Occupational lung disease medical therapy: Difference between revisions

Jump to navigation Jump to search
No edit summary
No edit summary
 
(6 intermediate revisions by 3 users not shown)
Line 1: Line 1:
__NOTOC__
__NOTOC__
{{Occupational lung disease}}
{{Occupational lung disease}}
{{CMG}};{{AE}}{{HM}}
{{CMG}}; {{AE}}{{HM}}


==Overview==
==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.
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 ==
==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.
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 Prefibrotic stage of lung disease'''
** 1.1 '''Glucocorticoids'''
** 1.1 '''Glucocorticoids'''
*** 1.1.1 '''Adult'''
*** 1.1.1 '''Adult'''
**** Preferred regimen (1): Prednisolone or Prednisone 0.5 - 0.6 mg/kg q12h for 6 - 12 weeks<ref name="pmid18757698">{{cite journal |vauthors=Marchand-Adam S, El Khatib A, Guillon F, Brauner MW, Lamberto C, Lepage V, Naccache JM, Valeyre D |title=Short- and long-term response to corticosteroid therapy in chronic beryllium disease |journal=Eur. Respir. J. |volume=32 |issue=3 |pages=687–93 |year=2008 |pmid=18757698 |doi=10.1183/09031936.00149607 |url=}}</ref><ref name="pmid15596705">{{cite journal |vauthors=Sood A, Beckett WS, Cullen MR |title=Variable response to long-term corticosteroid therapy in chronic beryllium disease |journal=Chest |volume=126 |issue=6 |pages=2000–7 |year=2004 |pmid=15596705 |doi=10.1378/chest.126.6.2000 |url=}}</ref>
**** Preferred regimen (1): [[Prednisolone]] or [[Prednisone]] 0.5 - 0.6 mg/kg q12h for 6 - 12 weeks<ref name="pmid18757698">{{cite journal |vauthors=Marchand-Adam S, El Khatib A, Guillon F, Brauner MW, Lamberto C, Lepage V, Naccache JM, Valeyre D |title=Short- and long-term response to corticosteroid therapy in chronic beryllium disease |journal=Eur. Respir. J. |volume=32 |issue=3 |pages=687–93 |year=2008 |pmid=18757698 |doi=10.1183/09031936.00149607 |url=}}</ref><ref name="pmid15596705">{{cite journal |vauthors=Sood A, Beckett WS, Cullen MR |title=Variable response to long-term corticosteroid therapy in chronic beryllium disease |journal=Chest |volume=126 |issue=6 |pages=2000–7 |year=2004 |pmid=15596705 |doi=10.1378/chest.126.6.2000 |url=}}</ref>
***: '''Note (1):''' Taper down to 20mg after clinical improvement of DLCO, arterial blood gases, and pulse oxygen saturation. Followed by 40mg on alternate days. Finally, 5 - 10mg q12h.
***: '''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 asthma===
====Mild Intermittent Asthma====
Step 1 Therapy:
*Preferred treatment:
**Short-acting inhaled [[Bronchodilator#Short-acting β2-agonists|β2-agonist]] PRN<ref name="pmid7436160">Shim C, Williams MH (1980) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=7436160 Bronchial response to oral versus aerosol metaproterenol in asthma.] ''Ann Intern Med'' 93 (3):428-31. PMID: [http://pubmed.gov/7436160 7436160]</ref><ref name="pmid7282733">Shim C, Williams MH (1981) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=7282733 Comparison of oral aminophylline and aerosol metaproterenol in asthma.] ''Am J Med'' 71 (3):452-5. PMID: [http://pubmed.gov/7282733 7282733]</ref>
Step 2 Therapy:
