M103 T4 L17 Flashcards
What are the different types of occupational lung diseases?
COPD
Malignant diseases
Occupational asthma
Pneumoconioses (mineral dust)
What are examples of malignant occupational lung diseases?
Lung cancer (asbestos and non asbestos related) Mesothelioma
What are examples of pneumoconioses? (CAS)
Coal Workers’ Lung
Asbestosis
Silicosis
What are pneumoconioses caused by?
the inhalation of certain dusts
the lung tissue’s reaction to the dust
Which job occupations are linked to silicosis?
Slate workers (Wales) Potters (Stoke-on-Trent) Knife grinders (Sheffield) Hard rock miners (Canada etc) Sand-blasting Foundry workers
What is silicosis a risk factor for?
lung cancer
TB
What is the main aim for treatment of pneumoconioses?
to prevent further exposure
Which symptoms of pneumoconioses have to be managed? (BCCD)
breathlessness, cough, cor pulmonale & dyspnoea
Which areas was asbestos historically mined in?
Canada
Australia
South Africa
How did asbestos get to the UK?
it was imported via docks (esp Southampton)
When was asbestos widely used?
in the 1930s-70s
What was asbestos used in?
building (roofs, insulation, plumbing) power stations ship-building (engine rooms, bulkheads) railways cars (brake pads)
Other than from working in astestos-containing environments, how else could people get related illnesses?
family members at home who washed contaminated clothes
When did Europe bring in a ban on all forms of asbestos?
2005
Is asbestos still used?
yes, there are other countries outside of teh EU that are mining and exporting asbestos
Which benign conditions can asbestos cause?
pleural plaques / thickening
benign pleural effusion
asbestosis
What is the effect of pleural thickening?
restriction on lung function
What do pleural plaques indicate?
they are a marker of exposure
What pattern is seen on the lung function of a patient with penumoconioses?
a restrictive pattern of abnormality
How would FVC and gas transfer of a patient with pneumoconioses be affected?
FVC - reduced
gas transfer - reduced
Which malignant diseases can asbestos cause?
lung cancer
mesothelioma
What features of a patient history can indicate a malignant disease caused by asbestos?
Pleural plaques on previous CXRs
persistent unexplained chest pain
Weight loss
Breathless / unilateral pleural effusion
What are the two distinct scenarios of asthma related to work?
occupational
work-aggrevated
What is occupational asthma caused by?
by workplace exposure to asbestos
What is work-aggrevated asthma caused by?
by pre-existing cases that are exacerbated by asbestos in the workplace
What are the other risk factors of occupational asthma? (SAR)
smoking
atopy
rhinitis
What are two types of features in substances might lead to allergic occupational asthma?
HMW (80-90% cases)
LMW
Which HMW substances can be assessed for by skin prick / allergy testing? (FALE)
Flour (bakers)
Animals (farmers)
Latex
Enzymes (eg detergents)
What is the relationship between LMW or HMW substances and IgE antibodies?
low - independent of IgE
high - IgE-dependent
Which LMW substances can be assessed for by skin prick / allergy testing in limited circumstances?
Isocyanates (printing, plastics)
Metals (welders)
Dyes (hairdressers)
What might be a consequence of irritant induced asthma?
the patient developing asthma
What are the two types of irritant induced asthma?
acute
subacute
What is an example of an acute irritant induced asthma?
Reactive Airways Dysfunction Syndrome
What substances can cause Reactive Airways Dysfunction Syndrome?
Can Chlorine Arise From Teachers Failing
Caustic vapours Chlorine Ammonia Fire/Smoke Tear Gas Floor Sealants
What factors does exposure to a certain toxin depend on?
the concentration of the toxin / pollutant
the duration and intensity of the exposure
the route by which the exposure occured (skin vs inhaled)
the mechanism and metabolism of the toxin
any co-morbidities of the patient
Which factors determine a patient’s susceptibility to developing allergic occupational asthma?
Genetic factors
Co-morbidity / underlying diseases
Environmental factors
Which Genetic factor might contribute to a patient developing allergic occupational asthma?
the protective effect of HbS against falciparum malaria
What are examples of Environmental factors that might contribute to a patient developing allergic occupational asthma?
Heat waves
cold snaps
smogs
Why might a co morbidity contribute to a patient developing allergic occupational asthma?
the co morbidity might augment the clinical impact of the toxic load
What is the difference between primary and secondary pollutants?
1o - are from fossil fuel combustion
2o - are from reactions between pollutants in the atmosphere
What are examples of primary pollutants?
Nitrogen oxide
Sulphur dioxide (diesel)
Carbon monoxide
Particulate matter
What are the outdoor sources of NO?
vehicle exhausts
power stations
What are the indoor sources of NO?
fuel burning cookers
unfueled heaters
cigarette smoke
What conditions are NOs associated with?
COPD
asthma
What are the health effects of ground level ozone?
decreases lung function
decreases pro-inflammatory effects
increases response to inhaled allergens
increases respiratory morbidity
What structures in the airways are affected by particulate matter?
cilia
cell DNA
mucus
epithelium
What is the effect of airway structural elements on the human body?
affects airway structural elements
promotes airway inflammation
promotes IgE production
What are the two categories of exposure that can be reduced?
Occupational
Environmental
What can be done to reduce Occupational exposure to pollutants?
the use of FFP3 masks
Ventilation / extraction of chemicals
What can be done to reduce Environmental exposure to pollutants?
Air quality warnings
Remain indoors, close windows
Minimise duration/intensity of outdoor activities
Why are airway provocation tests performed in the first place?
bc people with sensitive lungs will be affected by a much lower dose of this medication than people with healthy lungs
What is the objective of airway provocation tests?
to carefully to make sure specific drugs for individual patients is safe
How do airway provocation tests work?
by breathing in gradually increasing doses of a medication that can irritate the airways and cause them to get narrower
g What structures are indicative of Progressive Massive Fibrosis on CXRs?
a fibrotic pneumoconiotic lesion with a diameter of x > 1cm
the formation of large mass-like conglomerates, predominantly in the upper pulmonary lobes
g What are the consequences of Progressive Massive Fibrosis?
progressive scarring, causes stiff lungs
g What is Progressive Massive Fibrosis primarily caused by ?
conioses, which results in the activation of alveolar macrophages, which phagocytose dust particles after their deposition
What medication is used to manage a cough & breathlessness?
opiates
What medication is used to manage r. HF?
diuretics
What can specific IgE assays test for?
allergic reactions in most HMW allergens and some LMW agents
What are the effects of particulate matter in the airways?
Mucous production
Oxidative stress to cell DNA
Induction of epithelial apoptosis
What is the difference between FFP 1, FFP 2 or FFP 3 masks?
the higher the number, the better the protection against toxic substances
