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T2: Theme 4: Lungs > Lecture 15: Occupational lung disease > Flashcards

Lecture 15: Occupational lung disease Flashcards

1
Q

What % of lung disease is related to COPD?

A

32%

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2
Q

What % of lung disease is related to non-asbestos lung cancer?

A

22%

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3
Q

What % of lung disease is related to asbestos lung cancer?

A

20%

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4
Q

What % of lung disease is related to mesothelioma?

A

20%

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5
Q

What occupational lung diseases are there?

A

COPD

Malignant diseases - lung cancer (asbestos and non asbestos related) - mesothelioma

Occupational asthma

Pneumoconioses (mineral dust)

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6
Q

What are the pneumoconioses?

A

Coal Workers’ Lung

Asbestosis

Silicosis

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7
Q

Who gets silicosis?

A 
Slate workers Potters 
Knife grinders 
Hard rock miners 
Sand-blasting
Foundry workers
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8
Q

What is silicosis?

A

Fibrotic lung disease

Activation of macrophages

Restrictive lung function deficit

Eggshell calcification of lymph nodes

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9
Q

How can you improve pneumoconiosis?

A

Prevent further exposure

Stop smoking

Monitor lung function

Symptomatic treatment

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10
Q

What are the benign consequences of asbestos exposure?

A

Pleural plaques (marker of exposure)

Benign pleural effusion

Pleural thickening (with subsequent restriction on lung function)

Asbestosis- interstitial lung disease-restrictive lung function (FEV1/FVC> 0.7) with reduction in forced vital capacity (FVC) and reduced gas transfer

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11
Q

What are the malignant consequences of asbestos exposure?

A

Lung cancer

Mesothelioma

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12
Q

What is the relative risk of lung cancer in asbestosis?

A

7x in non-smokers

93x in smokers

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13
Q

What is mesothelioma?

A

Malignancy of pleura and peritoneum caused by asbestos

Consider in with patient with history of asbestos exposure

  • Pleural plaques on previous chest x-rays
  • Persistent unexplained chest pain
  • Weight loss
  • Breathless/unilateral pleural effusion
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14
Q

What are the two scenarios of occupational asthma?

A

Occupational asthma that is caused by workplace exposures

Work-aggravated asthma in which pre-existing cases are made worse by factors in the workplace

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15
Q

What are the differentials of occupational asthma?

A

COPD
Heart failure
Interstitial lung disease

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16
Q

What are other risk factors of occupational asthma?

A

Atopy
Rhinitis
Smoking

17
Q

What are the roles of challenge testing?

A

Confirm diagnosis when new agent blamed

Identify responsible agent when multiple sensitisers in workplace

Confirm diagnosis when history & PEFR records are equivocal

(Rarely) to exclude diagnosis in patient who will otherwise lose their job

18
Q

How is challenge testing carried out in asthma?

A

Asthma should be stable

Withhold bronchodilators

A placebo exposure day is advisable

Equipment that delivers known concentration of suspected agent

Monitor spirometry for several hours after each increase in exposure dose

May take several days

19
Q

What are the high molecular weight molecules associated with allergic occupational asthma?

A

Proteins, polysaccharides

80-90% cases

Sensitisation with latency period (weeks-years)

IgE-dependent

Skin prick/allergy testing

  • Flour (bakers)
  • Animals (farmers)
  • Latex
  • Enzymes (eg detergents)
20
Q

What are the low molecular weight molecules associated with allergic occupational asthma?

A

Mechanism poorly understood

Usually independent of IgE

Limited utility of skin prick/allergy testing

  • Isocyanates (printing, plastics)
  • Metals (welders)
  • Dyes (hairdressers)
21
Q

What is irritant-induced (non-allergic) asthma?

A

Direct effect on airways, not immune-mediated, occurs without pre-existing asthma

Acute:

  • Reactive Airways Dysfunction Syndrome (RADS)
  • Develops within hours of a single, very high exposure to an irritant

Subacute:
- Insidious onset of asthma symptoms after multiple moderate/high exposure incidents

22
Q

What are some causative agents of RADS?

A 
Caustic vapours	
Ammonia		
Fire/Smoke
Chlorine 
Tear Gas	
Floor Sealants
23
Q

What is a toxin?

A

A naturally occurring poison produced within living cells or organisms

Botulinum, Ricin, Snake venom

24
Q

What is a pollutant?

A

Any substance that contaminates the environment

25
Q

What are the different factors that are important in exposure?

A

Concentration of toxin/pollutant

Duration

Intensity (exercise etc)

Route (skin vs inhaled)

Metabolism of toxin

26
Q

What are the different factors that are important in susceptibility?

A

Genetic factors - protective effect of HbS against falciparum malaria

Co-morbidity / underlying diseases that augment clinical impact of toxic load

Environmental factors - heat waves, cold snaps, smogs

27
Q

What are primary pollutants from vehicle exhausts?

A

From fossil fuel combustion

  • Nitrogen oxide
  • Sulphur dioxide (diesel)
  • Carbon monoxide
  • Particulate matter
28
Q

What are secondary pollutants from vehicle exhausts?

A

From reactions between pollutants in the atmosphere

29
Q

What are the outdoor sources of NO?

A

Vehicle exhausts

Power stations

30
Q

What are the indoor sources of NO?

A

Fuel burning cookers

Unflued heaters

Cigarette smoke

31
Q

What is the importance of NO in lung disease?

A

Associated with COPD and asthma related morbidity and mortality

Augments response to inhaled allergens

Increases likelihood that URTI will cause wheezing in children

32
Q

What are the health effects of ground level ozone?

A

Decrease lung function

Pro-inflammatory effects:

  • Increase cytokines (IL-6, IL-8, GM-CSF)
  • Neutrophilic bronchitis

Increase response to inhaled allergens

Increase respiratory morbidity

33
Q

What airway elements are affected by particulate matter in asthma?

A

Airway cilia

Mucous production

Oxidative stress to cell DNA

Induction of epithelial apoptosis

Promotes airway inflammation and ↑ IgE production

34
Q

How can you reduce occupational exposure?

A

FFP masks

ventilation

35
Q

How can you reduce environmental exposure?

A

Air quality warnings

Remain indoors, close windows

Minimise duration/intensity of outdoor activities

T2: Theme 4: Lungs (16 decks)

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