Occupational lung disease

Question 1

What concerns might patients have regarding asthma and work?

Answer 1

Patients may present with concerns that chemicals at work are worsening their asthma or symptoms seem better at weekends or when away from work.

Question 2

What are common chemicals associated with occupational asthma?

Answer 2

Exposure to the following chemicals is associated with occupational asthma: isocyanates, platinum salts, soldering flux resin, glutaraldehyde, flour, epoxy resins, and proteolytic enzymes.

Isocyanates are the most common cause; example occupations include spray painting and foam moulding using adhesives.

Question 3

What is recommended for monitoring asthma symptoms at work?

Answer 3

Serial measurements of peak expiratory flow are recommended at work and away from work.

Question 4

When should a referral be made for asthma patients?

Answer 4

Referral should be made to a respiratory specialist for patients with suspected occupational asthma.

Question 5

What is coal worker’s pneumoconiosis?

Answer 5

Coal worker’s pneumoconiosis, also known as ‘black lung disease’, is an occupational lung disease caused by long-term exposure to coal dust particles.

Question 6

Who is most commonly affected by coal worker’s pneumoconiosis?

Answer 6

It is most commonly experienced by those involved in the coal mining industry.

Question 7

What is the relationship between exposure and severity of coal worker’s pneumoconiosis?

Answer 7

Severity is linked to the extent of exposure to coal dust.

Question 8

What is the typical time frame for the diagnosis of coal worker’s pneumoconiosis?

Answer 8

Diagnosis is usually made 15-20 years after initial exposure to coal dust.

Question 9

What is the prevalence of coal worker’s pneumoconiosis?

Answer 9

Prevalence is higher in populations with higher levels of exposure, such as areas with large coal mining industries.

Question 10

What percentage of all pneumoconiosis cases does coal worker’s pneumoconiosis account for?

Answer 10

Coal worker’s pneumoconiosis makes up around 7% of all pneumoconiosis.

Question 11

What happens to coal dust particles once inhaled?

Answer 11

Coal dust particles are engulfed by alveolar and interstitial macrophages and are then moved by the macrophages via the mucociliary elevator.

Question 12

What is simple pneumoconiosis?

Answer 12

Simple pneumoconiosis is the commonest type of pneumoconiosis, often asymptomatic, and increases the risk of lung diseases such as COPD.

Question 13

What may simple pneumoconiosis lead to?

Answer 13

It may lead to Progressive Massive Fibrosis (PMF), occurring in around 30% of those with stage 3 grading.

Question 14

How is coal worker’s pneumoconiosis graded?

Answer 14

The disease is graded on the appearance of the chest X-ray using categories outlined by the International Labour Office.

Question 15

What are the categories for grading coal worker’s pneumoconiosis?

Answer 15

Category 1: some opacities but normal lung markings visible; Category 2: large number of opacities but normal lung markings visible; Category 3: large number of opacities with normal lung not visible.

Question 16

What is Progressive Massive Fibrosis?

Answer 16

Dust exposure causes patients to develop round fibrotic masses, often in the upper lobes, and they are usually symptomatic.

Question 17

What symptoms do patients with Progressive Massive Fibrosis typically experience?

Answer 17

Patients often experience breathlessness on exertion and cough, with some having black sputum.

Question 18

What do lung function tests show in patients with Progressive Massive Fibrosis?

Answer 18

Lung function testing shows a mixed obstructive/restrictive picture.

Question 19

What investigations are used for coal worker’s pneumoconiosis?

Answer 19

Chest x-ray shows upper zone fibrosis; spirometry shows restrictive lung function tests with a normal or slightly reduced FEV1 and a reduced FVC.

Question 20

What is the management for coal worker’s pneumoconiosis?

Answer 20

Management includes avoiding exposure to coal dust and other respiratory irritants, managing symptoms of chronic bronchitis, and potential eligibility for compensation via the Industrial Injuries Act.

Question 21

What does pneumoconiosis mean?

Answer 21

Pneumoconiosis refers to the accumulation of dust in the lungs and the response of the bodily tissue to its presence.

Question 22

What is silicosis?

Answer 22

Silicosis is a fibrosing lung disease caused by the inhalation of fine particles of crystalline silicon dioxide (silica).

It is a risk factor for developing tuberculosis (silica is toxic to macrophages).

Question 23

What occupations are at risk of silicosis?

Answer 23

Occupations at risk include mining, slate works, foundries, and potteries.

Question 24

What are the features of silicosis?

Answer 24

Features include upper zone fibrosing lung disease and ‘egg-shell’ calcification of the hilar lymph nodes.

Question 25

Answer 25

Chest x-ray from a patient with silicosis. Note the bilateral diffuse upper lobe reticular shadowing superimposed with occasional scattered mass like opacities. These features are in keeping with silicosis and progressive massive fibrosis (PMF)

Question 26

Answer 26

CT scan from a patient with silicosis showing upper zone predominant mass-like scarring with calcification and volume loss. Hilar and mediastinal lymph node calcification also noted. No cavitary changes are seen. There is a left pleural effusion.