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Year 1 HLB Respiratory > Smoking and Occupational Lung Disease > Flashcards

Smoking and Occupational Lung Disease Flashcards

1
Q

How many people smoke worldwide?

A
  • aprox 2 billion
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2
Q

How many people die each year from smoking worldwide?

A
  • aprox 5 million deaths/year
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3
Q

What % of men and women in UK smoke tobacco?

A
  • men = 17.5%
  • women = 15.8%
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4
Q

Tobacco smoke contains carcinogens, how can carcinogens cause lung damage and cancer?

A
  • cause genetic mutations and malignancy
  • causes lung cancer
  • mesothelioma (tumour on myoepithelial cells)
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5
Q

In addition to containing carcinogens, tobacco also increase carbon monoxide intake, what does this cause to the blood?

A
  • CO bind preferentially binds to haemoglobin
  • carboxyhaemoglobin
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6
Q

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?

A
  • infections
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7
Q

How does smoke cause an increase in mucus production?

A
  • irritate the airways
  • goblet cell hyperplasia follows to protect the lungs
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8
Q

Smoking can increase the risk of morbidity, what are the most common causes of death of smokers?

A
  • lung cancer
  • mesothelioma
  • bladder cancer
  • renal cell cancer
  • COPD
  • Interstitial Lung Disease (ILD)
  • Peripheral Vascular Disease
  • Ischemic Heart Disease
  • Cerebrovascular Accident
  • Foetal Growth Development
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9
Q

Smoking can cause dependence on cigarettes. Nicotine can be addictive, why?

A
  • nicotine binds to nicotinic receptors - acetylcholine ⬆️
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10
Q

Nicotine in cigarettes can increase increase pleasure through the release of neurotransmitters, what is the main neurotransmitter released?

A
  • dopamine
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11
Q

In addition to increasing pleasure, what other psychological things can smoking do?

A
  • ⬇️ appetite - ⬇️ anxiety
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12
Q

When people try to quit smoking, this is called dependence. Does this lead to mental dependence only?

A
  • no - physical and pyschological
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13
Q

What is the process to help patient stop smoking?

A
  • ASK - do you smoke
  • ADVISE - that patients should quit
  • ASSESS - is patient willing to quit
  • ASSIST - provide support
  • ARRANGE - follow up patient
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14
Q

Can smoking cessation help patients?

A
  • yes - ⬇️ morbidity and mortality
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15
Q

Can advice from GP help patients quit smoking?

A
  • yes - helps 2% of smokers quit (75,000)
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16
Q

How has the smoking cessation been encouraged in the UK?

A
  • quit-line through NHS - ban on public space smoking - smoking cessation clinics
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17
Q

Following advice and support, what is generally the first step to help smokers quit smoking?

A
  • nicotine replacement therapy - gum, spray, inhalator or cigarettes
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18
Q

Why is nicotine replacement therapy better than smoking?

A
  • nicotine without tar, CO or carcinogens - few people become addicted
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19
Q

How good is nicotine replacement therapy at helping people quit smoking?

A
  • doubles the chance of quitting - ⬇️ withdrawal symptoms
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20
Q

What is the most effective method when a patient needs to quit smoking?

A
  • Varenicline (Champix) - combined with smoking cessation clinics
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21
Q

How does Varenicline (Champix) help patients quit smoking?

A
  • partial agonist of nicotinic acetylcholine receptors
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22
Q

How many people self report lung diseases due to occupation per year?

A
  • aprox 20,000/year self reported
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23
Q

What is the estimated prevalence of lung diseases due to occupation?

A
  • 130 / 100,000 people
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24
Q

How many people each year are estimated to die due to occupational exposure to toxins?

A
  • 12,000/year
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25
Q

Does occupational lung disease present immediately following exposure in the work place?

A
  • no - generally long latency period
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26
Q

What are the 3 main things that have helped reduced occupational lung disease in the UK?

