Occupational lung disease medical therapy: Difference between revisions
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__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 | ==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):''' | ***: '''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 [[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== | ||
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[[Category:Pulmonology]] | [[Category:Pulmonology]] | ||
[[Category:Occupational diseases]] | [[Category:Occupational diseases]] | ||
[[Category: | [[Category:Medicine]] | ||
[[Category:Up-To-Date]] | |||
[[Category:Primary Care]] | |||
Latest revision as of 14:34, 15 March 2018
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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[1][2]
- 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.
- 1.1.1 Adult
- 1.1 Glucocorticoids
Therapeutic regimen for occupational asthma
1 Mild Intermittent Asthma
1.1 Step 1 therapy:
- Preferred treatment (1): Short-acting inhaled β2-agonist PRN[3][4]
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[5]
- 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[6]
- 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
References
- ↑ 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.
- ↑ 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.
- ↑ Shim C, Williams MH (1980) Bronchial response to oral versus aerosol metaproterenol in asthma. Ann Intern Med 93 (3):428-31. PMID: 7436160
- ↑ Shim C, Williams MH (1981) Comparison of oral aminophylline and aerosol metaproterenol in asthma. Am J Med 71 (3):452-5. PMID: 7282733
- ↑ Berridge MS, Lee Z, Heald DL (2000) Pulmonary distribution and kinetics of inhaled [11Ctriamcinolone acetonide.] J Nucl Med 41 (10):1603-11. PMID: 11037987
- ↑ 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