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== | ||
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*** 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 20mg after clinical improvement of DLCO, arterial blood gases, and pulse oxygen saturation. Followed by 40mg on alternate days. Finally, 5 - 10mg q12h. | ||
===Therapeutic regimen for occupational asthma=== | ===Therapeutic regimen for occupational asthma=== | ||
Revision as of 14:34, 5 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.
- 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 20mg after clinical improvement of DLCO, arterial blood gases, and pulse oxygen saturation. Followed by 40mg on alternate days. Finally, 5 - 10mg q12h.
- 1.1.1 Adult
- 1.1 Glucocorticoids
Therapeutic regimen for occupational 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