A
  • ⬇️ asbestos
  • ⬆️ PPE
  • ⬆️ employer accountability
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27
Q

What is the main occupational lung disease?

A
  • asthma
  • 3000/year
  • 10-15% adult occupational asthma
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28
Q

Why is it important to take a full occupational history when examining a patients lungs?

A
  • long latency periods
  • need to understand what exposure they have had
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29
Q

What sort of things do we need to know about a patients occupation in references to all materials they have worked with?

A
  • material exposed to
  • duration of exposure
  • intensity of exposure
  • exposure and symptom association
  • availability of PPE at work
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30
Q

In addition to work history, what are 2 other key history questions that need to be asked?

A
  • history of lung disease
  • history of smoking (pack years)
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31
Q

Why is it important to ask patients about symptoms in relation to their occupation?

A
  • are symptoms worse at work
  • do symptoms improve when leaving work
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32
Q

Can occupational asthma be instant when exposed to an allergen, or can it accentuate asthma that was already present?

A
  • both
33
Q

What are the common symptoms of occupational asthma?

A
  • same as normal asthma
  • breathlessness, tight chest, wheezing, cough
  • ⬇️ PEF and spirometry used to diagnose
34
Q

Prior to treating occupational asthma what must the clinician and patient identify between them?

A
  • identify allergen
  • avoid allergen
35
Q

What are a few common workplace measures that may help reduce occupational asthma?

A
  • appropriate PPE (FFP3 masks) - adequate ventilation - avoid allergen/re-deploy
36
Q

What are some personal measures for management of occupational asthma?

A
  • smoking cessation - optimal asthma management
37
Q

What is pneumoconiosis?

A
  • inhalation of dust and dangerous chemicals/toxins
  • leads to lung fibrosis
38
Q

What are some common occupational causes of pneumoconiosis?

A
  • coal - asbestos - silica - siderosis (iron and steel)
39
Q

What size dust particles can get lodged in patients airways?

A
  • 1-4um
40
Q

Do all dusts and chemicals need to be inhales at the same concentration to cause the same damage?

A
  • no - high concentration of coal dust - lower concentration of silica or asbestos
41
Q

How does dust lead to fibrosis in pneumoconiosis?

A
  • macrophages fill with dust and then burst
  • inflammation follows
  • fibroblasts migrate and proliferate
  • fibrosis follows
42
Q

What does pneumoconiosis do to patients?

A
  • breathlessness - cough - weight loss
43
Q

Silicosis is a form of pneumoconiosis, what is silicosis?

A
  • silica dust can be from sand blasters or silica miners
  • causes lung fibrosis
44
Q

How many people a year die from Silicosis?

A
  • 10-20 people
45
Q

Does silicosis affect the whole lungs equally?

A
  • no - generally upper lobes
46
Q

What does silicosis do to the lungs in addition to fibrosis?

A
  • causes restrictive lung deficits
  • eggshell calcification of lymph nodes
47
Q

Silicosis can increase the risk of a lung cancer and a certain infection, what is the infection?

A
  • mycobacterium tuberculosis (TB)
48
Q

How can patients manage silicosis?

A
  • ⬇️ exposure to silica in workplace - ⬆️ PPE - washing hand, face and clothing after exposure
49
Q

What can patients do on a personal help to mitigate the effects of silicosis?

A
  • smoking cessation
50
Q

What is the most important scan and lung test clinicians should do if they suspect a patient has silicosis?

A

1 - chest X-ray

2 - monitor lung function

51
Q

What treatment options are available for patients with silicosis?

A
  • no known cure
  • symptomatic treatment
  • cough treatment
  • dyspnoea (dysfunctional breathing)
  • long term O2 therapy
52
Q

What forms of benign lung disease can asbestos inhalation cause?

A
  • calcified pleural plaques
  • pleural effusion
  • pleural thickening
53
Q

What is asbestosis?

A
  • pulmonary fibrosis caused by asbestos inhalation
54
Q

What are the 2 malignant lung disease asbestos inhalation can cause?

