Environmental influences of Lung Disease

Question 1

Exhaled nitric oxide (FeNO) or (eNO)

Answer 1

Simple measure of nitric oxide in exhaled breath
Simple machines able to do this
Measured in ppt
Generally increased in asthma
Not diagnostic
A reflection of eosinophilia airway inflammation
High> 50ppb, normal < 225 ppb

Question 2

Workplace causes of asthma- These are high molecular weight allergens

Answer 2

Grain
Wood
Animals, fish
Latex
Flour

Question 3

Workplace causes of asthma- these are low molecular allergens

Answer 3

Gluctaraldehyde
Isocyanates
Paints
Metal working fluids
Metal

Question 4

What is asthma

Answer 4

Common, chronic inflammatory disease of the airways characterised by variable and recurring symptoms
Reversible airflow obstruction and bronchopasm

Sometimes the muscles that line your bronchi tighten and cause your airways to narrow. This is called a bronchospasm

Question 5

Common symptoms of asthma

Answer 5

wheezing, coughing, chest tightness, and shortness of breath

Question 6

Asthma epidemiology

Answer 6

5-16% of people worldwide have asthma
Wide variation between countries

Increase in prevalence second half of the 20th century
Now plateaued mostly
US study; Poorer individuals, African-Americans

Question 7

Environmental influences of importance

Answer 7

pollens, infectious agents, fungi, pets, animals, air pollution

Question 8

Pollens

Answer 8

Thunderstorms increase pollen levels, leading to increased asthma

Question 9

Infectious agents and microorganisms

Answer 9

Farm life protected the subsequent development of asthma
Early and in utero life seem to have an important role
Specific agents not identified, but likely to be a mix of bacterial and other agents, potentially altering GI immune response
Airway bacteria may also play a role in causing asthma, role of rhinovirus

Question 10

Fungi

Question 11

Air pollution- aggregates lung disease

Answer 11

Responses to pollutants can be comparable to viral responses

Asthma hospitalisations relate to PM2.5 and PM10 (PM means particulate matter)

Question 12

Air pollution- including allergy less clear

Answer 12

NO exposure in the first year of life related to pollen sensitisation at 4 years old
Increasing evidence

Question 13

Hypersensitivity Pneumonitis

Answer 13

is an inflammation of the alveoli within the lung caused by hypersensitivity to inhaled dusts.

Acute, sub acute and chronic forms

Immune complex related disease
Antigen reacts with antibody
Normally IgG response

Very significant environmental influences; farmers lung, bird fanciers lung, metal working fluids

Question 13

Hypersensitivity Pneumonitis

Answer 13

is an inflammation of the alveoli within the lung caused by hypersensitivity to inhaled dusts.

Acute, sub acute and chronic forms

Immune complex related disease
Antigen reacts with antibody
Normally IgG response
Very significant environmental influences; farmers lung, bird fanciers lung, metal working fluids

Question 14

COPD

Answer 14

Chronic obstructive

pulmonary disease (COPD) is a type of obstructive lung disease characterized by chronically poor airflow. It typically worsens over time, with the main symptoms include: shortness of breath,
cough, and sputum production

Typified by airways obstruction
(FEV1/FVC ratio < 0.7)

Question 15

Causes of COPD

Answer 15

The commonest cause is tobacco smoking (PAR %80)

Other causes include
-occupational, environmental
-biomass fuels globally are recognised as a cause

Question 16

COPD and other exposures

Answer 16

Silica
Coal
Grain
Cotton
Cadmium

Question 17

Hot Tub lung

Answer 17

Hot tub use in general identified as a cause of Extrinsic allergic alveolitis EAA