Lung disease Flashcards
What is pneumoconosis
describes interstitial fibrosis secondary to occupational exposure causing an inflammatory reaction.
pneumoconioses…?
group of lung diseases caused by the lung’s reaction inhaling certain dusts.
most common death relating to work in the UK
asbestos
Aetiology of OCLD
- Coal worker’s pneumoconiosis: exposure to carbon in coal mines
- Silicosis: sandblasters, quarry workers and silica miners
- Berylliosis: aerospace industry and beryllium miners
RF for ocl
- male- prevalence in the coal mining industry
- increasing age
- substance exposure
Pathophysiology of ocld
- dust particles are inhaled which reach the terminal bronchioles
- dust ingested by interstitial and alveolar macrophages
- dust expelled as mucus
over time the process of expelling mucous becomes dysfunctional
What occurs when mucus production no longer occurs
- macrophages accumulate in alveoli
- immune system activation
- fibroblasts arrive on scene and try repair the damage
- Fibroblasts leave depositions of collagen
Most common location of deposits
upper lobes
How would progressive massive fibrosis present
- exertional breathlessness
- cough with black sputum
sign of pneumoconosis
- Fine crackles
- Wheezing
- Clubbing
symptoms of OCL?
- Exertional dyspnoea
- Dry cough
- May be productive of black sputum in progressive massive fibrosis
- Wheezing
- Haemoptysis
- Weight loss
Coal workers pneumoconiosis
- Mild exposure is often asymptomatic
- Significant exposure can lead to ‘progressive massive fibrosis’
- Upper zonefibrosis
iNVESTIGATIONS ?
- CXR- to check for fibrosis
- Spirometry- typically FEV1/ FVC
- High resolution CT chest
- Rheumatoid Factor and ANA
What may a CXR show
- Nodular opacities in the upper zones are classical of silicosis and coal workers’ lungs.
- In advanced disease, there is calcification of hilar lymph nodes known as eggshell calcification.
Staging classification ?
- Category 0: small rounded opacities are absent or less profuse than category 1
- Category 1: small rounded opacities are present but few in number
- Category 2: small rounded opacities are numerous, but normal lung markings are visible
- Category 3: small rounded opacities are very numerous, with normal lung markings partially or totally obscured
Treatment?
Uncurable
- smoking cessation
- pulmonary rehabilitation
- supplementary oxygen
- corticosteroids
- lung transplantation
Complications ?
- lung cancer
- cor pulmonale
- TB
- Caplan Syndrome
What to remember about occupational asthma?
- Latent period
- Deteriorating symptoms
- Gradual improvement
- Most jobs – in exams – wood, flour, metal
working fluids, isocyanate paint. - Depression
- Reduced quality of life
What are the features of asbestosis ?
- interstitial lung fibrosis
- long latency
- no effective treatment
- may progress slowly
what is mesothelioma
Rapidly progressive and
incurable pleural cancerencasing lung.
* Often presents as an
unexplained pleural effusion
* Progressive breathlessness,
chest pain, weight loss
social aspects post diagnosis
unemployment (up to one third of OA)
* loss of earnings
* chronic resp ill health
* depression
* loss of self worth
* breakdown of relationships
