Treatment algorithm

Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups: see disclaimer

ONGOING

all patients

1st line – advice on importance of not smoking

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ONGOING
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all patients
1st line – 

advice on importance of not smoking

This is the most important physician intervention given the synergy between cigarettes and asbestos for increasing the risk of lung cancer.

The increased risk of lung cancer in nonsmoking asbestos workers is 5.2, in smoking nonasbestos-exposed individuals the risk is 10.8, but in smoking asbestos workers the risk of lung cancer is increased 53-fold.[25]

Plus – supportive care

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ONGOING
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all patients
Plus – 

supportive care

Treatment recommended for ALL patients in selected patient group

Antibiotics should be given if there is evidence of infection, such as change in sputum production, fever and increasing dyspnea.

Patients with evidence of obstructive airways disease should receive appropriate bronchodilator therapy.

Consider – pulmonary rehabilitation ± oxygen therapy

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ONGOING
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all patients
Consider – 

pulmonary rehabilitation ± oxygen therapy

Treatment recommended for SOME patients in selected patient group

Pulmonary rehabilitation is designed to reduce symptoms and optimize functional status. It involves exercise training, education, nutritional intervention, and psychosocial support and is recommended by the American Thoracic Society for patients with interstitial lung disease.[31][32]​ There is low- to moderate-quality evidence for improvements in dyspnea and quality of life for people with interstitial lung disease, and moderate-quality evidence for improvements in exercise capacity.[32][33] Further studies are needed to establish the optimal exercise prescription and to determine the long-term benefits.[33]

Patients with progressive fibrosis and PaO₂ of ≤55 mmHg or oxygen saturation of ≤89% are candidates for oxygen therapy.[34]

Oxygen therapy improves exercise tolerance and reduces the risk of developing pulmonary hypertension and cor pulmonale.

2nd line – pleural decortication or lung transplant

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all patients
2nd line – 

pleural decortication or lung transplant

A patient may develop diffuse pleural thickening of sufficient extent that pleural decortications should be considered. However, this is very rare and pleural thickening does not usually require treatment.

Patients with end-stage respiratory failure (PaO₂ <60 mmHg despite oxygen therapy) due to parenchymal disease are potential candidates for lung transplants.[35]

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Choose a patient group to see our recommendations

Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups. See disclaimer

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