Envrionmental And Occupational Lung Diseases

Question 1

Environmental/ occupational exposure lung diseases

Answer 1

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

Question 2

Inorganic Pneumoconioses

Answer 2

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

Question 3

Organic pneumoconioses

Answer 3

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

Question 4

Hypersensativity pneumonitis

Answer 4

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

Question 5

Endemic myocosis

Answer 5

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)

Question 6

Histoplasmosis

Answer 6

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

Question 7

Coccidiomycosis

Answer 7

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

Question 8

Blastomycosis

Answer 8

Caused by blastomyces dermatitdis

Seen most east of the Mississippi River in the US

Symptoms = mostly pneumonia like symptoms

Treatment is itraconazole