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Respiratory > Occupational lung diseases > Flashcards

Occupational lung diseases Flashcards

1
Q

What is meant by occupational lung diseases?

A

Diseases of the lung that are caused by a person’s occupation.

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2
Q

What type of things might cause occupational lung diseases?

A

Fumes
Dust
Gas or vapour
Mists or aerosols

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3
Q

Occupational lung diseases present can present themselves immediately or decades later.

Give some examples of OLDs that present themselves after:

  • minutes
  • years
  • decades
A

Minutes:

  • Direct injury: acute irritant asthma
  • Infection: silicotuberculosis
  • Allergy: asthma

Years:

  • Chronic inflammation: COPD, bronchitis
  • Destruction of lung tissue: emphysema

Decades:

  • Lung or pleural thickening: asbestosis
  • Carcinogenesis: lung, mesothelioma
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4
Q

Which are the 2 most common occupational lung disease?

A

Non-malignant pleural disease

Mesothelioma

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5
Q

There are 2 types of occupational asthma. What are they?

Which is most common?

A
  1. Asthma induced by allergy to an agent inhaled at work
  2. Asthma induced by accidental irritant exposure at work

1 is most common

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6
Q

What type of agents can trigger occupational asthma?

A

Flour in a bakery
Animal dander
Car fumes
Many more

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7
Q

What sort of occupations can cause occupational COPD?

A

Mining, any job that involves the inhalation of dust or fumes

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8
Q

What is the non-UK name for Extrinsic Allergic Alveolitis (EAA)?

A

Hypersensitivity pneumonitis

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9
Q

What is EAA? (describe the disease not just what it stands for?

A

Extrinsic Allergic Alveolitis

Diffuse, granulomatous inflammation of the lung parenchyma and airways

That occurs in people who have been sensitised by repeated inhalation of certain antigens at work or in their environment

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10
Q

List some causes of EAA, and their specific names.

A

Bird fancier’s lung:
- proteins in bird dropping

Farmer’s lung:
- exposure to mouldy hay

Malt worker’s lung:
- Exposure to mouldy malt

Many more.

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11
Q

EAA exists in 3 different phases/stages?

A

Acute
Sub-acute
Chronic

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12
Q

Describe acute EAA?

  • Clinical features
  • Timing
A

A self-limiting febrile response
Occurs 4-8 hours post exposure

Fever
Rigors
Myalgia
Cough
Dyspnoea
Crackles
Flu-like illness
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13
Q

Describe sub-acute EAA?

  • Clinical features
  • Timing
A

Less severe, gradual onset
Intermittent, repeated acute attacks

Productive cough
Dyspnoea
Fatigue
Anorexia
Weight loss
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14
Q

Describe chronic EAA?

  • Clinical features
  • Timing
A

Irreversible pulmonary fibrosis
If allergen is removed completely, there is little improvement of symptoms

Increasing dyspnoea
Weight loss
Type I respiratory failure
Cor pulmonale

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15
Q

What investigations would you do for acute EAA?

A

Blood: neutrophilia, raised ESR

CXR: Upper-zone mottling/consolidation

Lung function:
Restrictive lung disease (low FVC, high FEV1:FVC)

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16
Q

What investigations would you do for chronic EAA?

A

Blood: serum antibodies will be raised in some people

CXR: Upper-zone fibrosis, honeycomb lung

Lung function:
Restrictive lung disease (low FVC, high FEV1:FVC)

Bronchoalveolar lavage:
Fluid shows raised lymphocytes and mast cells

17
Q

What is a bronchoalveolar lavage?

A

A bronchoscope is passed through the mouth or nose into the lungs

Fluid is squirted into a small part of the lung and then collected for examination.

18
Q

What is the pathogenesis of silicosis?

A

Inhalation of silica particles which are very fibrotic

Silica particles can embed themselves into alveolar sacs and ducts in the lungs impairing gas exchange

Macrophages ingest the silica particles setting off an inflammation response

This then stimulates fibroblasts to proliferate and produce collagen around the silica particle, thus resulting in fibrosis

19
Q

What are asbestos-related lung diseases?

A

Inhalation of asbestos fibres which causes various problems in the lungs

20
Q

What problems can exposure to asbestos cause?

A

Benign pleural disease: pleural plaques, pleural thickening

Asbestosis: pulmonary fibrosis

Cancer: lung + mesothelioma

21
Q

What 2 types of asbestos are there?

A

Amphiboles

Serpentine

22
Q

What is the most common problem caused by asbestos exposure?

A

Pleural plaques

23
Q

What is the latency period of asbestos-related lung diseases?

A

About 30 years

24
Q

What are pleural plaques?

A

Calcified layers of collagen found on the pleura

Completely harmless
No symptoms
Not pre-malignant

25
Q

What is diffuse pleural thickening?

A

Asbestos fibres become embedded in the pleura.

This triggers an inflammatory response that causes the progressive build up of fibrous scar tissue - thickening of the pleura

26
Q

What are the problems caused by pleural thickening?

A

Lung expansion is restricted

So you get SOB, respiratory failure (restrictive)

27
Q

What is the treatment of pleural thickening?

A

No effective treatment

Try to ease symptoms

28
Q

What is asbestosis?

A

Chronic inflammation and scarring of lung tissue, not pleura.

29
Q

What are the clinical features of asbestosis?

A

Progressive dyspnoea
Respiratory failure
End-inspiratory crackles

30
Q

Is asbestosis a pre-malignant condition?

A

Yes

31
Q

What is the pathogenesis of asbestosis?

A

Phagocytes try to digest asbestos fibres but they are unable, so they release cytokines causing an inflammatory response

If these keeps happening over time it will cause scarring + fibrosis

32
Q

Treatment of asbestosis?

A

Not much,
Try to manage symptoms
Monitor closely for signs of cancer

33
Q

Which cancers can asbestos cause?

A

Lung cancer
Larynx cancer
Pleural cancer: mesothelioma

34
Q

What are the consequences of occupational lung disease?

A

People can end up unemployed, sacked because of poor health

Loss of earnings, poverty

Chronic ill-health

35
Q

What are companies supposed to do to prevent occupational lung diseases?

A

Risk assessment

Prevent or minimise exposure to harmful substances

  • Gloves, masks, respirators
  • Better ventilation
  • Elimination of toxins

Respiratory (17 decks)

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