Occupational lung diseases Flashcards
What is the hierarchy of controls when it comes to management of risk in occupational settings?
Start at top and work down:
elimination
substitution
engineering controls
administrative controls
personal protective equipment
List some occupational lung diseases
occupational asthma
asbestos related disease
pneumoconiosis
byssinosis
beryllium disease
lung cancers
hypersensitivity pneumonitis
infections
COPD
Trades/industries susceptible to occupational lung disease
construction
engineering
welding
foundries/quarries/potteries
motor vehicle repair
stonemasons
farmers
How does asbestos affect the lungs?
pleural plaques
diffuse pleural thickening
malignant mesothelioma
asbestosis (example of pneumoconiosis)
lung cancer
laryngeal cancer
When do symptoms of asbestosis usually start?
2+ decades following asbestos exposure
Clinical features of asbestosis
dyspnoea
non-productive cough
weight loss
fine inspiratory crackles
finger clubbing
smoking increases susceptibility and deterioration
What investigations should be done for suspected asbestosis?
spirometry - usually restrictive
reduced transfer factor
CXR - fine nodular shadowing
HRCT - more sensitive than CXR at showing fibrosis
lung biopsy - interstitial fibrosis + asbestos bodies
Asbestosis management
supportive
stop smoking
risk of lung cancer increased
What is malignant mesothelioma?
cancer affecting the pleura and peritoneum
almost always fatal (usually within 12 months)
strong association with asbestos exposure
long latency period
Malignant mesothelioma presentation?
> 20 years after asbestos exposure
chest pain
SOB
pleural effusion (repeated)
Industries at risk of malignant mesothelioma?
plumbers/electricians/maintenance
demolition
construction
plumbing + pipe lagging
brake lining manufacture/mechanics
railway engineering
asbestos mining
Which diseases enable an individual to claim Industrial Injuries Disablement Benefit?
Asbestosis
Mesothelioma
Primary carcinoma lung
Diffuse pleural thickening
Not pleural plaques
What is work aggravated asthma?
provoked symptoms of pre-existing asthma
acute transient airway narrowing after exposure to respiratory irritants eg. dust, smoke, SO2, cold, exercise
What is irritant induced occupational asthma?
Caused by:
single exposure to high level or irritant substance eg. ammonia, chloride, hydrofluoric acid
multiple high level exposures
chronic moderate level exposures
What is sensitiser induced occupational asthma?
asthma caused by immunological sensitisation to agents in the workplace
latency between weeks and years
What does RIDDOR stand for?
Reporting of Injuries, Diseases and Dangerous Occurrences Regulations)
How does occupational asthma present?
wheeze
dyspnoea
chest tightness
at work or after work, improving over weekends/holidays
Causative agents and occupations at risk of occupational asthma?
Isocyanates - paint spraying
Cleaning agents - cleaners
Flour - bakers
Animals - Lab workers
Rosin flux fume - electronics
Latex - healthcare
Wood dust - carpentry
Enzymes - detergent manufacture
Persulfate salts - hairdressers
How is occupational asthma diagnosed?
history - occupation
serial peak flow - looking for >20% variation across shift and lower/more variable peak flow on work days
RAST (specific IgE), skin prick testing
specific inhalation challengw
workplace challenge
Occupational asthma treatment
BTS guidelines for asthma
often resolves if exposure eliminated
What are pneumoconioses?
group of diseases caused by inhalation of mineral dust
deposition of dust in alveoli
localised inflammatory response causes longer term changes
List the pneumoconioses and their causative agents
coal workers pneumoconiosis - coal dust
asbestosis - asbestos
silicosis - silica
slate workers pneumoconiosis - slate
kaolin - china clay
stannosis - tin ore
siderosis - iron oxide
Occupational causes of lung cancer
passive smoking
mineral dusts
asbestos
arsenic
nickel
