Occupational lung disease medical therapy: Difference between revisions
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== Medical Therapy == | == Medical Therapy == | ||
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. | ||
* '''1 Prefibrotic stage of lung disease''' | * '''1 Prefibrotic stage of lung disease''' | ||
** 1.1 '''Glucocorticoids''' | ** 1.1 '''Glucocorticoids''' | ||
| Line 19: | Line 17: | ||
====Mild Intermittent Asthma==== | ====Mild Intermittent Asthma==== | ||
Step 1 Therapy: | Step 1 Therapy: | ||
* Preferred treatment: | *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> | **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: | Step 2 Therapy: | ||
*Preferred treatment: | *Preferred treatment: | ||
| Line 26: | Line 24: | ||
*Alternative therapies include: | *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> | **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==== | ====Moderate Persistent Asthma==== | ||
Step 3 Therapy: | Step 3 Therapy: | ||
| Line 32: | Line 29: | ||
**Medium-dose inhaled [[steroid|corticosteroid]] combined with a short-acting inhaled [[Bronchodilator#Short-acting β2-agonists|β2-agonists]] PRN, ''OR'' | **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 | **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: | *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 | **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==== | ====Severe Persistent Asthma==== | ||
Step 4 Therapy: | Step 4 Therapy: | ||
| Line 46: | Line 41: | ||
**High-dose inhaled [[steroid|corticosteroid]] combined with [[Bronchodilators#Long-acting β2-agonists|inhaled long-acting β2-agonists]] and [[omalizumab]] in patients who have allergies | **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: | Step 6 Therapy: | ||
* Preferred treatment: | *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 | |||
** 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== | ||
Revision as of 19:14, 19 February 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
Pharmacologic medical therapy such as glucocorticoid is recommended among patients without fibrotic lung disease to decelerate lung disease progression and to improve lung function.
- 1 Prefibrotic stage of lung disease
- 1.1 Glucocorticoids
Therapeutic regimen for asthma
Mild Intermittent Asthma
Step 1 Therapy:
- Preferred treatment:
- Short-acting inhaled β2-agonist PRN[3][4]
Step 2 Therapy:
- Preferred treatment:
- Low-dose inhaled corticosteroid combined with a short-acting inhaled β2-agonist PRN
- Alternative therapies include:
- Either cromolyn or nedocromil, or theophylline, or montelukast, or zafirlukast combined with a short-acting inhaled β2-agonist PRN[5]
Moderate Persistent Asthma
Step 3 Therapy:
- Preferred treatment:
- Medium-dose inhaled corticosteroid combined with a short-acting inhaled β2-agonists PRN, OR
- Low-dose inhaled corticosteroid along with either inhaled long-acting β2-agonists [6] or sustained-release theophylline for nocturnal symptoms combined with a short-acting inhaled β2-agonists PRN
- Alternative therapies include:
- 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
Severe Persistent Asthma
Step 4 Therapy:
- Preferred treatment:
- Medium-dose inhaled corticosteroid combined with inhaled long-acting β2-agonists
- Alternative therapies include:
- 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
Step 5 Therapy:
- Preferred treatment:
- High-dose inhaled corticosteroid combined with inhaled long-acting β2-agonists and omalizumab in patients who have allergies
Step 6 Therapy:
- Preferred treatment:
- 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