How do you prescribe a steroid taper for radiation and checkpoint inhibitor related pneumonitis?

I subscribe to the philosophy of "hitting hard, tapering slowly" for cases of pneumonitis, either radiation pneumonitis, or checkpoint inhibitor-related pneumonitis (some of those cases probably have mixed origin, with contributions from radiation and/or checkpoint inhibitors).

For severely symptoma...

Approach to treatment-related pneumonitis, whether drug or radiation-induced, should always be governed by the severity of the presentation. In my opinion, any patient with severe symptoms, new oxygen requirements, or out-of-field findings on imaging should be managed in concert with a pulmonologist...