Occupational Lung Disease

Question 1

What can occupational lung disease be classed as?

Answer 1

Pneumoconiosis

Question 2

What are different types of occupational lung disease?

Answer 2

1. Coal worker pneumoconiosis (CWP)
2. Progressive massive fibrosis
3. Caplan’s sydnrome
4. Silicosis
5. Chronic beryllium disease
6. Asbestosis

Question 3

What is CWP?

Answer 3

1. Common dust disease in countries underground coal mines

2. Inhalation of coal dust particles over 15-20yrs

Question 4

What is the patho of CWP?

Answer 4

ingested by macrophages which die, releasing their enzymes causes fibrosis

Question 5

What are symptoms of CWP?

Answer 5

asymptomatic but coexisting chronic bronchitis common

Question 6

What would CXR show in CWP?

Answer 6

many round opacities (1-10mm) esp in upper zone

Question 7

What is progressive massive fibrosis caused by?

Answer 7

progression of CWP

Question 8

What are symptoms of progressive massive fibrosis?

Answer 8

1. progressive dyspnoea
2. fibrosis
3. cor pulmonale
4. Extertional dypnoea + cough +/- black sputum

Question 9

What would CXR show in progressive massive fibrosis?

Answer 9

1. bilateral upper zone fibrotic masses (1-10cm) develop from periphery towards hilum
2. large round fibrotic masses in upper lobes

Question 10

What is Caplan’s syndrome?

Answer 10

association between RA, pneumoconiosis and pulmonary rheumatoid nodules

Question 11

What is silicosis caused by?

Answer 11

inhalation of silica particles which are fibrogenic

Question 12

What sort of work may get silicosis?

Answer 12

metal mining, stone quarrying, sand blasting and pottery/ceramic manufacture

Question 13

What would the symptoms of silicosis be?

Answer 13

1. progressive dyspnoea

2. increase incidence of TB

Question 14

What would CXR show in silicosis?

Answer 14

1. diffuse military or nodular pattern in upper and middle zones
2. egg shell calcification of hilar nodes
3. Upper lobe fibrotic masses often with hilar “egg shell calcifications”

Question 15

What would spirometry show in silicosis?

Answer 15

restrictive ventilatory defect

Question 16

What investigations are done for occupational lung disease?

Answer 16

1. CXR
2. Spirometry
3. Beryllium lymphocyte proliferation test

Question 17

What are some DDx for occupational lung disease?

Answer 17

1. Asbestosis
2. IPF
3. Sarcoidosis
4. Rheumatoid arthritis

Question 18

What is the treatment for acute secondary alveolar proteinosis (acute silicosis)?

Answer 18

lung lavage

Question 19

What is the treatment for acute berylliosis?

Answer 19

corticosteroid therapy

Question 20

What is the 1st line treatment for ongoing silicosis, CWP or chronic berylliosis?

Answer 20

1st line: smoking cessation + removal or occupation exposure

Question 21

What would you add to the treatment with chronic berylliosis?

Answer 21

corticosteroid therapy

Question 22

What would you add to the treatment with exertional dyspnoea?

Answer 22

pulmonary rehab

Question 23

What would you add to the treatment with hypoxia?

Answer 23

supplementary oxygen

Question 24

What would you add to the treatment with COPD?

Answer 24

bronchodilator therapy

Question 25

What would you add to the treatment for end stage rep failure?

Answer 25

referral for lung transplant

Question 26

What are possible complications for occupational lung disease?

Answer 26

1. COPD 2. Chronic renal failure 3. Non small-cell lung cancer 4. Small cell lung cancer 5. Cor pulmonale 6. Acute bronchitis or pneumonia 7. Rheumatoid arthritis

Question 27

What should all occupational lung disease get?

Answer 27

compensation!!

Question 28

How do you treat CWP?

Answer 28

treat chronic bronchitis, claim compensation

Question 29

What is simple pneumoconiosis?

Answer 29

1. Exertional dyspnoea and cough | 2. Category 1-3 based on CXR

Question 30

What is the aietology of hypersensitivity pneumonitis aka extrinsic allergic alveolitis?

Answer 30

inhaled microscopic allergens that deposit in small airways and alveoli, leads to allergic response in small airways and alveoli

Question 31

What are different types of hypersensitivity pneumonitis?

Answer 31

- Farmer’s lung: mouldy hay or vegetables - Bird fancier’s lung: pigeons esp poo - Malt worker’s lung - cheese washes

Question 32

What is the classic history of of hypersensitivity pneumonitis?

Answer 32

1. Exposure to allergen 2. Dyspnoea 3. Cough +/- sputum 4. Malaise

Question 33

What is acute hypersensitivity pneumonitis?

Answer 33

- 4-6 hr after exposure - fever/flu like symptoms - resolves within 48hr

Question 34

What is subacute hypersensitivity pneumonitis?

Answer 34

-symptoms after lower dose exposure with slow recovery over weeks/months

Question 35

What is chronic hypersensitivity pneumonitis?

Answer 35

-insidious onset + weight loss +/- clubbing and is progressive with fibrosis which can be fatal

Question 36

What would examination sign show on hypersensitivity pneumonitis?

Answer 36

1. Nothing distinct 2. bilateral diffuse or basal end inspiratory creps 3. maybe inspiratory wheeze 4. clubbing

Question 37

What investigations are done for hypersensitivity pneumonitis?

Answer 37

1. Nothing pathopneumonia 2. FBC/ESR/CRO for infection/inflammation 3. CXR 4. HRCT 5. Antibody testing 6. Lung function non specific restriction with low DLCO

Question 38

What would CXR show for hypersensitivity pneumonitis?

Answer 38

patchy nodular infiltrates in acute or sub acute and fibrosis in chronic

Question 39

What would HRCT show in hypersensitivity pneumonitis?

Answer 39

ground glass

Question 40

What is differential for hypersensitivity pneumonitis?

Answer 40

Asthma triggered by antigen

Question 41

What is management for hypersensitivity pneumonitis?

Answer 41

1. Avoid allergen 2. Steroids if symptoms persist after allergen removal 3. Farmer lung eligible to comp