A
  • mesothelioma
  • lung cancer
55
Q

Does asbestos occupational lung disease present immediately following exposure in the work place?

A
  • no
  • long latency period - 20-40 years
56
Q

Are all asbestos equally dangerous?

A
  • no
  • crocidolite (blue asbestos) is most dangerous
57
Q

Lung cancer risk is increased with exposure to asbestos. Does smoking combined with asbestos exposure increase the risk of lung disease further?

A
  • yes - asbestos alone = 7 fold ⬆️ risk of lung cancer
  • asbestos + smoking = 93 fold ⬆️ of lung cancer
58
Q

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?

A
  • asbestos was stopped being sued in 1970s
  • latency period means people will present 1990 onwards and even now
59
Q

What are the common symptoms of patients with Mesothelioma?

A
  • persistant chest pain
  • breathlessness
  • weight loss
  • unilateral pleural effusion (exudate)
60
Q

Can mesothelioma be cured?

A
  • no - unless detected very early
61
Q

What is the common treatment pathway for patients with mesothelioma, considering it is generally an incurable cancer?

A
  • surgery if detecvted early
  • standard cancer treatment
  • chemotherapy
  • symptomatic treatment
  • palliative care
62
Q

Do recreational drugs cause lung disease?

A
  • yes
63
Q

What does epistaxis mean?

A
  • nose bleed
64
Q

What is a pollutant?

A
  • substance that contaminates the enviroment
65
Q

What is a toxin?

A
  • naturally occurring poison produced within organisms
66
Q

What is exposure in reference to lung disease?

A
  • concentration of pollutant/toxin
  • duration of exposure
  • intensity of exposure
  • route of exposure (skin vs. inhaled)
  • metabolism of toxin
67
Q

Are all people equally susceptible to pollutants and toxins?

A
  • no
  • patients with atopy have ⬆️ sensitivity (⬆️ IgE)
68
Q

Can exercising affect exposure to pollutants and toxins?

A
  • yes - exercise opens airways - intensity of exposure could be ⬆️
69
Q

What are 3 common factors that determine susceptibility to pollutants and toxins?

A

1 - genetic susceptibility (atopy)

2 - co-morbidities ⬇️ immune response

3 - environmental factors (temp, smog)

70
Q

What is particulate matter, which is classified as a primary pollutant?

A
  • sum of all solid and liquid particles suspended in air
71
Q

What are the most common pollutants created from fossil fuel, which are classified as primary pollutants?

A
  • nitric oxide (NO) - sulphur dioxide (SO2) - carbon monoxide (CO)
72
Q

What are secondary pollutants

A
  • reactions between pollutants in the atmostphere
73
Q

How many groups of pollutants are there?

A
  • 2 - primary and secondary pollutants
74
Q

Why is particulate matter important in relation to hypersensitivity type I?

A
  • can ⬆️effect of airborne allergens - can ⬆️ atopic sensitisation - can initiate an asthma attack
75
Q

What are the 2 most common causes of outdoor nitric oxide?

A
  • vehicle fumes - power stations
76
Q

What are the 2 most common causes of indoor nitric oxide?

A
  • fuel burning cookers - heaters without flue - cigarette smoke
77
Q

Why is nitric oxide important in relation to lung disease?

A
  • ⬆️ exacerbation of asthma and COPD - can ⬆️effect of airborne allergens - ⬆️ infection risk - children are at ⬆️ risk
78
Q

Ozone is a secondary pollutant, what is the main source of ozone (O3)?

A
  • heat and sunlight create ozone - nitric oxide interacts with ozone - NO interacts with heat and sunlight and ⬆️ O3
79
Q

What can O3 do to a patient?

A
  • ⬆️ exacerbation of asthma and COPD - ⬆️ response to inhales allergens - ⬆️ inflammation - ⬇️ lung function

Year 1 HLB Respiratory (25 decks)

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