions. Duration of therapy depends on disease and clinical response, but is generally months.
If patient has invasive Aspergillus infection, is eating well, has good GI function, and is not on medication that reduces gastric acidity or induces cytochrome P-450, can use as alternative to amphotericin B.
Highly protein–bound with poor CSF penetration. Should not be used to treat primary meningitis.

Adult

200 mg PO bid; take tabs with food and acidic drink (eg, carbonated beverages); take PO solution while in fasting state
Invasive Aspergillus infection: 200 mg PO tid for 4 d then 200 mg PO bid; alternatively, 200 mg IV bid for 4 doses, then 200 mg qd
Blastomycosis: 200-400 mg PO qd for 6 mo
Coccidioidomycosis (mild to moderate): 200 mg PO/IV bid for 3-12 mo

Pediatric

Not established

Antacids may reduce absorption; edema may occur with coadministration of calcium channel blockers (eg, amlodipine, nifedipine); hypoglycemia may occur with sulfonylureas; may increase tacrolimus and cyclosporine plasma concentrations when high doses are used; rhabdomyolysis may occur with coadministration of HMG-CoA reductase inhibitors (eg, lovastatin, simvastatin); may increase digoxin levels; coadministration may increase plasma levels of midazolam or triazolam; phenytoin and rifampin may reduce levels (phenytoin metabolism may be altered)

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Caution in hepatic impairment; may cause adrenal insufficiency, hepatotoxicity, GI symptoms, headache, edema, hypertension, fatigue, fever, rash, pruritus, hypokalemia, and somnolence


Fluconazole (Diflucan)

Synthetic oral antifungal (broad-spectrum bistriazole) that selectively inhibits fungal cytochrome P-450 and sterol C-14 alpha-demethylation. Used as first-line treatment of progressive or disseminated coccidioidomycosis or in host who is immunocompromised.
Also used in candidal and cryptococcal infections.
Dosage, dose intervals, and duration of therapy vary with age and illness.

Adult

Coccidioidomycosis (progressive, disseminated, or in host who is immunocompromised): 400 mg PO qd for 3-12 mo
Candidemia (stable): 400 mg IV, then PO for 7 d
Candidemia (unstable): 800 mg IV qd for 14 d
Cryptococcosis: 400 mg PO/IV for 8-10 wk

Pediatric

6-12 mg/kg PO/IV q24-72h

Levels may increase with hydrochlorothiazides; levels may decrease with long-term coadministration of rifampin; may increase concentrations of theophylline, phenytoin, tolbutamide, cyclosporine, glyburide, and glipizide; effects of anticoagulants may increase with coadministration

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Closely monitor patient if rashes develop, and discontinue drug if lesions progress; may cause clinical hepatitis, cholestasis, and fulminant hepatic failure (including death) with underlying medical conditions (eg, AIDS, malignancy) and while taking multiple concomitant medications; not recommended during breastfeeding; may cause adrenal insufficiency; may cause Stevens-Johnson syndrome, hepatotoxicity, angioedema, leukopenia, agranulocytosis, seizures, GI symptoms, rash, pruritus, changes in taste, and dizziness


Amphotericin B (Fungizone)

Produced by a strain of Streptomyces nodosus. Can be fungistatic or fungicidal. Binds to sterols, such as ergosterol, in the fungal cell membrane, causing intracellular components to leak, with subsequent fungal cell death.
Used for severe or life-threatening fungal infections (eg, invasive aspergillosis, blastomycosis, candidiasis, disseminated histoplasmosis, zygomycoses, penicilliosis, sporotrichosis, progressive or disseminated coccidioidomycosis).
No benefit demonstrated in aspergilloma.
Available as nonlipid form, which is less expensive. Also available as lipid, liposomal, or cholesteryl complexes, which achieve higher tissue levels, are cleared more rapidly, and have larger volumes of distribution. The latter forms are used in individuals intolerant of or refractory to nonlipid therapy. Liposomal form is used in patients who are refractory, those with renal insufficiency, or those intolerant of nonlipid form. Lipid forms have less toxicity than nonlipid form.

