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PubMed This is a summary of 14 peer-reviewed journal articles Updated
Pulmonology

Monitoring, Relapse, and Long-Term Health with ICEP

At a Glance

Idiopathic chronic eosinophilic pneumonia can relapse during or after a steroid taper, so follow-up should track symptoms, blood eosinophils, lung imaging, and breathing tests. Long-term care also checks for steroid-related bone, adrenal, blood sugar, blood pressure, eye, infection, weight, and mood problems.

Living with Idiopathic Chronic Eosinophilic Pneumonia (ICEP) involves a shift from intensive treatment to long-term vigilance. While the initial response to medication is often excellent, the goal of long-term care is to maintain your lung health while minimizing the side effects of treatment [1][2].

Monitoring for Relapse

Because ICEP has a high relapse rate (between 30% and 60%), monitoring is essential during and after your steroid taper [1][3]. Relapses can happen quickly or develop slowly over weeks [4].

Your care team will typically monitor three key areas. It’s important to remember that asthma control, avoiding smoking/vaping, and promptly treating infections are also a major part of keeping your lungs healthy and avoiding a flare-up.

  • Symptoms: A return of your original symptoms—such as a persistent dry cough, increasing shortness of breath, or night sweats—is often the first sign of a relapse [4][5]. Do not wait for a scheduled blood test if you feel worse.
  • Blood Eosinophils: Your doctor will likely order regular blood tests to check your absolute eosinophil count. A rising count can signal that the inflammation is returning. However, the count may not always spike back above 1,000 cells/mm³ during a relapse because steroids can artificially suppress the number [2][4].
  • Imaging: If symptoms or blood counts suggest a relapse, a new CT scan or X-ray may be used to look for new “patchy” white areas (infiltrates) in the lungs [5][6].

Long-Term Lung Health

While many people with ICEP recover fully, a significant number of patients may have persistent changes in their lung function or structure.

  • Persistent Impairment: Roughly one-third (31.6%) of patients in one cohort study had lasting lung function issues [7]. This most commonly presents as obstruction (difficulty exhaling air quickly), especially in those who also have asthma [7].
  • Pulmonary Fibrosis (Scarring): Chronic inflammation can sometimes leave residual scarring on the lungs. Research from a specific long-term CT follow-up cohort suggests that up to 37% of patients may show some visible signs of structural scarring on CT scans [8]. Note that this residual radiographic scarring is not necessarily the same as progressive, life-threatening fibrotic lung disease. Many patients live completely normal lives with mild residual scarring.
  • Pulmonary Function Tests (PFTs): Regular spirometry (breathing tests) or full PFTs are used to track how well your lungs are working. Used together with symptoms and imaging, these tests help your doctor distinguish between an ICEP relapse, an asthma flare, or the development of long-term scarring [7][9].

Managing Steroid Side Effects

Because you may need to take systemic corticosteroids (like prednisone) for many months or even years, managing “steroid toxicity” is a major part of your care [10].

Potential Side Effect Monitoring & Management
Adrenal Suppression Your body stops making its own stress hormones. Never stop steroids abruptly. Your doctor will test your adrenal function as you taper off [4].
Bone Loss Steroids can lead to osteoporosis (thinning bones) and increased fracture risk [11][12]. Your doctor may recommend a DEXA scan (bone density test) and supplements like Calcium and Vitamin D or other medications based on your risk [13].
Blood Sugar & Pressure Long-term use can cause “steroid-induced diabetes” or worsen existing diabetes, and raise blood pressure [10][14]. Regular monitoring of blood glucose or HbA1c and home blood pressure checks are necessary [10].
Eye Health Steroids increase the risk of cataracts (clouding of the eye lens) and glaucoma (increased eye pressure) [13][1]. Periodic eye exams are recommended.
Infection Risk These medications suppress your immune system, making you more vulnerable to unusual infections, such as certain types of fungal or mycobacterial pneumonia [10][13]. Your doctor may prescribe prophylactic antibiotics.
Weight & Mood Weight gain, “moon face” (swelling of the face), and mood changes or insomnia are common and should be discussed with your doctor [14][4].

Your pulmonologist will often work closely with your primary care doctor or an endocrinologist to monitor these risks and ensure you are on the lowest effective dose of steroids to keep your ICEP in remission [2][13].

Common questions in this guide

How often should I be checked for an ICEP relapse?
There is no single follow-up schedule for everyone; your care team will set one based on your symptoms, steroid taper, and response to treatment. Monitoring may include symptom review, blood eosinophil counts, pulmonary function tests, and imaging when a relapse is suspected.
What symptoms could mean that ICEP has come back?
A persistent dry cough, worsening shortness of breath, or night sweats can be early warning signs of relapse. Contact your care team promptly if these symptoms return or worsen rather than waiting for your next scheduled blood test.
Can ICEP relapse even if my eosinophil count is not very high?
Yes. Steroids can suppress blood eosinophils, so the count may not rise above 1,000 cells per cubic millimeter even during a relapse. Doctors consider your symptoms and may use imaging or lung function tests as well as blood results.
What long-term lung problems can happen after ICEP?
Some people have lasting changes in lung function, most often trouble exhaling air quickly, especially when asthma is also present. CT scans may show residual scarring, but mild scarring is not necessarily progressive or life-threatening, and many people live normal lives.
How are prednisone side effects monitored during long-term ICEP treatment?
Your care team may check whether your body is making enough stress hormones, along with bone density, blood pressure, blood sugar, eye health, weight, mood, and signs of infection. Bone protection may include a DEXA bone-density scan, calcium or vitamin D, or other medication depending on your risk. Your pulmonologist may coordinate this monitoring with primary care or endocrinology.
Is it safe to stop prednisone as soon as I feel better?
No. Do not stop systemic steroids abruptly because your body may not be making enough of its own stress hormones, and ICEP may return. Your doctor should guide a gradual taper and may test adrenal function as you approach stopping.
What can I do to protect my lungs and reduce an ICEP flare?
Use your asthma inhalers as prescribed, avoid smoking and vaping, and have infections treated promptly. Report a returning cough, shortness of breath, night sweats, or other concerning changes to your care team.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.What is my baseline bone density, and do I need to start calcium, Vitamin D, or a prescription medication to protect my bones?
  2. 2.How often will you check my blood eosinophils, blood pressure, and blood sugar while I am on steroids?
  3. 3.When should we schedule my next set of pulmonary function tests to check for persistent lung impairment?
  4. 4.What specific symptoms should prompt me to call the clinic the same day versus waiting for my next appointment?
  5. 5.How will we test my adrenal function as I get closer to stopping the steroids entirely?

