Occupational Lung Disease

Question 1

When should occupational exposure be suspected?

Answer 1

In any case of lung disease symptoms - a through hx of occupational exposure should be determined

Question 2

How to differ from others?

Answer 2

1. exclude COPD, TB and cardiac causes
2. are upper airway symptoms present
3. are there work risk factors - atopy or occupational

Question 3

How do you know the disease is work related?

Answer 3

> absence of symptoms prior to work
symptomatic trigger on exposure
relief of symptoms on weekends or leave
chemical spills

Question 4

Objective evidence of asthma

Answer 4

airflow obstruction on PEAK flow

Question 5

how will you check if the patient is sensitised?

Answer 5

skin prick or serum IgE = ImmunoCAP

Question 6

Gold standard for diagnosing occupational asthma

Answer 6

Specific bronchial challenge test

Question 7

See classification

Question 8

define occupational asthma

Answer 8

condition characterised by variable airflow limitation and airway hyper-responsiveness and inflammation due to causes and conditions in a work environment and not due to any stimuli outside of work

Question 9

types of occupational asthma

Answer 9

1. Sensitiser induced = Immunological with latency
2. Irritant induced = Non-immuno with variable latency

Question 10

Mx of occupational asthma

Answer 10

1. remove exposure
2. drug rx
3. COIDA compensation form
4. notify chief inspector in dept of labour
5. limit and control exposure

Question 11

upper nodular disease

Answer 11

silicosis

Question 12

basal reticular disease

Answer 12

asbestos

Question 13

clinical appearance of silicosis

Answer 13

• progressive massive fibrosis
• lung cancer
• systemic sclerosis
• TB

Question 14

path of silicosis

Answer 14

impairs macrophage function

Question 15

overall silicosis prevalence

Answer 15

2-4% in gold miners, if older then 20-30%

Question 16

silicosis latency

Answer 16

10-20 yrs

Question 17

CXR findings of silicosis

Answer 17

• round nodules in upper zone
• TB
• possible fibrosis

Upper zone and then extends

Question 18

Spiro of silicosis

Answer 18

Obstructive pattern

Question 19

benign pleural abnormalities in asbestos

Answer 19

• plaques and calcified
• diffuse thinking
• effusions

+ malignant mesothelioma

Question 20

clinical features of asbestos

Answer 20

• clubbing
• fine late inspiratory creps in axillae
• cor pulmonale

Question 21

CXR in asbestos

Answer 21

• irregular opacities in lower zones
• plaques
• pleural thickening

Question 22

spiro in asbestos

Answer 22

restrictive pattern

Question 23

silicosis mx

Answer 23

1. TB Rx
2. COIDA
3. Control measures