Berylliosis Treatment & Management

Updated: Apr 30, 2020
  • Author: Raed A Dweik, MD, MBA, FACP, FRCPC, FCCP, FCCM, FAHA; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
  • Print
Treatment

Approach Considerations

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. [2] 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. Supportive and preventive therapies are administered as needed, similar to the management of other types of interstitial lung disease. Lung transplantation has been used in a few patients with end-stage CBD, but its effectiveness is unknown.

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

Next:

Prevention

On January 9, 2017, the US Department of Labor Occupational Safety and Health Administration (OSHA) published its final ruling on Occupational Exposure to Beryllium and Beryllium Compounds. The ruling reduced the permissible exposure limit (PEL) for beryllium to an 8-hour time-weighted-average (TWA) of 0.2 micrograms per cubic meter of air (μg/m3). The final rule also established a new short-term exposure limit of 2.0 μg/m3 over a 15-minute sampling period. The new 8-hour exposure limit represents a ten-fold decrease from the previous PEL and is expected to reduce the risk of disease among approximately 62,000 beryllium-exposed workers. [15]

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.

Previous