Treatment algorithm

Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups: see disclaimer

ACUTE

acute secondary alveolar proteinosis (acute silicosis)

1st line – lung lavage

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ACUTE
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acute secondary alveolar proteinosis (acute silicosis)
1st line – 

lung lavage

Rare in the US. Can occur within weeks to months of extremely high exposure.

Severe symptoms that occur weeks to months after high exposure.

Treatment is with whole lung lavage.[55]

acute berylliosis

1st line – oral corticosteroid

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ACUTE
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acute berylliosis
1st line – 

oral corticosteroid

Rare in the US. Presents with an acute pneumonitis and should be managed with corticosteroid therapy. The dose can gradually be tapered as the patient's condition improves.

Primary options

prednisone: 40-70 mg orally once daily initially, taper gradually according to response

ONGOING

chronic silicosis, coal workers' lung, or chronic berylliosis

1st line – smoking cessation + removal of occupational exposure

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ONGOING
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chronic silicosis, coal workers' lung, or chronic berylliosis
1st line – 

smoking cessation + removal of occupational exposure

Given the increased severity of lung disease and the risk of cancer associated with the interaction between cigarettes and mineral dusts, the most important physician intervention is to ensure the patient stops smoking.

Identification of an individual with disease should initiate a review of workplace controls, and should result in the removal of the patient from exposure to reduce the chance of progression. In the US, some states require cases of pneumoconiosis to be reported to the state health department.

Plus – advice regarding compensation

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ONGOING
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chronic silicosis, coal workers' lung, or chronic berylliosis
Plus – 

advice regarding compensation

Treatment recommended for ALL patients in selected patient group

Patients should be advised of their legal rights regarding compensation. US DoL: health benefits, retirement standards, and state workers' compensation programs: black lung compensation Opens in new window​​

Please consult local resources for more information.

Plus – oral corticosteroid

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ONGOING
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chronic silicosis, coal workers' lung, or chronic berylliosis
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with chronic berylliosis
Plus – 

oral corticosteroid

Treatment recommended for ALL patients in selected patient group

Oral corticosteroid therapy is used in patients with chronic beryllium disease.

Follow-up is at 3-month intervals to evaluate changes in pulmonary function results and radiographic studies. Doses are titrated in response to symptoms and pulmonary function and radiographic test results over many years.

There are no clinical trials on the use of corticosteroids in chronic beryllium disease. However, there are case series data.[54]

Primary options

prednisone: 40-70 mg orally once daily initially, taper gradually according to response

Consider – pulmonary rehabilitation

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ONGOING
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chronic silicosis, coal workers' lung, or chronic berylliosis
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with exertional dyspnea
Consider – 

pulmonary rehabilitation

Treatment recommended for SOME patients in selected patient group

Pulmonary rehabilitation is recommended for patients with exertional dyspnea.[50]​ This is a structured exercise program that aims to improve exercise capacity, reduce dyspnea, and improve quality of life.[50]​[51]​​

Plus – supplementary oxygen

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ONGOING
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chronic silicosis, coal workers' lung, or chronic berylliosis
|
with hypoxia
Plus – 

supplementary oxygen

Treatment recommended for ALL patients in selected patient group

Patients with a PaO₂ of 55 mmHg or less, or an oxygen saturation of 89% or less, are candidates for continuous oxygen therapy.

Oxygen may just be used at night if desaturation only occurs during sleep.

There are no studies concerning continuous oxygen that are specific to pneumoconiosis patients. Oxygen therapy improves exercise tolerance and reduces the risk of developing pulmonary hypertension and cor pulmonale.[52]

Consider – bronchodilator ± inhaled corticosteroid

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ONGOING
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chronic silicosis, coal workers' lung, or chronic berylliosis
|
with COPD
Consider – 

bronchodilator ± inhaled corticosteroid

Treatment recommended for SOME patients in selected patient group

Complications require specific management. One of the most common is COPD. Treatment with bronchodilators and inhaled corticosteroids should be started as appropriate.

See Chronic obstructive pulmonary disease.

Plus – referral for lung transplant

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ONGOING
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chronic silicosis, coal workers' lung, or chronic berylliosis
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with end-stage lung disease
Plus – 

referral for lung transplant

Treatment recommended for ALL patients in selected patient group

Patients with chronic end-stage lung disease who have a high risk of death (>50%) within 2 years without lung transplant and a high likelihood of 5-year survival (>80%) following lung transplant are potential transplant candidates.[53]

Absolute contraindications include active tuberculosis infection, active substance abuse (including use of tobacco and electronic cigarettes), progressive cognitive impairment, and repeated episodes of nonadherence.[53]

Relative contraindications include age >70 years and extremes of weight (BMI <16 kg/m² or >35 kg/m²).​[53]

The indications, complications, and contraindications are the same as for other chronic lung diseases. Major complications include graft failure and development of bronchiolitis obliterans. There is an increased risk of hypertension, diabetes, dyslipidemia, renal dysfunction, and infection from the immunosuppressive medication.

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Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups. See disclaimer

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