Occupational lung disease Flashcards
What are some types of Occupational Lung Diseases?
- COPD
- Malignant diseases
- Lung cancer
- Mesothelioma
- Occupational asthma
- pneumoconiosis
- Coal Workers Lung
- Asbestosis
- Silicosis
How would you identify a restrictive lung disease?
- a FEV1/FVC less than 70
What is this lung disease?
Coal workers pneumoconiosis
- bilateral interstitial changes
- increased opacification
Who is at risk of silicosis?
- Slate workers (Wales)
- Potters (Stoke-on-Trent)
- Knife grinders (Sheffield)
- Hard rock miners (Canada etc)
- Sand-blasting
- Foundry workers
What is the treatment of Pneumocoioses?
- Prevent further exposure
- Stop smoking
- Monitor lung function
- Symptomatic treatment: - Cough, dyspnoea, cor pulmonale
- No specific treatment or cure for the disease itself
Who would be exposed to Asbestos?
- Mined in Canada, Australia, S Africa
- Imported via docks (esp Southampton)
- Used widely in 1930s-70s:
- building (roofs, insulation, plumbing)
- power stations
- ship-building (engine rooms, bulkheads)
- railways
- cars (brake pads)
- Occupation history is vital
• Risk from washing contaminated clothes
What benign things would be seen in lungs exposed to Asbestos?
- Benign Pleural plaques (a marker of exposure): increased risk to malignancy
- Benign pleural effusion
- Pleural thickening (with a subsequent restriction on lung function)
- Asbestosis- interstitial lung disease-restrictive lung function (FEV1/FVC> 0.7) with a reduction in forced vital capacity (FVC) and reduced gas transfer
What are malignant risks from asbestos?
How would they present themselves?
• Lung cancer
In asbestosis RR of lung cancer: 7x in non-smokers, 93x in smokers
• Mesothelioma
- Malignancy of pleura and peritoneum caused by asbestos Expected to peak in 2020
- Consider in with patient with a history of asbestos exposure
- Pleural plaques on previous chest x-rays
- persistent unexplained chest pain
- Weight loss
- Breathless/unilateral pleural effusion
Describe what is seen in this CT?
Abnormal irregular pleural thickening-mesothelioma
- a biopsy would be needed to be definitive
What are two scenarios for occupational Asthma?
- Occupational asthma: caused by workplace exposures
- Work-aggravated asthma: pre-existing cases are made worse by factors in the workplace
How could occupational asthma be diagnosed/ confirmed?
- Peak flow monitoring at work
- Role of challenging test: expose the patient to the agent they think is causing asthma, has to be done when stable
What is irritant induced/ Non-allergic Asthma?
• Direct effect on airways, not immune-mediated, occurs without pre-existing asthma
Acute
• Reactive Airways Dysfunction Syndrome (RADS)
- Develops within hours of a single, very high exposure to an irritant
Subacute
- Insidious onset of asthma symptoms after multiple moderate/high exposure incidents
What are the two main causes of occupation asthma?
High Molecular Weight
- Proteins, polysaccharides
- 80-90% cases
- Sensitisation with latency period (weeks-years)
- IgE-dependent
- Skin prick/allergy testing
- Flour (bakers)
- Animals (farmers)
- Latex
- Enzymes (eg detergents)
Low Molecular Weight
- Mechanism poorly understood
- Usually independent of IgE
- Limited utility of skin prick/allergy testing
- Isocyanates (printing, plastics)
- Metals (welders)
- Dyes (hairdressers)
What are some causative agents of Reactive Airway Dysfunction Syndrome (RADS)?
- Caustic vapours
- Ammonia
- Fire/Smoke
- Chlorine
- Tear Gas
- Floor Sealants
What is the definition of a Toxin and the definition of a Pollutant?
•Toxin: A naturally occurring poison produced within living cells or organisms
-Botulinum, Ricin, Snake venom
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• Pollutant: Any substance that contaminates the environment
