Berylliosis Treatment & Management

Updated: Dec 31, 2015
  • Author: Raed A Dweik, MD, MBA, FACP, FRCPC, FCCP, FCCM, FAHA; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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Treatment

Medical Care

Prevention is a key component in the management of chronic beryllium disease (CBD). The current Occupational Safety and Health Administration (OSHA) standards for workplace air require an 8-hour, time-weighted average maximum permissible level of 2 mcg/m3 along with a peak level of 25 mcg/m3. The beryllium concentration in the air around factories is not to exceed 0.01 mcg/m3. Some studies suggest that the current standard of 2 mcg/m3 is not protective. [12] Although no proof exists that cessation of exposure to beryllium improves the disease course or slows the progression, advising all patients with CBD to avoid any further exposure to beryllium is prudent.

Due to the use of BeLPT testing to screen workers exposed to beryllium, many cases now are diagnosed very early in the course of the disease, before radiographic or physiologic changes are observed and before symptoms or physical signs develop.

The natural history of the disease is not clear in patients who have granulomas on TBBX but who are asymptomatic and have no physiologic or radiographic abnormalities.

The current indications for therapy include the presence of symptoms, abnormal pulmonary function test results, or a decline in pulmonary function over time. In the absence of any of these criteria, no therapy is recommended. Close monitoring of symptoms and follow-up pulmonary function testing is recommended.

No controlled studies for CBD therapy are available. Based on the pathogenesis of the disease (immune-mediated) and due to the similarities with sarcoidosis, CBD is treated with corticosteroids. When corticosteroid therapy fails or in patients who develop significant adverse effects, methotrexate (MTX) may be considered.

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Surgical Care

In end-stage cases, lung transplantation may be considered.

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Consultations

A team approach involving industrial hygiene, occupational health, and pulmonary specialists is necessary for prevention, screening, early diagnosis, and appropriate treatment of CBD.

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