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

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

      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 asthma

Mild Intermittent Asthma

Step 1 Therapy:

• Preferred treatment:
  • Short-acting inhaled β2-agonist PRN

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

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 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