• Reviewed on 5/11
    By Dr. Maier et al.

Chronic Beryllium Disease: Treatment

 

Can CBD be cured?

At the present time, there is not a known cure for CBD. However, with monitoring and treatment by your physician, the disease can be slowed down. Researchers in the United States and abroad are studying the mechanisms of CBD to better understand how the disease works and the complicated biological processes involved. Eventually, this understanding may lead to better treatments for CBD, if not a complete cure.

 

How is CBD treated?

CBD is treated differently for each patient, as the course and progression of the disease is different for each individual. Not everyone who has CBD will need treatment, but many patients will eventually need treatment as the disease progresses. The type of treatment a patient requires depends on the severity of the disease. In general, the goals of treatment for CBD are to improve the symptoms, to protect the lungs from further damage caused by inflammation and scarring, and to improve the oxygen levels in the bloodstream. The treatment of CBD is designed to manage the symptoms. At National Jewish Health®, our goal is to help you maintain your normal lifestyle as much as possible, so that you can continue to enjoy the people and activities that are important to you

If CBD is diagnosed in early stages, the lungs function may be normal and no symptoms of the illness are apparent. As the disease progresses, symptoms, such as dry cough or wheezing, similar to asthma, may become noticeable. An inhaled steroid may be prescribed to manage these symptoms. Symptoms may worsen or abnormalities in the gas exchange (the ability of the lungs to exchange oxygen for carbon dioxide in the bloodstream) may be detected, as the disease progresses. At that time, an immunosuppressive medication, such as prednisone, may be prescribed. Once the disease is advanced supplemental oxygen may be necessary. 

 

Medications

Will I need to take prednisone for my CBD?

If an individual with CBD requires medication to improve symptoms and lung function, the drug most commonly prescribed is prednisone.

Immunosuppressive medications, such as prednisone, slow the immune system’s response to the beryllium in your lungs, and generally help decrease symptoms while improving gas exchange between the lungs and bloodstream. Typically patients are given a course of prednisone that is gradually decreased over a period of time. Long-term use of prednisone does have side effects, and you should discuss the risks and benefits of prednisone use with your physician before beginning treatment. 

 

Are there other medications that can be used to treat CBD?

Other immunosuppressive drugs may be used in combination with prednisone. The most commonly used agents are methotrexate and azathioprine. While they may effectively decrease the amount of prednisone needed, and hence the steroid side-effects, they have their own side effects, and the risks and benefits of these medications needs to be carefully considered before they are used. Other types of immunomodulatory agents are under investigation, such as the TNFa blocking agent Infliximab, and antioxidants. 

 

Follow Up

How often should I see my doctor?

Patients with CBD should see their physician at least once a year. At that time, you should have pulmonary function tests and exercise tolerance tests to see if your lungs are having difficulty exchanging oxygen and carbon dioxide in the bloodstream, and a chest x-ray or CT scan to check for inflammation and scarring in the lungs. The types of testing your physician performs may be different based on your overall health. If you develop worsening symptoms of CBD you should see your physician as soon as possible. Patients with more advanced disease should see a physician more frequently. You should talk with your physician about how frequently you should be seen.

 

For more information on beryllium, please contact National Jewish Health® at 1.800.222.5864.

 

References

  1. Mroz MM, Balkissoon R, Newman LS. Beryllium. In: Bringham E, Cohrssen B, Powell C (eds.) Patty’s Toxicology, Fifth Edition. New York: John Wiley & Sons 2001, 177-220.
  2. Balkissoon RC, Newman LS. Beryllium cooper alloy (2%) causes chronic beryllium disease. J Occup Environ Med 1999; 41: 304-308.
  3. Kreiss K, Mroz MM, Ahen B, Martyny JW, Newman LS. Epidemiology of beryllium sensitizations and disease in nuclear workers. Am Rev Respir Dis 1993; 148:985-991.
  4. Newman LS, Kreiss K. Non-occupational chronic beryllium disease masquerading as sarcoidosis: Identification by blood lymphocyte proliferative response to beryllium. Am Rev Respir Dis 1992; 145:1212-1214.
  5. Steenland K, Ward E. Lung Cancer Incidence Among Patients with Beryllium Disease: a Cohort Mortality Study. J Natl Cancer Inst 1991; 83:1380-1385.
  6. Kriebel D, et al. The pulmonary toxicity of beryllium. Am Rev Respir Dis 1988; 137: 464-473.
  7. Kreiss K, Newman LA, Mroz M, Campbell PA. Screening blood test identifies subclinical beryllium disease. J Occ Med 1989; 31:603-608.
  8. Kreiss K, Wasserman S, Mroz MM, Newman LS. Beryllium disease screening in ceramics industry: Blood test performance and exposure-disease relations. J Occup Med 1993; 35: 267-274.
  9. Kreiss K, Mroz MM, Newman LS, Martyny J, Zhen B. Machining risk of beryllium disease and sensitization with median exposures below 2 µg/m3. Am J Indust Med 1996; 30:16-25.
  10. Kreiss K, et al. Risks of beryllium disease related to work processes at a metal, alloy and oxide production plant. Occup Environ Med 1997; 54:605-612.
  11. Mroz MM, Kreiss K, Lezotte DC, Campbell PA, Newman LS. Re-examination of the blood lymphocyte transformation test in the diagnosis of chronic beryllium disease.  J Allergy Clin Immunol 1991; 88:54-60.
  12. Kreiss K, Miller F, Newman LS, Ojo-Amaize EA, Rossman MD, Saltini C. Chronic beryllium disease: From the work place to cellular immunology, molecular immunogenetics, and back. Cl Immunol Immunopath 1994; 71:123-129.
  13. Rossman MD. Differential diagnosis of chronic beryllium disease. In: Rossman MD, Preuss OP, Powers MB, eds. Beryllium: Biomedical and Environmental Aspects. Baltimore: Williams & Wilkins, 1991; 167-175.
  14. Newman LS, Mroz MM, Maier LA, Danilof EM, Balkissoon R. Efficacy of serial medical surveillance for chronic beryllium disease in a beryllium machining plant. J Occup Environ Med 2001; 43:231-237.
  15. Yoshida T, Shima S, Nagoka K et al. A study on the beryllium Lymphocyte Transformation Test and the beryllium levels in working environment. Ind Health 1997; 35:374-379.
  16. Cullen M, et al. Chronic beryllium disease in a precious metal refinery: clinical, epidemiologic, and immunologic evidence for continuing risk from exposure to low-level beryllium fume, Am Rev Respir Dis 1987; 135:201-208.
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