Occupational lung disease - collins Flashcards
What is pneumoconiosis
interstitial lung disease caused by particulate inhalation
- asbestos, silicosis, coal workers penumoconiosis (CWP) the big three
what does pneumoconiosis lead to
pulmonary fibrosis: inflammation -> scarring of the interstituium
What is black lung
coal workers pneumoconiosis - aka anthracosis, anthrasilicosis
carbon contraining particulate from coal mining
where are rates of CWP most common
central appalachia - kentucky, virginia and west virginia
what does the federal coal mine and health safety act do
established safety standards/inspection for coal mines
also funding for workers who develop CWP
reduced rates of CWP
what is the presentation of CWP
primarily asymptomatic
if symptoms develop: non-specific symptoms: SOB, cough, sputum production +/- black tinge, chest tightness
what is the first line diagnostic test for CWP
chest x-ray
what is seen on CXR with CWP
alveolar macrophages attempt to remove coal dust -> “coal macules”
2-5mm diffuse, small, round, nodular opacities on CXR
predilection for the upper lung, often with granular appearance
what are the diagnostic tests for CWP
CXR
PFTs on all - CWP produces minimal, if any, PFT changes - BUT coal dust can also cause chronic bronchitis and/or COPD
+/- Chest CT (more sensitive and specific)
What is the goal of treatment for CWP
identify CWP early through screening
screening via CXR including PFTs
what are the treatment options for CWP
no cure or definitive treatment
supportive treatment: bronchodilators, pulmonary rehabilitation, supplemental O2, smoking cessation, ? lung transplants
what are the complications of CWP
pulmonary HTN
Right sided HF
Respiratory failure
premature death
if abnormal screening test, how often are screenings from then on out
every 2 years
how often are routine normal screenings for CWP done
once every 5 years
how is CWP prevented
NIOSH set acceptable levels for coal dust in mines
use of PPE
avoid smoking/smoking cessation
encourage periodic screenings
What is silicosis
causative agent silica dust
M>F
exposure occurs during: manufacturing of glass, pottery, ceramics, bricks, concrete and artificial stone. abrasive blasting, foundry work, hydraulic fracturing, stone cutting, rock drilling, quarry work, tunneling
may be co-occuring with CWP
what is the presentation of chronic and accelerated silicosis
primarily asymptomatic, if symptoms develop, non-specific: SOB, cough, sputum production
What is the presentation of acute form of silicosis
dyspnea
weight loss
fatigue
diffuse bilateral crackles
respiratory failure within 2 years
how is silicosis diagnosed
Chest CT is preferred
+/- chest x-ray
PFTs for monitoring of progression
why is Chest CT preferred for silicosis
better to differentiate from asbestosis
better to assess severity/progression
findings similar to CWP: 1-3mm small rounded opacities, mostly upper lungs, mediastinal and hilar lymphadenopathy, +/- lymph node calcifications
what is seen with acute silicosis on chest CT
bilateral consolidation with ground glass opacities
What are eggshell calcifications
lymph node calcifications
what is the treatment of silicosis
no cure or definitive treatment
supportive treatment: bronchodilators, ICS, pulmonary rehab and ? lung transplant
what are the complications of silicosis
TB and non-TB mycobacterial infections (30x increased risk)
spontaneous pneumothorax
emphysema
lung cancer
progressive massive fibrosis
pulmonary HTN
right sided HF
respiratory failure
premature death
