Smoking and Occupational Lung Disease Flashcards
How many people smoke worldwide?
- aprox 2 billion
How many people die each year from smoking worldwide?
- aprox 5 million deaths/year
What % of men and women in UK smoke tobacco?
- men = 17.5%
- women = 15.8%
Tobacco smoke contains carcinogens, how can carcinogens cause lung damage and cancer?
- cause genetic mutations and malignancy
- causes lung cancer
- mesothelioma (tumour on myoepithelial cells)
In addition to containing carcinogens, tobacco also increase carbon monoxide intake, what does this cause to the blood?
- CO bind preferentially binds to haemoglobin
- carboxyhaemoglobin
Tobacco damages cilia in the respiratory tract and reduces the muco-ciliary escalator (clearing of mucus from the lungs), which can increase the risk of what in the lungs of smokers?
- infections
How does smoke cause an increase in mucus production?
- irritate the airways
- goblet cell hyperplasia follows to protect the lungs
Smoking can increase the risk of morbidity, what are the most common causes of death of smokers?
- lung cancer
- mesothelioma
- bladder cancer
- renal cell cancer
- COPD
- Interstitial Lung Disease (ILD)
- Peripheral Vascular Disease
- Ischemic Heart Disease
- Cerebrovascular Accident
- Foetal Growth Development
Smoking can cause dependence on cigarettes. Nicotine can be addictive, why?
- nicotine binds to nicotinic receptors - acetylcholine ⬆️
Nicotine in cigarettes can increase increase pleasure through the release of neurotransmitters, what is the main neurotransmitter released?
- dopamine
In addition to increasing pleasure, what other psychological things can smoking do?
- ⬇️ appetite - ⬇️ anxiety
When people try to quit smoking, this is called dependence. Does this lead to mental dependence only?
- no - physical and pyschological
What is the process to help patient stop smoking?
- ASK - do you smoke
- ADVISE - that patients should quit
- ASSESS - is patient willing to quit
- ASSIST - provide support
- ARRANGE - follow up patient
Can smoking cessation help patients?
- yes - ⬇️ morbidity and mortality
Can advice from GP help patients quit smoking?
- yes - helps 2% of smokers quit (75,000)
How has the smoking cessation been encouraged in the UK?
- quit-line through NHS - ban on public space smoking - smoking cessation clinics
Following advice and support, what is generally the first step to help smokers quit smoking?
- nicotine replacement therapy - gum, spray, inhalator or cigarettes
Why is nicotine replacement therapy better than smoking?
- nicotine without tar, CO or carcinogens - few people become addicted
How good is nicotine replacement therapy at helping people quit smoking?
- doubles the chance of quitting - ⬇️ withdrawal symptoms
What is the most effective method when a patient needs to quit smoking?
- Varenicline (Champix) - combined with smoking cessation clinics
How does Varenicline (Champix) help patients quit smoking?
- partial agonist of nicotinic acetylcholine receptors
How many people self report lung diseases due to occupation per year?
- aprox 20,000/year self reported
What is the estimated prevalence of lung diseases due to occupation?
- 130 / 100,000 people
How many people each year are estimated to die due to occupational exposure to toxins?
- 12,000/year
Does occupational lung disease present immediately following exposure in the work place?
- no - generally long latency period
What are the 3 main things that have helped reduced occupational lung disease in the UK?
- ⬇️ asbestos
- ⬆️ PPE
- ⬆️ employer accountability
What is the main occupational lung disease?
- asthma
- 3000/year
- 10-15% adult occupational asthma
Why is it important to take a full occupational history when examining a patients lungs?
- long latency periods
- need to understand what exposure they have had
What sort of things do we need to know about a patients occupation in references to all materials they have worked with?
- material exposed to
- duration of exposure
- intensity of exposure
- exposure and symptom association
- availability of PPE at work
In addition to work history, what are 2 other key history questions that need to be asked?
- history of lung disease
- history of smoking (pack years)
Why is it important to ask patients about symptoms in relation to their occupation?
- are symptoms worse at work
- do symptoms improve when leaving work
Can occupational asthma be instant when exposed to an allergen, or can it accentuate asthma that was already present?
- both
What are the common symptoms of occupational asthma?
- same as normal asthma
- breathlessness, tight chest, wheezing, cough
- ⬇️ PEF and spirometry used to diagnose
Prior to treating occupational asthma what must the clinician and patient identify between them?
- identify allergen
- avoid allergen
What are a few common workplace measures that may help reduce occupational asthma?
- appropriate PPE (FFP3 masks) - adequate ventilation - avoid allergen/re-deploy
What are some personal measures for management of occupational asthma?
- smoking cessation - optimal asthma management
What is pneumoconiosis?
- inhalation of dust and dangerous chemicals/toxins
- leads to lung fibrosis
What are some common occupational causes of pneumoconiosis?
- coal - asbestos - silica - siderosis (iron and steel)
What size dust particles can get lodged in patients airways?
- 1-4um
Do all dusts and chemicals need to be inhales at the same concentration to cause the same damage?
