Occupational lung disease (RESP) Flashcards
Define occupational lung disease.
Long-term exposure to irritants being inhaled into lungs - any respiratory disease that is caused or made worse by exposures at work
AKA pneumoconiosis
What are pneumoconioses (occupational lung disease)?
Group of interstitial lung diseases, mostly of occupational origin, caused by the inhalation of mineral or metal dusts
What are the two main types of occupational lung disease?
- sensitiser-induced: immunological stimuli - latency between first exposure and onset of symptoms
- irritant-induced: non-immunological stimuli
What are some common irritants and the type of occupational lung disease they cause? (4)
- coal - coal worker’s pneumoconiosis
- asbestos - asbestosis/asbestos-related lung disease
- silicon - silicosis
- beryllium - berylliosis
What are some common types of occupational lung disease? (8)
- COPD
- asthma
- lung cancer
- infectious diseases
- pneumoconiosis
- asbestos-related lung disease
- silicosis
- allergic alveolitis
When should occupational asthma be suspected?
In all adult patients with asthma
Which occupation is coal workers’ pneumoconiosis most common in?
Coal miners - diagnosis usually 15-20 years after initial exposure to coal dust
How does simple pneumoconiosis present?
Asymptomatic
Which condition does simple pneumoconiosis increase the risk of?
COPD
What condition may simple pneumoconiosis lead to?
Progressive massive fibrosis
How does progressive massive fibrosis (occupational lung disease) present? (2)
- exertional SOB
- cough +/- black sputum
Which lobes does progressive massive fibrosis (occupational lung disease) most commonly affect?
Upper lobes
What is found on CXR in (coal workers’) pneumoconiosis?
Upper zone fibrosis
What will spirometry show in (coal workers’) pneumoconiosis?
Restrictive pattern
What is silicosis (occupational lung disease)?
Fibrotic lung disease caused by inhalation of silica
Which condition is silicosis a risk factor for?
TB
Which occupations is silicosis most prevalent in? (3)
- stonemason
- pottery
- ceramics
What do we see on CXR in silicosis (occupational lung disease)?
‘Egg shell’ calcification of hilar lymph nodes
What conditions are linked to asbestos exposure (occupational lung disease)? (2+3)
- asbestosis
- mesothelioma- malignant disease of the pleura:
- progressive SOB
- chest pain
- pleural effusion
What substance is the most common cause of occupational asthma?
Isocyanates
What are the clinical features of occupational lung disease? (4)
- insidious onset SOB
- cough + sputum production / dry
- black sputum = melanoptysis - coal workers’ pneumoconiosis
- pleuritic chest pain - due to acute asbestos pleurisy
What is seen on examination in occupational lung disease? (2)
- similar to any respiratory condition especially intersitital lung disease
- coal workers’ pneumoconiosis + silicosis: decreased breath sounds
What are some risk factors for occupational lung disease? (4)
- high exposure
- previous respiratory conditions
- genetic factors
- cigarette smoking
What exposures are risk factors for occupational lung disease? (4+4)
- coal
- asbestos
- silica
- beryllium
- spray painting/foam product manufacture
- welding, soldering, cutting/grinding metals
- dusts: stone, cement, brick, concrete
- general work environment
What are the first-line investigations for occupational lung disease? (4)
- CXR (PA and lateral)
- spirometry (pre- and post-bronchodilator)
- beryllium lymphocyte proliferation test (BeLPT)
- CT
What might CXR show in occupational lung disease?
Hyperinflation, nodular appearance
Complicated disease:
- nodular opacities in upper lobes
- micronodular shadowing
- silicosis: ‘egg shell’ calcification of hilar lymph nodes
What might spirometry show in occupational lung disease?
Obstructive or restrictive disease - depending on cause
Why might skin prick test be useful in occupational lung disease?
To find allergen
What are some differential diagnoses for occupational lung disease? (6)
- occupational asthma
- work-exacerbated asthma (preceding before job)
- occupational eosinophilic bronchitis (cough at work without wheeze)
- hypersensitivity pneumonitis (CXR: patchy nodular infiltrates and fibrosis)
- COPD
- vocal cord dysfunction (PFTs show extrathoracic vocal airflow limitation)
How do we manage sensitiser-induced occupational asthma?
- removal from any further exposure to agent
- ICS and bronchodilators
How do we manage irritant-induced occupational asthma?
Preventative measures implemented in workspace to reduce further exposure and episodes
How do we manage silicosis AKA acute secondary alveolar proteinosis? (3)
- lung lavage
- smoking cessation
- removal of occupational exposure
How do we manage berylliosis?
Oral corticosteroid - prednisolone 40-70mg OD then taper gradually