Adult

Nonlipid form: 0.3-1 mg/kg/d IV over 4 h
Lipid complex: 5 mg/kg/d infused at 2.5 mg/kg/h
Liposomal form: 3-5 mg/kg/d IV over 120 min
Cholesteryl form: 3-4 mg/kg/d up to 6 mg/kg/d IV at 1 mg/kg/h

Pediatric

Administer as in adults

Antineoplastic agents may enhance the potential for renal toxicity, bronchospasm, and hypotension; corticosteroids, digitalis, and thiazides may potentiate hypokalemia; the risk of renal toxicity is increased with cyclosporine

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Monitor renal function, serum electrolytes (eg, magnesium, potassium), liver function, CBC count, and hemoglobin concentrations; resume therapy at the lowest level (eg, 0.25 mg/kg) when therapy is interrupted for > 7 d; hypoxemia, acute dyspnea, and interstitial infiltrates may occur in patients who are neutropenic and are receiving leukocyte transfusions (separate time of amphotericin infusion from time of leukocyte transfusion); may cause nephrotoxicity, renal tubular acidosis, hypokalemia, hypotension, cardiovascular collapse, arrhythmias, anaphylaxis, GI bleed, thrombocytopenia, rigors, fever, GI symptoms, dyspnea, generalized malaise and pain, and rash; preinfuse and postinfuse saline at 500 mL, if clinical status allows, to hydrate patient; premedication with acetaminophen, meperidine, and hydrocortisone is often performed but is not shown to be useful

Antiparasitic agents

Several of the azoles inhibit microtubule assembly and, in some instances, glucose uptake. Albendazole is a preferred agent because of the low incidence of adverse effects, in contrast to thiabendazole.


Albendazole (Albenza)

Decreases ATP production in worm, causing energy depletion, immobilization, and finally death. First-line agent for ascariasis, hookworm, strongyloidiasis, and C sinensis infection. Alternative agent for visceral larva migrans.
Efficacy in echinococcal disease not demonstrated but is used in conjunction with surgery.

Adult

Ascariasis, hookworm, strongyloidiasis: 400 mg PO once
C sinensis infection: 10 mg/kg/d PO for 7 d
Echinococcal disease: 400 mg PO bid for 28 d, followed by 14 d off, repeat for total of 3 cycles; 15 mg/kg/d if <60 kg

Pediatric

Not established

Coadministration with carbamazepine may decrease efficacy; dexamethasone, cimetidine, and praziquantel may increase toxicity

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Discontinue use if LFTs increase significantly (resume when levels decrease to pretest values); may cause pancytopenia or isolated granulocytopenia, GI symptoms, headache, vertigo, increased intracranial pressure, alopecia, or fever


Mebendazole (Vermox)

Causes worm death by selectively and irreversibly blocking uptake of glucose and other nutrients in susceptible adult intestine where helminths dwell. For treatment of ascariasis, hookworm infection, and toxocariasis. Alternative agent for visceral larva migrans and trichinosis.

Adult

Ascaris and hookworm: 100 mg PO bid for 3 d
Trichinosis: 5 mg/kg PO bid for 10-13 d

Pediatric

<2 years: Not established
>2 years: Administer as in adults

Carbamazepine and phenytoin may decrease effects; cimetidine may increase levels

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Adjust dose in hepatic impairment; potential for seizures, angioedema, neutropenia, GI symptoms, headache, or dizziness


Thiabendazole (Mintezol)

Inhibits helminth-specific mitochondrial fumarate reductase. Alleviates symptoms of trichinosis during invasive phase. Little value in disease that spreads beyond lumen of intestines because absorption from GI tract is poor. Alternative agent for treatment of strongyloidiasis, toxocariasis, and hookworm infection (eg, Necator species, Ancylostoma species).

Adult

25 mg/kg PO bid for 2 d; if hyperinfection, continue for total of 2 wk

Pediatric

Not established

May elevate serum levels of theophylline, increasing toxicity (monitor serum levels and reduce dose prn)

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Closely monitor in patients with hepatic or renal dysfunction; prior to initiating therapy, supportive therapy is necessary for patients who are anemic, dehydrated, or malnourished; use in confirmed worm infestation (not prophylactically); may cause nausea, vomiting, mild CNS depression, Stevens-Johnson syndrome, hepatotoxicity, seizures, hallucinations, renal toxicity, tinnitus, visual changes, and pruritus


Ivermectin (Mectizan)

First-line therapy for strongyloidiasis and filariasis (W bancrofti or B malayi). Binds selectively with glutamate-gated chloride ion channels in invertebrate nerve and muscle cells, causing cell death.

Adult

Strongyloidiasis: 200 mcg/kg PO once
Filariasis: 100-440 mcg/kg PO once

Pediatric

Administer as in adults or double therapy with a single dose each of ivermectin (200-400 mcg/kg PO) and albendazole (400 mg PO)

May interact with other ligand-gated chloride channels, such as those gated by GABA

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Treat mothers who intend to breastfeed only when risk of delayed treatment outweighs possible risks to the newborn caused by ivermectin excretion in milk; repeat courses of therapy may be required in patients who are immunocompromised; may cause nausea, vomiting, and mild CNS depression; potential for rash, fever, lymphadenopathy, transaminasemia, and hypotension; Mazzotti reaction (due to death of worms) may occur (ie, fever, urticaria, bronchospasm, GI symptoms)


Praziquantel (Biltricide)

DOC in most infections and active against all schistosomal species. Increases cell membrane permeability in susceptible worms, resulting in loss of intracellular calcium, massive contractions, and paralysis of musculature. In addition, produces vacuolization and disintegration of schistosome tegument. This is followed by attachment of phagocytes to parasite and death.
Tabs should be swallowed completely with some liquid during meals. Keeping tabs in mouth may reveal bitter taste, which can produce nausea or vomiting.

