occupational lung disease Flashcards
What is occupational lung disease known as
Pneumoconiosis
What are the main pneumoconiosis
Asbestosis
Silicosis
Coal workers pneumoconiosis (CWP)
What does pneumoconiosis lead to
pulmonary fibrosis and scarring of the interstitium
What is another name of CWP
Black lung
What is the causative agent of CWP
carbon containing particulate from coal mining
What is the importance of the federal coal mine and health and safety act of 1969
Established safety standards/inspections of coal mines
Established funding for workers who develop CWP
How does CWP present
Primarily asymptomatic
*if symptoms develop, they’re non-specific
What is first line dx test for CWP
CXR
-will see coal macules
-predilection for upper lungs w/ granular appearance
What are coal macules
2-5mm diffuse, small, round, nodular opacities
What is the most sensitive/ specific test for CWP
chest CT
What will be seen on PFT for CWP
Minimal changes but coal can cause chronic bronchitis
What can CWP progress to
Progressive massive fibrosis (PMF)
What is the screening tool used for CWP
CXR every 4-5 years unless an abnormal finding is seen… then every 2 years
What is supportive treatment for lung disease
Bronchodilators
pulmonary rehab
supplemental O2
smoking cessation
What are complications of CWP
Pulmonary HTN
R-sided HF
Respiratory failure
premature death
What is in place to help prevent CWP
NIOSH
use of masks (PPE)
Avoid smoking
encourage periodic screening
What cause silicosis
silica dust
What activities expose you to silica dust
abrasive blasting
foundry wokr
quarry work
tunneling
stone cutting
hydraulic fracturing
Which population is at higher risk for silicosis
Males
What are three main form of silicosis
Acute
Accelerated
chronic
What causes acute silicosis
large volume exposure (high mortality)
When does accelerated silicosis occur
after 5-10 years of exposure
How does silicosis present
Chronic & accelerated is primarily asymptomatic
Acute form = dyspnea, fatigue, weight loss, diffuse bilateral crackles, respiratory failure within 2 years
What diagnostic test is preferred with silicosis
Chest CT
Why is chest CT preferred for silicosis dx
Helps differentiate from asbestosis
helps assess severity/progression
What will be seen on CT with silicosis
Egg shell calcification (found in lymph nodes)
How do you monitor progression of silicosis
PFTs
What is supportive treatment for silicosis
bronchodilators
ICS
Pulmonary rehab
lung transplant
What are complications of silicosis
TB and non-TB mycobacterial infections
Spontaneous pneumo
emphysema
cancer
pulmonary HTN
Respiratory failure
premature death
What is the best treatment for silicosis
Prevention
-industrial interventions
-PPE
-PFT/CXR
-Annual PPD
-pneumoccocal/flu vaccines in at risk patients
What causes asbestosis
Asbestos
Where do you get asbestos from
heat, fire, electricity, and chemically resistant material
occupations, passive, and community exposure
direct toxic/macrophage activation
Which populations are at higher risk for asbestosis
shipyard workers
construction worker
textile workers
boilermakers
sheet metal workers
HVAC, plumbing, electrical workers
How does asbestosis present
primarily asymptomatic
*if symptoms present: non-productive cough and clubbing fingers
What imaging is preferred for asbestosis
Chest CT
What will be seen on chest CT with asbestosis
bilateral, linear reticular opacities (honeycombing)
Predilection for lower lobes
pleural plaques
What are complications from asbestosis
pulmonary HTN
R sided HF
Respiratory failure
premature death
lung cancer
What lung cancer are people at higher risk for with asbestosis
Mesothelioma
Non-small cell lung cancer
What preventative measures can be taken against asbestosis
asbestos abatement
Annual lung cancer screening
Smoking cessation
flu/pneumococcal immunizations
What is another name for hypersensitivity pneumonitis
Extrinsic allergic alveolitis
What are the types of hypersensitive pneumonitis
farmers lung
mushroom pickers disease
humidifier lung
bird fancier lung
detergent workers lung
When does hypersensitivity pneumonitis present
as an acute illness that occurs 4-8 hours after exposure
What symptoms will someone have with hypersensitivity pneumonitis
Fever/chills/ malaise/ cough/ dyspnea/ vomiting
What will be found on PE with hypersensitivity pneumonitis
Bibasilar crackles
tachycardia
tachypnea
How do you work up hypersensitivity pneumonitis
CXR
CBC (look for left shift)
Restrictive pattern on spirometry
What are treatments for hypersensitivity pneumonitis
oral steroids if severe
avoid further exposure
likely occupational change
What is more likely to kill someone in a fire, burns or smoke inhalation
smoke inhalation
What are the mechanisms of damage from smoke inhalation
impaired oxygenation
upper airway thermal burns
lower airway chemical injury/physical irritants
What are signs of smoke inhalation
fire in an enclosed space
singed nasal hair
burns on lips
deep/full thickness burn to face/neck/upper torso
black colored sputum
soot around nasal passages
What occurs in upper airway injuries
more rapid presentation (18-24hr)
lead to tissue edema and inability to clear secretions and airway obstruction
inspiratory stridor
What causes lower airway injuries
chemical burns - inhaling products of combustion
What happens with lower airway injuries
dyspnea, tachypnea, labored breathing, and cyanosis that worsens of 24-72 hours
diffuse wheezing and rhonchi on PE
What complications occur with lower airway injuries
ARDS (day 1-2)
Sloughing of bronchiolar mucosa (day 2-3)
Bacterial infection (day 5-7)
How do you treat lower airway injury
100% O2 to treat CO poisoning
Bronchodilators
ET tube
Suctioning / chest PT
Fluid resuscitation
daily sputum cultures
