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Tobacco Worker's Lung Treatment & Management

  • Author: Roger B Olade, MD, MPH; Chief Editor: Ryland P Byrd, Jr, MD  more...
Updated: Jun 03, 2014

Medical Care

The major treatment strategy is elimination of exposure to tobacco molds or leaves. Preventing further exposure to the offending agents usually leads to symptom resolution.

Most availabale studies have been on farmer's lung. Because farmer's lung has strong similarities to tobacco worker's lung, treatment strategies are generally extrapolated adapted from those for farmer's lung. Antigen avoidance usually results in regression of disease, but corticosteroid treatment may be required in more severe cases.

Corticosteroids are effective in the initial recovery in severely ill patients; however, the long-term outcome appears unchanged by corticosteroid treatment.[11] Treatment is recommended in patients with subacute or chronic disease presentations, patients with persistent symptoms, abnormal pulmonary function tests, hypoxemia, and radiographic evidence of extensive lung involvement.

Therapy is usually initiated with prednisone, 0.5 to 1 mg/kg of ideal body weight daily (up to a maximum daily dose of 60 mg per day), given as a single dose each morning. This dose is maintained for about two weeks and then tapered over the next 2-4 weeks.

Maintenance doses are not necessary, assuming patients have implemented good measures to avoid the culprit antigen. Inhaled corticosteroids might also be an option, but no strong supporting data are available at present.



Consultation with a pulmonologist is warranted.

Contributor Information and Disclosures

Roger B Olade, MD, MPH Medical Director, Genesis Health Group

Roger B Olade, MD, MPH is a member of the following medical societies: American College of Occupational and Environmental Medicine, American College of Physicians

Disclosure: Nothing to disclose.


Klaus-Dieter Lessnau, MD, FCCP Clinical Associate Professor of Medicine, New York University School of Medicine; Medical Director, Pulmonary Physiology Laboratory; Director of Research in Pulmonary Medicine, Department of Medicine, Section of Pulmonary Medicine, Lenox Hill Hospital

Klaus-Dieter Lessnau, MD, FCCP is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Medical Association, American Thoracic Society, Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Jazeela Fayyaz, DO Pulmonologist, Department of Pulmonology, Unity Hospital

Jazeela Fayyaz, DO is a member of the following medical societies: American College of Physicians, American Thoracic Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Ryland P Byrd, Jr, MD Professor of Medicine, Division of Pulmonary Disease and Critical Care Medicine, James H Quillen College of Medicine, East Tennessee State University

Ryland P Byrd, Jr, MD is a member of the following medical societies: American College of Chest Physicians, American Thoracic Society

Disclosure: Nothing to disclose.

Additional Contributors

Sat Sharma, MD, FRCPC Professor and Head, Division of Pulmonary Medicine, Department of Internal Medicine, University of Manitoba; Site Director, Respiratory Medicine, St Boniface General Hospital

Sat Sharma, MD, FRCPC is a member of the following medical societies: American Academy of Sleep Medicine, American College of Chest Physicians, American College of Physicians-American Society of Internal Medicine, American Thoracic Society, Canadian Medical Association, Royal College of Physicians and Surgeons of Canada, Royal Society of Medicine, Society of Critical Care Medicine, World Medical Association

Disclosure: Nothing to disclose.


Gregg T Anders, DO Medical Director, Great Plains Regional Medical Command , Brooke Army Medical Center; Clinical Associate Professor, Department of Internal Medicine, Division of Pulmonary Disease, University of Texas Health Science Center at San Antonio

Disclosure: Nothing to disclose.

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High-resolution CT scan of lungs shows ground-glass opacification seen in an acute phase of tobacco worker's lung.
Giant cells are a characteristic feature of acute tobacco worker's lung, which is a form of hypersensitivity pneumonitis.
High-resolution CT (HRCT) scan shows a ground-glass appearance and reticulonodular opacities in subacute phase of hypersensitivity pneumonitis (HP) secondary to moldy hay.
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