Questions For You

Tap a prompt to share your answer — we'll use it plus this page's context to start a tailored conversation.

References

References (14)
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    Chronic eosinophilic pneumonia: Adjunctive therapy with inhaled steroids.

    Chan C, DeLapp D, Nystrom P

    Respiratory medicine case reports 2017; (22()):11-14 doi:10.1016/j.rmcr.2017.05.014.

    PMID: 28626631
  2. 2

    Optimal dose of maintenance steroid therapy for relapse of chronic eosinophilic pneumonia: a multicentre retrospective study.

    Atsumi K, Nishima S, Tanaka T, et al.

    BMJ open respiratory research 2025; (12(1)) doi:10.1136/bmjresp-2024-002697.

    PMID: 40379264
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    Chronic eosinophilic pneumonia: clinical perspectives.

    Crowe M, Robinson D, Sagar M, et al.

    Therapeutics and clinical risk management 2019; (15()):397-403 doi:10.2147/TCRM.S157882.

    PMID: 30936702
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    Rapid and sustained effects of a single dose of benralizumab on chronic eosinophilic pneumonia.

    Izumo T, Kuse N, Awano N, et al.

    Respiratory medicine case reports 2020; (30()):101062 doi:10.1016/j.rmcr.2020.101062.

    PMID: 32373456
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    Successful treatment of acute relapse of chronic eosinophilic pneumonia with benralizumab and without corticosteroids: A case report.

    Izhakian S, Pertzov B, Rosengarten D, Kramer MR

    World journal of clinical cases 2022; (10(18)):6105-6109 doi:10.12998/wjcc.v10.i18.6105.

    PMID: 35949821
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    A case of chronic eosinophilic pneumonia associated with rheumatoid arthritis in glucocorticoid-free remission with JAK inhibitor: A case report.

    Yamane T, Hashiramoto A

    Medicine 2023; (102(13)):e33396 doi:10.1097/MD.0000000000033396.

    PMID: 37000107
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    Persistent impairment on spirometry in chronic eosinophilic pneumonia: A longitudinal observation study (Shizuoka-CEP study).

    Suzuki Y, Oyama Y, Hozumi H, et al.

    Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology 2017; (119(5)):422-428.e2 doi:10.1016/j.anai.2017.08.009.

    PMID: 28942952
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    Idiopathic Chronic Eosinophilic Pneumonia Evolving to Pulmonary Fibrosis: A Retrospective Analysis.

    Baqir M, Peikert T, Johnson TF, et al.

    Sarcoidosis, vasculitis, and diffuse lung diseases : official journal of WASOG 2022; (39(2)):e2022020 doi:10.36141/svdld.v39i2.12656.

    PMID: 36118537
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    10-Year Follow-Up of Frequently Relapsed Chronic Eosinophilic Pneumonia Starting at 15 Years Old; Attempts to Treat with Inhaled Corticosteroid (A Case Report).

    Murayama N, Doi S, Kameda M

    The American journal of case reports 2019; (20()):822-827 doi:10.12659/AJCR.915402.

    PMID: 31182706
  10. 10

    The Long-term Clinical Course of Chronic Eosinophilic Pneumonia.

    Ishiguro T, Takayanagi N, Uozumi R, et al.

    Internal medicine (Tokyo, Japan) 2016; (55(17)):2373-7 doi:10.2169/internalmedicine.55.6765.

    PMID: 27580536
  11. 11

    A Case of an 80-Year-Old Woman With Chronic Eosinophilic Pneumonia and Clinically Significant Giant Hepatic Hemangioma.

    Khazar V, Escobar S, Huang A, Szema AM

    Cureus 2025; (17(12)):e98917 doi:10.7759/cureus.98917.

    PMID: 41523533
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    Successful Treatment of Relapsing Chronic Eosinophilic Pneumonia With Mepolizumab: A Case Report.

    Worth L, Khreisat A, Iacobelli A

    Cureus 2024; (16(7)):e65097 doi:10.7759/cureus.65097.

    PMID: 39040614
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    New perspectives in the treatment of chronic eosinophilic pneumonia in the era of targeted therapies.

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    Frontiers in immunology 2026; (17()):1893402 doi:10.3389/fimmu.2026.1893402.

    PMID: 42666554
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    Mepolizumab and dupilumab as a replacement to systemic glucocorticoids for the treatment of Chronic Eosinophilic Pneumonia and Allergic Bronchopulmonary Aspergillosis - Case series, Almoosa specialist hospital.

    Eldaabossi SAM, Awad A, Anshasi N

    Respiratory medicine case reports 2021; (34()):101520 doi:10.1016/j.rmcr.2021.101520.

    PMID: 34692397

This page is for informational purposes only and does not constitute medical advice about idiopathic chronic eosinophilic pneumonia. Follow your pulmonologist’s plan and contact your care team about new or worsening symptoms or steroid side effects.

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