Adult

Clonorchis: 25 mg/kg PO tid for 1 d
Paragonimus: 25 mg/kg PO tid for 2 d
Schistosoma: 20 mg/kg PO tid for 1 d

Pediatric

<4 years: Not established
>4 years: Administer as in adults

Hydantoins may reduce serum concentrations, possibly leading to treatment failures; may increase albendazole levels

Documented hypersensitivity; ocular cysticercosis

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Destruction of parasite within eyes can cause irreparable lesions (do not treat ocular cysticercosis with praziquantel); caution while driving or performing other tasks requiring alertness on day of and day following treatment; minimal increases in liver enzymes reported; when schistosomiasis or fluke infection associated with cerebral cysticercosis, hospitalize patient for duration of treatment; may cause dizziness, fever, urticaria, anorexia, or headache


Diethylcarbamazine (Hetrazan)

First-line therapy for visceral larval migrans. Alternative therapy for filariasis. Not generally available in United States but possible through Wyeth-Ayerst or Parasite Disease Service of CDC.

Adult

Visceral larva migrans: 2 mg/kg PO tid for 10 d
Filariasis: 50 mg PO tid for 2 d, then 100 mg for 1 d, then 2 mg/kg PO tid for a total of 21 d

Pediatric

Not established

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Mazzotti reaction may occur (due to death of worms), which includes fever, bronchospasm, urticaria, and GI symptoms

More on Pulmonary Eosinophilia

Overview: Pulmonary Eosinophilia
Differential Diagnoses & Workup: Pulmonary Eosinophilia
Treatment & Medication: Pulmonary Eosinophilia
Follow-up: Pulmonary Eosinophilia
References
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Further Reading

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Keywords

pulmonary eosinophilia, pulmonary infiltrate with eosinophilia syndrome, PIE syndrome, eosinophilic lung disease, inflammatory lung disease, pulmonary disease, eosinophilic immune response, acute eosinophilic pneumonia, AEP, chronic eosinophilic pneumonia, CEP, idiopathic hypereosinophilic syndrome, IHES, Churg-Strauss syndrome, CSS, eosinophilic granuloma, EG, pulmonary histiocytosis X, Langerhans cell granulomatosis, pulmonary eosinophilia, TPE, Loeffler syndrome, Loeffler's syndrome, infestation, tapeworm, parasite infestation, strongyloidiasis, ascariasis, paragonimiasis, schistosomiasis, dirofilariasis, ancylostomiasis, trichomoniasis, clonorchiasis, visceral larva migrans, allergic bronchopulmonary aspergillosis, ABPA, aspergillosis, allergic bronchopulmonary mycosis, bronchocentric granulomatosis, extrinsic eosinophilic syndromes, intrinsic eosinophilic syndromes, coccidioidomycosis

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Contributor Information and Disclosures

Author

Jussi J Saukkonen, MD, Associate Professor, Department of Internal Medicine, Division of Pulmonary/Critical Care Medicine, Boston University School of Medicine, Boston Medical Center
Jussi J Saukkonen, MD is a member of the following medical societies: American Thoracic Society
Disclosure: Nothing to disclose.

Medical Editor

Gregory Tino, MD, Director of Pulmonary Outpatient Practices, Associate Professor, Department of Medicine, Division of Pulmonary, Allergy, and Critical Care, University of Pennsylvania Medical Center and Hospital
Gregory Tino, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and American Thoracic Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

CME Editor

Timothy D Rice, MD, Associate Professor, Departments of Internal Medicine and Pediatrics and Adolescent Medicine, Saint Louis University School of Medicine
Timothy D Rice, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Physicians
Disclosure: Nothing to disclose.

Chief Editor

Zab Mosenifar, MD, Director, Division of Pulmonary and Critical Care Medicine, Director, Women's Guild Pulmonary Disease Institute, Executive Vice Chair, Department of Medicine, Cedars Sinai Medical Center; Professor of Medicine, David Geffen School of Medicine at UCLA
Zab Mosenifar, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Federation for Medical Research, and American Thoracic Society
Disclosure: Nothing to disclose.

 
 
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