From the Research
Management of interstitial lung disease (ILD) caused by biologic dusts should prioritize removing the exposure and providing supportive care, with antifibrotic therapy such as nintedanib or pirfenidone being considered for patients with progressive pulmonary fibrosis, as evidenced by the most recent study 1. The first critical step is to identify and eliminate the offending biologic dust exposure through workplace modifications, personal protective equipment, or occupational changes.
- Corticosteroids are the primary pharmacological treatment, typically starting with prednisone 0.5-1 mg/kg/day for 2-4 weeks, followed by a gradual taper over 3-6 months depending on clinical response.
- For hypersensitivity pneumonitis, a common form of biologic dust ILD, maintenance doses of 5-10 mg daily may be needed for prolonged periods.
- In severe or steroid-resistant cases, immunosuppressants like azathioprine (2-3 mg/kg/day) or mycophenolate mofetil (1000-1500 mg twice daily) may be added, although the evidence for their efficacy is of very low certainty 2. Supportive measures include:
- Supplemental oxygen for patients with hypoxemia
- Pulmonary rehabilitation to improve exercise capacity
- Vaccinations against influenza and pneumococcal pneumonia Regular pulmonary function tests every 3-6 months help monitor disease progression. These treatments aim to suppress the inflammatory response triggered by biologic dusts like agricultural products, bird proteins, or mold spores, which cause alveolar damage and fibrotic changes in the lung interstitium. According to the most recent and highest quality study 1, antifibrotic therapy with nintedanib or pirfenidone slows annual FVC decline by approximately 44% to 57% in individuals with IPF, scleroderma associated ILD, and in those with progressive pulmonary fibrosis of any cause, making it a crucial consideration in the management of ILD caused by biologic dusts.