Occupational and Environmental Lung diseases Flashcards
General Considerations of Occupational and Environmental lung diseases?
A worldwide problem – Diverse group of diseases Exposures are a major cause of respiratory diseases
Lung diseases caused by inhalation of particular matter or gases and fumes in the workplace or environment
Site of deposition of inhaled matter in the respiratory tract is dependent upon water solubility for gases and fumes and particle size for solids
History of the patient with occupational/environmental lung disease?
- Medical history
- Occupational history All jobs held past to present, job details/work environment, how long worked at the job
- Environmental history
- Pets
- Hobbies
- Travel history
- Social history
- Smoking history
Approach to a patient with suspected occupational/environmental?
- Physical exam
- PFT – Spirometry, lung volume, DLCO – ± Bronchoprovocation test
- Radiology imaging: – Chest x-ray, – CT thorax
- Lab – ± Serology studies, and skin test depending upon disease under consideration
Ask yourself Why did this patient develop this illness? Is there an intervention to prevent disease progression
What factors play into occupational/environmental exposure?
- Where deposition occurs with the respiratory tract
- Concentration of material retained
- Dose of exposure
- Physical and chemical properties of the matter
- Host susceptibility: Anatomy of the airway, Clearance mechanism, Genetic make up of the host, Immune status, Underlying/coexisting lung disease
For gases and fumes what deteremines level of penetration? For particular matter what determines the level of deposition?
For gases/fumes solubility determines level of penetration
High soluble gases are trapped in the moist lining of the upper airway
Low soluble gases can reach the lower lung parenchyma down to the alveoli
For particular matter the particle size or aerodynamic diameter is of greatest importance in determining the level of deposition Inhaled particles of dust <5mm can reach the terminal bronchioles and alveoli
List the different gases and where they deposit based off of where they go in the lung?
Pulmonary disease is related to?
Pulmonary disease risk is related to the total burden of inhaled particles.
Toxic inhalation lung injury? Due to? Level of deposition depends on? Pathologically dependent on?
Due to chemical release into the atmosphere as gases, fumes or mist
Level of deposition in the respiratory tract depends on the chemicals water solubility High: Nose and oropharynx Intermediate: Trachea, upper lung zone, bronchi Low: Lower lung, bronchioles, and alveoli
Pathologically dependent on physical properties of inhaled substance and host factors
What is Silo Filler’s Disease? Different ppm of nitrogen oxides and what they manifest to?
Oxides of nitrogen (primarily NO2) releases as a byproduct of decomposing silage, typically corn or alfalfa
Oxides of nitrogen low water solubility putting the lower respiratory tract at risk
15-25 ppm: Acute mucous membrane irritation eyes and throat
25-100 ppm: Toxic pneumonitis and bronchiolitis often with smothering sensation and dyspnea
>150 ppm: Often fatal obstructive bronchiolitis, chemical pneumonitis, and pulmonary edema
Symptoms of Silo Filler’s? Treatment?
Symptom onset may be delayed, hours after exposure patients may develop severe pulmonary edema resembling ARDS
Relapse 3-6 weeks after initial exposure cough, chills, fever, dyspnea
Treatment: Removal from the environment Consider corticosteroids
Air pollution can be caused by?
Air pollution can be caused by a wide range of substances in the environment. Particulate matter and volatile organic compounds are the major contributors.
Air pollution can lead to?
Explain indoor air pollution?
- Common in developing countries where around 3 billion people use biomass fuels for heating and cooking
- Over 4 million premature deaths attributed from cooking with solid fuels: Wood, charcoal, crop residues, dung
- More than 50% f premature deaths due to pneumonia among children under 5 caused by particulate matter
4.3 million people a year die premature from illness attributable to household air pollution due to biomass fuels for cooking • 12% are due to pneumonia • 34% are due to stroke • 26% from ischemic heart disease • 22% from chronic obstructive pulmonary disease (COPD) • 6%% from lung cancer
What is Pneumoconiosis?
Derived from the Greek term Pneumo meaning “Breath” And Konis meaning “Dust”
Fibrotic lung diseases following inhalation of inorganic dust
What are the three major types of Pneumoconiosis?
- Silicosis
- Coal Worker’s Pneumoconiosis
- Asbestosis and other asbestos related lung disease
What is Silicosis?
Most prevalent chronic occupational disease worldwide
A diffuse parenchymal lung disease due to exposure to silica (quartz)
Pattern of disease depends on intensity of exposure and duration
Pathology cytotoxic effect of silica on alveolar macrophage
Hallmark lesion silicotic nodule (small)
What are the three forms of Silicosis?
- Chronic (10-20 years after exposure)
- Accelerated (<10 years after exposure) Change similar to chronic but more intense
- Acute (weeks to 4-5 years) Classic example: sandblasting
Explain chronic Silicosis?
Silicotic nodule
Lower dust concentration than accelerated or acute
single chronic silicosis nodules can coalesce and lead to complicated chronic complicated nodules which coalesce to large mass (PMF)
PMF progressive massive fibrosis
Chest x-ray of Silicosis? for chronic? Accelerated? Acute?
Chronic disease: 1°involves upper lung zones
Nodules can coalesce → large masses spoken of as Progressive Massive Fibrosis (PMF) May see “egg shell calcification” in hilar lymph nodes
Chest x-ray: Accelerated similar to chronic
Chest x-ray: Acute mid-lower lung zone ground-glass opacities
Increased risk for what with Silicosis? Treatment? Prevention? Example occupations?
Increased risk for: 1. Lung cancer 2. M. Tuberculosis and Atypical Mycobacterium 3. Rheumatoid Arthritis and Systemic Sclerosis
Treatment: None
Prevention Management: Prevention minimize exposure
Example Occupations: Mining, tunneling, quarrying, sandblasting, glass workers