- no - high concentration of coal dust - lower concentration of silica or asbestos
How does dust lead to fibrosis in pneumoconiosis?
- macrophages fill with dust and then burst
- inflammation follows
- fibroblasts migrate and proliferate
- fibrosis follows
What does pneumoconiosis do to patients?
- breathlessness - cough - weight loss
Silicosis is a form of pneumoconiosis, what is silicosis?
- silica dust can be from sand blasters or silica miners
- causes lung fibrosis
How many people a year die from Silicosis?
- 10-20 people
Does silicosis affect the whole lungs equally?
- no - generally upper lobes
What does silicosis do to the lungs in addition to fibrosis?
- causes restrictive lung deficits
- eggshell calcification of lymph nodes
Silicosis can increase the risk of a lung cancer and a certain infection, what is the infection?
- mycobacterium tuberculosis (TB)
How can patients manage silicosis?
- ⬇️ exposure to silica in workplace - ⬆️ PPE - washing hand, face and clothing after exposure
What can patients do on a personal help to mitigate the effects of silicosis?
- smoking cessation
What is the most important scan and lung test clinicians should do if they suspect a patient has silicosis?
1 - chest X-ray
2 - monitor lung function
What treatment options are available for patients with silicosis?
- no known cure
- symptomatic treatment
- cough treatment
- dyspnoea (dysfunctional breathing)
- long term O2 therapy
What forms of benign lung disease can asbestos inhalation cause?
- calcified pleural plaques
- pleural effusion
- pleural thickening
What is asbestosis?
- pulmonary fibrosis caused by asbestos inhalation
What are the 2 malignant lung disease asbestos inhalation can cause?
- mesothelioma
- lung cancer
Does asbestos occupational lung disease present immediately following exposure in the work place?
- no
- long latency period - 20-40 years
Are all asbestos equally dangerous?
- no
- crocidolite (blue asbestos) is most dangerous
Lung cancer risk is increased with exposure to asbestos. Does smoking combined with asbestos exposure increase the risk of lung disease further?
- yes - asbestos alone = 7 fold ⬆️ risk of lung cancer
- asbestos + smoking = 93 fold ⬆️ of lung cancer
Mesothelioma, tumour formation of the mesoepithelial cells of the pleural walls around the lungs, is due to peak around the early 2020s, why is this?
- asbestos was stopped being sued in 1970s
- latency period means people will present 1990 onwards and even now
What are the common symptoms of patients with Mesothelioma?
- persistant chest pain
- breathlessness
- weight loss
- unilateral pleural effusion (exudate)
Can mesothelioma be cured?
- no - unless detected very early
What is the common treatment pathway for patients with mesothelioma, considering it is generally an incurable cancer?
- surgery if detecvted early
- standard cancer treatment
- chemotherapy
- symptomatic treatment
- palliative care
Do recreational drugs cause lung disease?
- yes
What does epistaxis mean?
- nose bleed
What is a pollutant?
- substance that contaminates the enviroment
What is a toxin?
- naturally occurring poison produced within organisms
What is exposure in reference to lung disease?
- concentration of pollutant/toxin
- duration of exposure
- intensity of exposure
- route of exposure (skin vs. inhaled)
- metabolism of toxin
Are all people equally susceptible to pollutants and toxins?
- no
- patients with atopy have ⬆️ sensitivity (⬆️ IgE)
Can exercising affect exposure to pollutants and toxins?
- yes - exercise opens airways - intensity of exposure could be ⬆️
What are 3 common factors that determine susceptibility to pollutants and toxins?
1 - genetic susceptibility (atopy)
2 - co-morbidities ⬇️ immune response
3 - environmental factors (temp, smog)
What is particulate matter, which is classified as a primary pollutant?
- sum of all solid and liquid particles suspended in air
What are the most common pollutants created from fossil fuel, which are classified as primary pollutants?
- nitric oxide (NO) - sulphur dioxide (SO2) - carbon monoxide (CO)
What are secondary pollutants
- reactions between pollutants in the atmostphere
How many groups of pollutants are there?
- 2 - primary and secondary pollutants
Why is particulate matter important in relation to hypersensitivity type I?
- can ⬆️effect of airborne allergens - can ⬆️ atopic sensitisation - can initiate an asthma attack
What are the 2 most common causes of outdoor nitric oxide?
- vehicle fumes - power stations
What are the 2 most common causes of indoor nitric oxide?
- fuel burning cookers - heaters without flue - cigarette smoke
Why is nitric oxide important in relation to lung disease?
- ⬆️ exacerbation of asthma and COPD - can ⬆️effect of airborne allergens - ⬆️ infection risk - children are at ⬆️ risk
Ozone is a secondary pollutant, what is the main source of ozone (O3)?
- heat and sunlight create ozone - nitric oxide interacts with ozone - NO interacts with heat and sunlight and ⬆️ O3
What can O3 do to a patient?
- ⬆️ exacerbation of asthma and COPD - ⬆️ response to inhales allergens - ⬆️ inflammation - ⬇️ lung function
