PO65 - Alveolar macrophage pneumonia: impact of smoking cessation and corticosteroid therapy
Andreia Daniel Simões (Portugal)1; Ana Rita Ribeiro (Portugal)2; Pedro Vicente de Almeida (Portugal)3; Carla Carvalho (Portugal)4; Helena Carvalho (Portugal)5; Luís Silva (Portugal)6; Nuno Ferreira (Portugal)7; Rita de Vasconcelos Pereira (Portugal)8; André Alexandre (Portugal)9; David Coelho (Portugal)9; Hélder Novais Bastos (Portugal)9; Patrícia Mota (Portugal)9; Natália Melo (Portugal)9; Susana Guimarães (Portugal)10; Conceição Souto Moura (Portugal)10; André Carvalho (Portugal)11; António Morais (Portugal)9;
1 - Serviço de Pneumologia, Hospital Beatriz Ângelo – ULS Loures-Odivelas; 2 - Serviço de Pneumologia, Hospital de Portimāo -ULS Algarve; 3 - Serviço de Pneumologia, ULS Aveiro; 4 - Serviço de Pneumologia, ULS Braga; 5 - Serviço de Pneumologia, ULS Santo António; 6 - Serviço de Pneumologia, ULS Entre Douro e Vouga; 7 - Serviço de Pneumologia, ULS Tâmega e Sousa; 8 - Serviço de Pneumologia, Hospital de Pedro Hispano -ULS Matosinhos; 9 - Serviço de Pneumologia, ULS São João; 10 - Serviço de Anatomia Patológica, ULS São João; 11 - Serviço de Radiologia, ULS São João;
Keywords: Alveolar Macrophage Pneumonia; Smoking Cessation; Corticosteroid therapy;
Select the theme: Rare diseases
Type: Original Papers
Presentation: Poster Presentation

Introduction: Alveolar Macrophage Pneumonia (AMP) is an uncommon smoking-related interstitial pneumonia with generally favorable prognosis, although some patients may experience disease progression and adverse outcomes.

Objectives: To characterize patients with AMP and evaluate the impact of smoking cessation and corticosteroid therapy on disease progression and long-term functional outcomes. 


Materials and Methods: We conducted a retrospective case series of biopsy-proven AMP patients followed at a pulmonology outpatient clinic in Portugal (01/2015–01/2026). Patients with follow-up <12 months or insufficient histological data were excluded, and clinical, demographic, radiological, and treatment data were analyzed.

Results: 37 patients were included; 70.3% were male, median age 58 years [53–65]. Most were current (81.1%) or former smokers (16.2%), and 19.4% had autoimmune disease. Dyspnea and cough were the main symptoms, while ground-glass opacities were the predominant CT finding, often associated with emphysema; 13.8% had fibrosis at diagnosis. Corticosteroids were administered to 13 patients (35.1%) for a median of 16 months [6–30]; four required additional immunosuppression and three received antifibrotic therapy. The corticosteroid group had lower baseline median FVC (95.7 vs 116.9, p=0.008). Treatment was mainly initiated due to respiratory symptoms with functional and/or radiological deterioration. Among active smokers, 30% achieved smoking cessation, and corticosteroid use was less frequent in quitters than in persistent smokers (22.2% vs 47.6%). Baseline median FVC was lower in active smokers requiring corticosteroids (89.7% vs 108.8%). Median FVC decline at 5 years was similar between quitters and persistent smokers (−4.4% vs −7%), but among persistent smokers, decline was greater without corticosteroids (−18.9% vs +1.5%). After a median follow-up of 7.3 years [5.2–10.1], 13.5% developed chronic respiratory failure and four patients died (two from lung cancer). 

Conclusions: Corticosteroid therapy appeared to improve functional outcomes, while the impact of smoking cessation remained unclear, likely due to the small sample size. AMP showed a variable prognosis, highlighting the need for individualized management and long-term follow-up.