Occupational Lung Flashcards
___ between onset of exposure and first expression of disease
latency period
clinical effects of many toxic exposures related to ___
exposure dose
what are examples of multifactorial causation
1) smoking and coal mine dust = emphysema
2) allergies + isocyanates (paint/auto body)= asthma
definition of dose KNOW!!!
dose = duration x concentration
where do most water soluble agents deposit
where do less water soluble agents deposit?
water soluble = upper airway (chlorine = nasopharyngeal mucosa
less soluble = distal airways/bronchioles = nitrogen oxides1
where are particles > 10 um
particles
> 10 um = filtered in upper airway
what questions to ask about history
1) where do you work?
2) what jobs?
3) job duties?
4) specific exposures/ventilation/
2 major categories of occupational lung disease
1) airways disease
2) interstitial disease
types of airways diseases (4)
1) Immunologic asthma (asthma with latency)
2) Irritant asthma (RADS)
3) Emphysema/COPD (coal mine dust)
4) Bronchiolitis (obliterative/ constrictive)
types of interstitial lung diseases
3 pneumoconioses
• Asbestos-related lung diseases
• Silicosis
• Coal Workers Pneumoconiosis (Black Lung)
Other:
• Chronic Beryllium Disease
• Hypersensitivity Pneumonitis (Farmer’s Lung)
Where do airways diseases occur?
PFT?
Imaging?
Large or small airways
obstructive = Low FEV1
air trapping = incr RV and/or decr DLCO
normal or show airway wall thickening, air trapping, emphysema
Interstitial diseases
define
PFT?
IMaging
inflammation/fibrosis of interstitial/distal/gas exchange units
restrictive (low TLC/FVC)
decr DLCO
centrilobular inflamm/ground glass opacity
fibrosis (rounded or linear opacity)
causes of immunologic asthma (asthma with latency)
HMW: baking flours, latex, detergent enzymes –> IgE rxn
LMW: isocyanates (car), platinum salts, red cedar (plicatic acid)
(combine with endogenous proteins to create new antigens)
causes of irritant asthma (RADS)
• Strong acids and bases (eg, chlorine-containing chemicals)
(world trade center worker exposed ot high pH alkaline dust)
causes of emphysema/COPD
• Coal mine dust, silica
biomass combustion, silica, vanadium, dusts
causes of bronchiolitis (obliterative/constrictive)
Flavoring chemicals (diacetyl), oxides of nitrogen, deployment particulate matter
Define occupational asthma
Presentation
1) variable airflow obstruction
airway hyperresponsive + inflamm from immunologic properties of exposure (like isocyanates= quaternary ammonium)
2) Onset = months to years after (long latnecy) Temporal pattern (improve symptoms on certain times)
Define RADS
Presentation
airway eptihelial injury from exposure to inhalants with irritant properties –> persistent hyperresponsiveness and obstruction
NO LATENCY; WITHIN 24-48 HRS AFTER EXPOSURE
Occupational chronic
Obstructive Pulm Disease
Presentation
COPD/emphysema (fixed airflow limitation) from occupation
cough, sputum, wheeze, chest tightness, dyspnea
____ found in coal mine exposure
emphysema (not just smoking)
constrictive/obliterative bronchiolitis
presentation
pathologic injury of small airways (extrinsic or intrinsic bronchiolar narrowing)
subtle onset with cough, dyspnea, chest tightness
2 major forms of asbestos related lung diseases
- Serpentine: chrysotile
* Amphibole: croccidolite, amosite, anthophyllite, tremolite, actinolite
asbestos lung diseases
cause
exposed groups
asbestos fibers = magnesium silicates when crushed break into fibers; aspect ratio (shape and size) confer disease
construction trade (boilermaker, shipyard, dock, mechanics with brakes)
define nonmalignant asbestos related lung disease consequences
vs. malignant asbetos lung disease
1) benign asbestos pleural effusion, pleural thickening/calcif, rounded atelectasis, asbestosis (LOWER LUNG)
2) lung cancer, mesothelioma
definition of silicosis
causes of silicosis
presentation
exposure to silica –> interstitial lung disease –> fibrotic lung disease (can’t get rid of silica from lung)
crystal silica (quartz), blast cut or grind gold or silver, foundry, sandblasters, granite,
LONG LATNECY unless high grade exposure (SOB and cough)
coal worker pneumoconiosis
(black lung)
definition
causes
presentation
PFT
imaging
1) coal mine –> interstitial lung disease
2) inhalation of coal mine dust (underground > surface)
3) cough + shortness of breath
4) normal PFT
5) upper lobe small rounde nodular opacity
DUST MACULES
CHRONIC beryllium disease
definition
causes
presentation
1) granulomatous disease can’t tell from sarcoidosis (except due to exposure and immune response to beryllium)
2) beryllium, inhaled during maching/grinding
3) subtle onset + cough + dyspnea + chest tightness
Hypersensitivity pneumonitis (extrinsic allergic alveolitis) definiton
causes
presentation
1) immune response to animal proteins (BIRD FANCIER’S OR FARMER’S LUNG
2) birds, fungi, contaminated hay, hot tubes and pools (tuberculous myco, gram neg),
3) acute = flu illness with respiratory sx
subacute/chronic = insidious (gradual)
Role of clinician in occupational expsoure
OCCUPATIONAL AND ENVIRON HISTORY-TAKING
DIAGNOSIS MAY BE SENTINEL HEALTH EVENT
PREVENTION
What are the 3 main determinants of the site and severity of occupational lung disease?
Dose (= duration x concentration), solubility, and particle size
What is the difference in onset of symptoms between occupational asthma and reactive airways dysfunction syndrome (RADS)?
No latency with RADS, symptoms occur within 24-48 hours after exposure
What are the 3 major types of pneumoconioses?
- Asbestos-related lung diseases
- Silicosis
- Coal Workers Pneumoconiosis (Black Lung)
What is the most useful clinical tool in assessing a patient for occupational lung disease?
Occupational and environmental history
Which occupations are associated with the radiographic finding of progressive massive fibrosis?
- Foundry work
- Hard rock mining
- Sandblasting
- Stone cutting (e.g. granite countertops)
What type of exposure should you suspect when you see pleural plaques on chest imaging?
Asbestos
Which of the following is NOT an occupation or exposure associated with hypersensitivity pneumonitis?
A. Bird breeding
B. Farming
C. Hot tub and indoor pools
D. Cat breeding
E. All of the above are associated with hypersensitivity pneumonitis
D – cat breeding
