Occupational & Environmental Lung Disease

Question 1

Tests of Occupational/Environmental Lung Disease

Answer 1

• CXR: detects lung response to inhaled dusts or metals (interstitial lung disease)
  
  • Restrictive–inorganic/organic dusts
  • Obstructive–chemical agents/organic dust
• Pulmonary function tests
• UA: heavy metal concentrations
• Allergy testing: hypersensitivity
• Bronchoscopy
• Biopsy

Question 2

Exposure Assessment

Answer 2

• Total time exposed

- Particle size (coarse-mode, fine-mode (e.g. condensation), or ultra fine-mode fractions)

Question 3

Asbestos

Answer 3

= Generic term used to describe different mineral silicates (e.g. chrysolite, amosite, anthophyllite, crocidolite)
- Previously used in thermal, electrical, textile, & construction products

Related health effects:

• Pleural & pulmonary fibrosis
• Cancer (e.g. mesothelioma)

Question 4

Asbestosis

Answer 4

• Diffuse intersitial fibrosing disease of the lung
• Directly related to the intensity & duration of exposure
• Usually manifests 10+ years after regular exposure

Question 5

Asbestos Radiographic Findings

Answer 5

• Pleural plaques characterized by thickening or calcification of the parietal pleura (imply exposure, not pulmonary impairment)
• Benign pleural effusions (blood or serous exudate)
• Irregular or linear opacities
• Indistinct heart border
• “Ground glass” appearance in the lung fields
• Fibrosis

Question 6

Asbestos Pulmonary Function

Answer 6

• Restrictive pattern
• Decrease in lung volumes
  +/- Mild obstruction d/t fibrosis

Question 7

Asbestos Related Cancer

Answer 7

• MC = Lung cancer
  
  • ~15-19 years after exposure
  • Significant interactive effect w/ smoking
• Mesothelioma (pleural & peritoneal)
  
  • Occurs 1 to 40 yrs. after exposure
  • 50% metastasize
• Tissue biopsy needed to confirm dx

Question 8

Grain Dust Pulmonary Disease

Answer 8

• Grain storage facilities contain large amounts of grain dust (1/3 capable of entering the lungs)

Risks:
- Farmers

S/S:

• Persistent cough
• Mucus hypersecretion
• Wheezing, dyspnea
• Decreased FEV1 and FEV1/FVC ratio

Question 9

Occupational Respiratory Carcinogens

Answer 9

Asbestos
Arsenic
Beryllium
Chromium
Formaldehyde
Polyaromatic hydrocarbons
Mustard gas
Uranium
Isopropanol

Question 10

Outdoor Air Pollution

Answer 10

• Generated by power plants, automobile exhaust, industerial processes
• Responsible for ~1.3 million deaths per year worldwide
• Composed of sulfate, nitrates, ammonia, sodium chloride, carbon, mineral dust, & water
• Smaller particles are more dangerous (ozone, NO2, SO2)

S/S of exposure:
- Wheezing, coughing, mucus secretion, bronchitis, inflammation of airways

Question 11

Indoor Air Pollution

Answer 11

• 2nd hand smoke
• Radon gas
  
  • Occurs in earth materials
• Allergens

Question 12

Biomass Smoke Exposure

Answer 12

• More than 1/2 of the world uses biomass (wood, dung, crop, charcoal) fuel
• MC in rural areas
• Can lead to infections, chronic lung disease (e.g. COPD, lung cancer)