From the Guidelines
The medical management of chronic cough secondary to asbestosis exposure should focus on symptom relief, as the condition is irreversible, and treatment typically begins with bronchodilators such as albuterol or ipratropium bromide to help relieve bronchospasm and improve airflow, as recommended by the American College of Chest Physicians 1.
Key Considerations
- The diagnosis of nonmalignant asbestos-related disease, including asbestosis, implies a lifelong elevated risk for asbestos-related cancer, as stated in the American Journal of Respiratory and Critical Care Medicine 1.
- Treatment of chronic cough due to asbestosis involves a multimodal approach, including bronchodilators, inhaled corticosteroids, and cough suppressants, with the goal of managing symptoms and improving quality of life.
- The use of bronchodilators such as albuterol (2 puffs every 4-6 hours as needed) or ipratropium bromide (2 puffs four times daily) is recommended to relieve bronchospasm and improve airflow, as supported by the ACCP guidelines 1.
- Inhaled corticosteroids like fluticasone (250-500 mcg twice daily) or budesonide (180-360 mcg twice daily) may be used to reduce airway inflammation and cough severity in patients with significant inflammation.
- Centrally acting cough suppressants such as codeine (15-30 mg every 4-6 hours) or dextromethorphan (30 mg every 6-8 hours) may be used to manage persistent cough, but should be used cautiously due to potential for dependence or side effects.
- N-acetylcysteine (600 mg twice daily) may help thin mucus secretions and improve symptoms.
- Pulmonary rehabilitation, supplemental oxygen for hypoxemia, and pneumococcal and annual influenza vaccinations are important adjunctive measures to improve quality of life and reduce morbidity.
Monitoring and Follow-up
- Regular follow-up with pulmonary function tests every 6-12 months is essential to monitor disease progression and adjust treatment accordingly, as the condition is irreversible and requires ongoing management.
- The goal of treatment is to manage symptoms, improve quality of life, and reduce morbidity, rather than reversing the underlying fibrotic lung damage caused by asbestos fibers.
From the Research
Medical Management of Chronic Cough Secondary to Asbestosis Exposure
The medical management of a chronic cough secondary to asbestosis exposure involves a comprehensive approach to diagnose and treat the underlying condition.
- The initial assessment should include cost-effective diagnostic tests such as chest radiography and spirometry, as well as empiric and targeted treatment for the most common etiologies 2.
- An assessment of medications, environment, occupation, and potential chemical triggers should be conducted 2.
- Patients with a history of significant asbestos exposure may warrant diagnostic testing and follow-up assessment, although it is unclear whether this improves outcomes 3.
- Treatment of patients with asbestos exposure and lung cancer is identical to that of any patient with lung cancer, and smoking cessation is essential 3.
- Patients with asbestosis or lung cancer should receive influenza and pneumococcal vaccinations 3.
Treatment Options
- For chronic refractory cough, physiotherapy and speech and language therapy combined with a trial of gabapentin or amitriptyline can be considered 2.
- Inhaled long-acting bronchodilators such as tiotropium or salmeterol can be used to alleviate symptoms and reduce the risk of exacerbations in patients with moderate-to-very-severe chronic obstructive pulmonary disease (COPD) 4, 5.
- Tiotropium has been shown to be more effective than salmeterol in preventing exacerbations of COPD 5.