From the Guidelines
Beryllium lung disease is a serious occupational condition that requires immediate medical attention, and individuals with suspected exposure should seek evaluation as early detection and treatment can improve quality of life 1.
Diagnosis and Treatment
Beryllium lung disease, also known as chronic beryllium disease (CBD) or berylliosis, is caused by inhaling beryllium dust or fumes, primarily affecting workers in industries that process beryllium, such as aerospace and electronics manufacturing 1. The disease develops when susceptible individuals become sensitized to beryllium, triggering an immune response that leads to the formation of granulomas in the lungs. Symptoms include:
- Shortness of breath
- Persistent dry cough
- Fatigue
- Weight loss
- Chest pain
- Reduced lung function Diagnosis involves a combination of occupational history assessment, chest X-rays, pulmonary function tests, and the beryllium lymphocyte proliferation test (BeLPT) to confirm beryllium sensitivity 1.
Prevention and Screening
Treatment typically consists of corticosteroids like prednisone to suppress inflammation, along with oxygen therapy for those with reduced oxygen levels 1. There is no cure for CBD, so prevention through proper workplace safety measures is crucial. Lung cancer screening with LDCT is appropriate to consider for patients at high risk for cancer who are potential candidates for definitive treatment, and agents like beryllium are identified as carcinogens targeting the lungs, increasing the risk of lung cancer 1.
Management
All current smokers should be advised to quit smoking, and former smokers should be advised to remain abstinent from smoking, as smoking cessation is essential for reducing the risk of lung cancer 1. Lung cancer screening should not be considered a substitute for smoking cessation, and individuals with suspected beryllium exposure should seek medical evaluation to slow disease progression and improve quality of life 1.
From the FDA Drug Label
7 Respiratory Diseases Symptomatic sarcoidosis Loeffler’s syndrome not manageable by other means Berylliosis Fulminating or disseminated pulmonary tuberculosis when used concurrently with appropriate antituberculous chemotherapy Aspiration pneumonitis The drug Prednisone is indicated for Berylliosis, which is a lung disease caused by exposure to beryllium.
- Berylliosis is listed as one of the conditions for which Prednisone is used as part of the treatment for Respiratory Diseases 2.
From the Research
Beryllium Lung Disease
- Beryllium lung disease, also known as chronic beryllium disease (CBD), is a condition that occurs when the body's immune system reacts to beryllium, a lightweight metal used in various industries 3.
- Exposure to beryllium can lead to sensitization (BeS) and CBD, with the beryllium lymphocyte proliferation test being the cornerstone of both medical surveillance and diagnosis 3, 4.
- The determinants of progression from BeS to CBD are uncertain, but higher exposures and the presence of a genetic variant in the HLA-DP β chain appear to increase the risk 3.
Diagnosis and Management
- A confirmed abnormal beryllium lymphocyte proliferation test without evidence of lung disease is diagnostic of BeS, while BeS with evidence of a granulomatous inflammatory response in the lung is diagnostic of CBD 3.
- Medical surveillance in workplaces that use beryllium-containing materials can identify individuals with BeS and at-risk groups of workers, which can help prioritize efforts to reduce inhalational and dermal exposures 3.
- Corticosteroid therapy is typically administered when a patient with CBD exhibits evidence of significant lung function abnormality or decline 3.
- Inhaled corticosteroids (ICS) may improve symptoms of cough and dyspnea in patients with CBD, especially in those with obstruction and air trapping 5.
Treatment Options
- The use of mycophenolate mofetil (MMF) or azathioprine (AZA) has been explored as alternative therapies for chronic hypersensitivity pneumonitis (cHP) and myositis-related interstitial lung disease (M-ILD) 6, 7.
- Treatment with MMF or AZA has been associated with improvements in diffusion capacity of the lung for carbon monoxide (Dlco) in patients with cHP 6.
- In M-ILD, AZA treatment was associated with improved forced vital capacity (FVC) % predicted and Dlco % predicted, and lower prednisone dose 7.