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
      • Preferred regimen (1): Prednisolone or Prednisone 0.5 - 0.6 mg/kg q12h for 6 - 12 weeks

      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:

• Preferred treatment (1): Short-acting inhaled β2-agonist PRN

1.2 Step 2 therapy:

• Preferred treatment (1): Low-dose inhaled corticosteroid combined with a short-acting inhaled β2-agonist PRN
• Alternative treatment (1): Cromolyn combined with a short-acting inhaled β2-agonist PRN
• Alternative treatment (2): Nedocromil combined with a short-acting inhaled β2-agonist PRN
• Alternative treatment (3): Theophylline combined with a short-acting inhaled β2-agonist PRN
• Alternative treatment (4): Montelukast combined with a short-acting inhaled β2-agonist PRN
• Alternative treatment (5): Zafirlukast combined with a short-acting inhaled β2-agonist PRN

2 Moderate Persistent Asthma

2.1 Step 3 Therapy:

• Preferred treatment (1): Medium-dose inhaled corticosteroid combined with a short-acting inhaled β2-agonists PRN
• Preferred treatment (2): Low-dose inhaled corticosteroid along with either inhaled long-acting β2-agonists
• Preferred treatment (3): Sustained-release theophylline for nocturnal symptoms combined with a short-acting inhaled β2-agonists PRN
• Alternative treatment (1): Low-dose of inhaled steroid combined with long-acting bronchodilators (either inhaled long-acting β2-agonists or sustained-release theophylline) combined with a short-acting inhaled β2-agonists PRN

3 Severe Persistent Asthma

3.1 Step 4 Therapy:

• Preferred treatment (1): Medium-dose inhaled corticosteroid combined with inhaled long-acting β2-agonists
• Alternative treatment (1): Medium-dose inhaled corticosteroid combined with long-acting bronchodilators (such as inhaled β2-agonists or sustained-release theophylline used alone or in combination) combined with a short-acting inhaled β2-agonists PRN

3.2 Step 5 Therapy:

• Preferred treatment (1): High-dose inhaled corticosteroid combined with inhaled long-acting β2-agonists and omalizumab in patients who have allergies

3.3 Step 6 Therapy:

• Preferred treatment (1): High-dose inhaled corticosteroid combined with oral corticosteroids, inhaled long-acting β2-agonists, and omalizumab in patients who have allergies