Occupational lung disorders

Question 1

What 4 types of exposure lead to occupational lung disease?

Answer 1

vapour
gases
dusts
fumes

Question 2

What is a vapour?

Answer 2

liquid or solid substances suspended in air

Question 3

What is dust?

Answer 3

aerosolised solid particles

Question 4

What types of conditions result within minutes/hours of exposure?

Answer 4

direct injury eg acute irritant asthma
infection eg silicotuberculosis
allergy eg asthma, EAA

Question 5

What types of condition result from years of exposure?

Answer 5

1. chronic inflammation eg COPD, bronchiolitis
2. destruction of lung tissue eg emphysema
3. lung/pleural fibrosis

Question 6

What type of condition takes decades to present?

Answer 6

carcinogenesis

Question 7

What is the treatment like for historical exposure?

Answer 7

supportive - not much treatment that will impact on prognosis

Question 8

Give an example of historical exposure

Answer 8

asbestosis

Question 9

What can be done to prevent sb getting worse from a current exposure?

Answer 9

identify and cease exposure

Question 10

Give examples of historical places of work with VDGF exposures

Answer 10

mines
foundry - a worksop or factory for casting metal
stone masons - making buildings, structures and sculptures from stone
silica

Question 11

Give examples of current exposures

Answer 11

car paint spraying

baker

Question 12

Give examples of gases that cause OLDs

Answer 12

CO
SO2
NO2

Question 13

What type of damage to the lung is immediate?

Answer 13

direct injury by catastrophic exposure

Question 14

What conditions are caused by catastrophic exposure?

Answer 14

EAA

acute pulmonary oedema

Question 15

What might differ between different people who are exposed/have OLDs?

Answer 15

susceptibility
severity
reversibility
working/unemployed

Question 16

What are the two biggest occupational lung diseases?

Answer 16

non-malignant pleural disease

mesothelioma

Question 17

What percentage of occupational asthma is allergy at work?

Answer 17

90%

Question 18

What percentage of all asthma is occupational?

Answer 18

9-15%

Question 19

What are the common causes of occupational asthma in the UK?

Answer 19

isocyanates
flour
cleaning products
wood dust
enzymes

Question 20

What happens to the PFT results if you are continuously exposed?

Answer 20

accelerated FEV1 decline

Question 21

What is the positive work effect index?

Answer 21

much worse FEV1 when at work than at the weekends

Question 22

What are the features of acute EAA?

Answer 22

breathlessness
chesty cough
phlegm
wheezing
constitutional symptoms: weight loss, fever, flu-like symptoms, headache

Question 23

What tissue of the lung does EAA affect?

Answer 23

interstitium

Question 24

What feature defines chronic EAA?

Answer 24

fibrosis

Question 25

What type of reaction is asthma?

Answer 25

type 1 hypersensitivity

Question 26

What part of the immune system mediates EAA?

Answer 26

cell mediated immunity and humoral immunity

Question 27

What are the four main causes of EAA?

Answer 27

microorganisms animals vegetation chemicals

Question 28

What is a big determinant of prognosis in OLDs?

Answer 28

recognition of exposure and cease exposure

Question 29

What percentage of COPD is occupational?

Answer 29

15%

Question 30

Give examples of exposures that can lead to COPD

Answer 30

coal silica grain concrete dust

Question 31

What is the normal FEV1 decline per year for a man and a woman?

Answer 31

men - 30ml/yr | women 25ml/year

Question 32

What condition does alpha 1 antitrypsin deficiency predispose to?

Answer 32

emphysema

Question 33

Give examples of asbestos related lung disease

Answer 33

``` pleural plaques diffuse pleural thickening asbestosis lung cancer mesothelioma ```

Question 34

What is asbestos?

Answer 34

naturally occurring mineral fibre

Question 35

Why was asbestos used?

Answer 35

good insulator strong tensile strength for ropes fire retardant

Question 36

What are pleural plaques?

Answer 36

asbestos fibres accumulate and cause deposition of collagen in the pleura, which may or may not calcify

Question 37

What is seen on a CXR in diffuse pleural thickening?

Answer 37

obliteration of the costophrenic angle

Question 38

What can diffuse pleural thickening lead to?

Answer 38

restriction of expansion SOB resp failure

Question 39

diffuse pleural thickening is a progressive condition. T or F

Answer 39

T

Question 40

What is asbestosis?

Answer 40

pulmonary fibrosis due to asbestos

Question 41

What increases the risk of cancer with asbestos exposure?

Answer 41

smoking

Question 42

What is mesothelioma?

Answer 42

Cancer of the pleura

Question 43

What is one cause of unexplained pleural effusion?

Answer 43

mesothelioma

Question 44

What are the symptoms of mesothelioma?

Answer 44

progressive breathlessness chest pain weight loss

Question 45

What is the prognosis for mesothelioma?

Answer 45

8-14 month survival

Question 46

What are the prevention strategies for OLDs?

Answer 46

``` elimination substitution engineering controls - eg ventilation worker education RPE health surveillance ```