*Preferred treatment:
**[[steroid|Low-dose inhaled corticosteroid]] combined with a short-acting inhaled [[Bronchodilator#Short-acting β2-agonists|β2-agonist]] PRN
*Alternative therapies include:
**Either [[cromolyn]] ''or'' [[nedocromil]], ''or'' [[Theophylline|''theophylline'']], ''or'' [[montelukast]], ''or'' [[zafirlukast]] combined with a short-acting inhaled [[Bronchodilator#Short-acting β2-agonists|β2-agonist]] PRN<ref name="pmid11037987">Berridge MS, Lee Z, Heald DL (2000) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=11037987 Pulmonary distribution and kinetics of inhaled [11C]triamcinolone acetonide.] ''J Nucl Med'' 41 (10):1603-11. PMID: [http://pubmed.gov/11037987 11037987]</ref>
====Moderate Persistent Asthma====
Step 3 Therapy:
*Preferred treatment:
**Medium-dose inhaled [[steroid|corticosteroid]] combined with a short-acting inhaled [[Bronchodilator#Short-acting β2-agonists|β2-agonists]] PRN, ''OR''
**Low-dose inhaled [[steroid|corticosteroid]] along with ''either'' inhaled [[Bronchodilators#Long-acting β2-agonists|long-acting β2-agonists]] <ref name="pmid11174215">Nelson HS (2001) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=11174215 Advair: combination treatment with fluticasone propionate/salmeterol in the treatment of asthma.] ''J Allergy Clin Immunol'' 107 (2):398-416. [http://dx.doi.org/10.1067/mai.2001.112939 DOI:10.1067/mai.2001.112939] PMID: [http://pubmed.gov/11174215 11174215]</ref> ''or'' [[Bronchodilators#Theophylline|sustained-release theophylline]] for nocturnal symptoms combined with a short-acting inhaled [[Bronchodilator#Short-acting β2-agonists|β2-agonists]] PRN
*Alternative therapies include:
**Low-dose of inhaled [[steroid]] combined with long-acting bronchodilators (either [[Bronchodilators#Long-acting β2-agonists|inhaled long-acting β2-agonists]] or [[Bronchodilators#Theophylline|sustained-release theophylline]]) combined with a short-acting inhaled [[Bronchodilator#Short-acting β2-agonists|β2-agonists]] PRN
====Severe Persistent Asthma====
Step 4 Therapy:
*Preferred treatment:
**Medium-dose inhaled [[steroid|corticosteroid]] combined with [[Bronchodilators#Long-acting β2-agonists|inhaled long-acting β2-agonists]]
*Alternative therapies include:
**Medium-dose inhaled [[steroids|corticosteroid]] combined with long-acting [[bronchodilators]] (such as [[Bronchodilators#Long-acting β2-agonists|inhaled β2-agonists]] or [[Bronchodilators#Theophylline|sustained-release theophylline]] used alone or in combination) combined with a short-acting inhaled [[Bronchodilator#Short-acting β2-agonists|β2-agonists]] PRN
Step 5 Therapy:
*Preferred treatment:
**High-dose inhaled [[steroid|corticosteroid]] combined with  [[Bronchodilators#Long-acting β2-agonists|inhaled long-acting β2-agonists]] and [[omalizumab]] in patients who have allergies
Step 6 Therapy:
*Preferred treatment:
**High-dose inhaled [[steroid|corticosteroid]] combined with oral corticosteroids, [[Bronchodilators#Long-acting β2-agonists|inhaled long-acting β2-agonists]], and [[omalizumab]] in patients who have allergies


