Occupational lung disease medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hadeel Maksoud M.D.[2]

Overview

Supportive therapy for occupational lung disease before fibrotic disease sets in includes glucocorticoid therapy. Anti-asthmatic drugs may also be used to provide relief from dyspnea.

Medical therapy to prevent disease progression

Pharmacologic medical therapy such as glucocorticoid is recommended among patients without fibrotic lung disease to decelerate lung disease progression and to improve lung function.

Therapeutic regimen to decelerate lung disease progression

  • 1 Prefibrotic stage of lung disease
    • 1.1 Glucocorticoids
      • 1.1.1 Adult
        Note (1): Taper down to 20 mg after clinical improvement of DLCO, arterial blood gases, and pulse oxygen saturation. Followed by 40 mg on alternate days. Finally, 5 - 10 mg q12h.

Therapeutic regimen for occupational asthma

1 Mild Intermittent Asthma

1.1 Step 1 therapy:

1.2 Step 2 therapy:

2 Moderate Persistent Asthma

2.1 Step 3 Therapy:

3 Severe Persistent Asthma

3.1 Step 4 Therapy:

3.2 Step 5 Therapy:

3.3 Step 6 Therapy:

References

  1. Marchand-Adam S, El Khatib A, Guillon F, Brauner MW, Lamberto C, Lepage V, Naccache JM, Valeyre D (2008). "Short- and long-term response to corticosteroid therapy in chronic beryllium disease". Eur. Respir. J. 32 (3): 687–93. doi:10.1183/09031936.00149607. PMID 18757698.
  2. Sood A, Beckett WS, Cullen MR (2004). "Variable response to long-term corticosteroid therapy in chronic beryllium disease". Chest. 126 (6): 2000–7. doi:10.1378/chest.126.6.2000. PMID 15596705.
  3. Shim C, Williams MH (1980) Bronchial response to oral versus aerosol metaproterenol in asthma. Ann Intern Med 93 (3):428-31. PMID: 7436160
  4. Shim C, Williams MH (1981) Comparison of oral aminophylline and aerosol metaproterenol in asthma. Am J Med 71 (3):452-5. PMID: 7282733
  5. Berridge MS, Lee Z, Heald DL (2000) Pulmonary distribution and kinetics of inhaled [11Ctriamcinolone acetonide.] J Nucl Med 41 (10):1603-11. PMID: 11037987
  6. Nelson HS (2001) Advair: combination treatment with fluticasone propionate/salmeterol in the treatment of asthma. J Allergy Clin Immunol 107 (2):398-416. DOI:10.1067/mai.2001.112939 PMID: 11174215