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Variable Response to Long-term Corticosteroid Therapy in Chronic Beryllium Disease^*

^* From the Division of Pulmonary and Critical Care Medicine (Dr. Sood), Southern Illinois University School of Medicine, Springfield, IL; University of Rochester School of Medicine and Dentistry (Dr. Beckett), Rochester, NY; and Yale Occupational and Environmental Medicine Program (Dr. Cullen), Yale University School of Medicine, New Haven, CT.

Correspondence to: Akshay Sood, MD, MPH, Southern Illinois University School of Medicine, Division of Pulmonary and Critical Care Medicine, 701 North First St, Room D434, PO Box 19636, Springfield, IL 62794-9636; e-mail: asood2{at}siumed.edu

Objectives: Chronic beryllium disease (CBD) shares many of its characteristics with sarcoidosis and is often treated with corticosteroids. There is limited available literature regarding the effect of long-term corticosteroid therapy on the natural history of CBD.

Methods and materials: We conducted an observational retrospective study of six patients with CBD who received prolonged corticosteroid treatment with a mean pulmonary function test follow-up period of 10.1 years. Five of the six patients were exposed to beryllium at the same workplace. The diagnosis in four of the six cases was confirmed by a positive beryllium lymphocyte proliferation test result on blood or BAL fluid. Periodic pulmonary function tests were analyzed in relation to removal from beryllium exposure and treatment with corticosteroids.

Measurements and results: Two broad patterns of response were noted in these patients. The first pattern seen in two patients showed no improvement in FVC or diffusion capacity of the lung for carbon monoxide (DLCO) with corticosteroids. However, a significant improvement in these parameters was noted on cessation of beryllium exposure in one of the two patients. The second pattern showed an initial improvement in FVC and DLCO with corticosteroids, which was not sustained. An improvement was noted on stopping beryllium exposure.

Conclusions: The response to long-term corticosteroids in CBD, quite like that in sarcoidosis, is variable. Significant lung function improvement may be seen following cessation of beryllium exposure.

Key Words: beryllium • chronic beryllium disease • corticosteroids • sarcoidosis

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