===Therapeutic regimen for occupational asthma===
====1 Mild Intermittent Asthma====
'''1.1 Step 1 therapy:'''
*Preferred treatment (1): Short-acting inhaled [[Bronchodilator#Short-acting β2-agonists|β2-agonist]] PRN<ref name="pmid7436160">Shim C, Williams MH (1980) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=7436160 Bronchial response to oral versus aerosol metaproterenol in asthma.] ''Ann Intern Med'' 93 (3):428-31. PMID: [http://pubmed.gov/7436160 7436160]</ref><ref name="pmid7282733">Shim C, Williams MH (1981) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=7282733 Comparison of oral aminophylline and aerosol metaproterenol in asthma.] ''Am J Med'' 71 (3):452-5. PMID: [http://pubmed.gov/7282733 7282733]</ref>
'''1.2 Step 2 therapy:'''
*Preferred treatment (1): [[steroid|Low-dose inhaled corticosteroid]] combined with a short-acting inhaled [[Bronchodilator#Short-acting β2-agonists|β2-agonist]] PRN
*Alternative treatment (1): [[Cromolyn]] combined with a short-acting inhaled [[Bronchodilator#Short-acting β2-agonists|β2-agonist]] PRN<ref name="pmid11037987">Berridge MS, Lee Z, Heald DL (2000) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=11037987 Pulmonary distribution and kinetics of inhaled [11C]triamcinolone acetonide.] ''J Nucl Med'' 41 (10):1603-11. PMID: [http://pubmed.gov/11037987 11037987]</ref>
*Alternative treatment (2):  [[Nedocromil]] combined with a short-acting inhaled [[Bronchodilator#Short-acting β2-agonists|β2-agonist]] PRN
*Alternative treatment (3): [[Theophylline]] combined with a short-acting inhaled [[Bronchodilator#Short-acting β2-agonists|β2-agonist]] PRN
*Alternative treatment (4): [[Montelukast]] combined with a short-acting inhaled [[Bronchodilator#Short-acting β2-agonists|β2-agonist]] PRN
*Alternative treatment (5): [[Zafirlukast]] combined with a short-acting inhaled [[Bronchodilator#Short-acting β2-agonists|β2-agonist]] PRN
====2 Moderate Persistent Asthma====
'''2.1 Step 3 Therapy:'''
*Preferred treatment (1): Medium-dose inhaled [[steroid|corticosteroid]] combined with a short-acting inhaled [[Bronchodilator#Short-acting β2-agonists|β2-agonists]] PRN
*Preferred treatment (2): Low-dose inhaled [[steroid|corticosteroid]] along with ''either'' inhaled [[Bronchodilators#Long-acting β2-agonists|long-acting β2-agonists]]<ref name="pmid11174215">Nelson HS (2001) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=11174215 Advair: combination treatment with fluticasone propionate/salmeterol in the treatment of asthma.] ''J Allergy Clin Immunol'' 107 (2):398-416. [http://dx.doi.org/10.1067/mai.2001.112939 DOI:10.1067/mai.2001.112939] PMID: [http://pubmed.gov/11174215 11174215]</ref>
*Preferred treatment (3):  [[Bronchodilator#Theophylline|Sustained-release theophylline]] for nocturnal symptoms combined with a short-acting inhaled [[Bronchodilator#Short-acting β2-agonists|β2-agonists]] PRN
*Alternative treatment (1): Low-dose of inhaled [[steroid]] combined with long-acting bronchodilators (either [[Bronchodilators#Long-acting β2-agonists|inhaled long-acting β2-agonists]] or [[Bronchodilators#Theophylline|sustained-release theophylline]]) combined with a short-acting inhaled [[Bronchodilator#Short-acting β2-agonists|β2-agonists]] PRN
====3 Severe Persistent Asthma====
'''3.1 Step 4 Therapy:'''
*Preferred treatment (1): Medium-dose inhaled [[steroid|corticosteroid]] combined with [[Bronchodilators#Long-acting β2-agonists|inhaled long-acting β2-agonists]]
*Alternative treatment (1): Medium-dose inhaled [[steroids|corticosteroid]] combined with long-acting [[bronchodilators]] (such as [[Bronchodilators#Long-acting β2-agonists|inhaled β2-agonists]] or [[Bronchodilators#Theophylline|sustained-release theophylline]] used alone or in combination) combined with a short-acting inhaled [[Bronchodilator#Short-acting β2-agonists|β2-agonists]] PRN
'''3.2 Step 5 Therapy:'''
*Preferred treatment (1): High-dose inhaled [[steroid|corticosteroid]] combined with [[Bronchodilators#Long-acting β2-agonists|inhaled long-acting β2-agonists]] and [[omalizumab]] in patients who have allergies
'''3.3 Step 6 Therapy:'''
*Preferred treatment (1): High-dose inhaled [[steroid|corticosteroid]] combined with oral corticosteroids, [[Bronchodilators#Long-acting β2-agonists|inhaled long-acting β2-agonists]], and [[omalizumab]] in patients who have allergies
==References==
==References==


Line 50: Line 47:
[[Category:Pulmonology]]
[[Category:Pulmonology]]
[[Category:Occupational diseases]]
[[Category:Occupational diseases]]
[[Category:Disease]]
[[Category:Medicine]]
[[Category:Up-To-Date]]
[[Category:Primary Care]]

Latest revision as of 14:34, 15 March 2018

Occupational lung disease Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Occupational lung disease from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X Ray

CT

MRI

Echocardiography or Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Occupational lung disease medical therapy On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Occupational lung disease medical therapy

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Occupational lung disease medical therapy

CDC on Occupational lung disease medical therapy

Occupational lung disease medical therapy in the news

Blogs on Occupational lung disease medical therapy

Directions to Hospitals Treating Coalworker's pneumoconiosis

Risk calculators and risk factors for Occupational lung disease medical therapy

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