Envrionmental And Occupational Lung Diseases Flashcards
Environmental/ occupational exposure lung diseases
Can be obstructive or restrictive, as well as upper or lower tracts
In order to diagnose, good history is especially imperative to note.
- HPO and ROS as well as occupation and exposure history
Labs/tests to determine
- PFT
- Spirometry
- bronchoscope
- lung biopsy
- chest xrays
- HRCT’s
Inorganic Pneumoconioses
Broad grouping of a lot of occupational exposures, which includes the following:
1) asbestos
- leads to mesothelioma, pleural diseases and lung cancer
- usually lower lungs affected
2) silica inhalation
- leads to cancer, fibrosis, COPD and TB
- usually upper lungs affected
- MOST common ( other than cigarettes)
3) coal dust
- leads to fibrosis and COPD
- usually upper lungs affected
4) beryllium exposure
- leads to acute pneumonitis, chronic granulomatous disease and lung cancers
- affects all parts of the lungs equally
Organic pneumoconioses
Broad grouping of a lot of occupational exposures, which includes the following:
1) cotton dust/milling
- leads to Byssinosis, chronic bronchitis and COPD
2) grain dust
- leads to asthma, chronic bronchitis and COPD
3) fungal spores
- leads to hypersensativity, farmers lung, valley fever, and chronic bronchitis
4) toxic chemicals
- leads to COPD, chronic bronchitis, cancer
5) uranium and radon exposure
- leads to 10% of all lung cancers. Also shows fibrosis and COPD
Hypersensativity pneumonitis
Inhalation of an antigen once type 1 sensitivity early phase is already set up
- seen in bacteria, yeast, fungi and dust agents
- most common is thermophillic actinomycetes
Signs/symptoms
1) acute/subacute
- fever, chills, myalgia, headache, coughing, dyspnea and tightness
2) chronic
- all of acute symptoms plus:
- clubbing of fingers, hypoxemia, restrictive lung physiology, fibrosis on HRCT
Treatment:
- systemic corticosteroids
- remove antigen exposure
Endemic myocosis
Environmental fungal causes of lung disease. The following four are the most common:
1) histoplasmosis (central US regions)
- coccidiomycosis (south west US”valley fever”)
- blastomycosis (northern and north-eastern US regions)
- paracoccidiomycosis (Central America and South America)
Histoplasmosis
Fungus Histoplasma capsulatum
Seen most often in Mississippi and ohio river valley areas
Most commonly associated with bird/bat droppings
Symptoms/signs
- most commonly asymptomatic*
- flu-like illness, fever, myalgia, coughing, chest pain
- nodules dispersely throughout chest xray
- diagnose w/ urinary and serum antigens
Treatment:
- azoles if needed
Coccidiomycosis
Caused by coccidioides posadasii
Seen most in southwestern US (AZ is most common)
- valley fever
Signs/symptoms
- flu-like illness
- mild respiratory illness appearing
- large infiltrates seen on chest xray (not always there)
Treatment
- self limiting is common
- if not self- limiting, treatment is azoles
Blastomycosis
Caused by blastomyces dermatitdis
Seen most east of the Mississippi River in the US
Symptoms = mostly pneumonia like symptoms
Treatment is itraconazole