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HLB > Smoking & Occupational Lung Diseases > Flashcards

Smoking & Occupational Lung Diseases Flashcards

1
Q

How many people smoke worldwide?

A

2bn people

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2
Q

How many people die from smoking a year?

A

5 million/ year

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3
Q

What’s the % of men and women in the UK that smoke?

A

Men: 17.5%
Women: 15.8%

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4
Q

Tobacco smoke:

Harmful substances and what they lead to.

A
  • carcinogens leads to genetic mutations, lung cancer, mesothelioma
  • CO leads to carboxyhaemoglobin
  • impairs ciliary function leads to decreased MCE and hence more respiratory infections
  • hyperplasia of goblet cells leads to increased mucus production
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5
Q

Increased risk of —– from smoking: (10)

A
  • lung cancer
  • mesothelioma
  • bladder cancer
  • renal cell cancer
  • COPD
  • ILD
  • PVD
  • IHD
  • CVA
  • Foetal Growth Retardation
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6
Q

Dependance and withdrawal of smoking:

A
  • nicotine binds to nicotine acetylcholine receptors in the brain
  • this leads to a release of neurotransmitters:
    • increase in pleasure
    • decrease in anxiety
    • decrease in appetite
  • nicotine addiction can lead to dependence
  • smoking cessation is a physical and psychological withdrawal
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7
Q

Smoking cessation 5A’s

A
  • ASK: identify smokers at every visit
  • ADVISE: every patient who smokes to quit
  • ASSESS: assess their willingness to quit
  • ASSIST: provide access to counselling and prescribe pharmacotherapy
  • ARRANGE: follow up
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8
Q

Evidence for smoking cessation

A
  • strong evidence that smoking cessation improves morbidity, mortality and is cost-effective
  • brief advice from GP helps 2% smokers stop = 75,000 ppl
  • Quitline or stop smoking services
  • smoking ban in public places
  • smoking cessation clinics
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9
Q

What does NRT stand for?

A

Nicotine Replacement Therapy

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10
Q

Examples of NRT

A
  • nicotine patches
  • nicotine gum
  • nicotine nasal spray
  • inhalator
  • e-cigarettes
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11
Q

NRT evidence

A
  • clinical trials have shown that NRT doubles the chance of success of smokers wishing to stop
  • NRT provides nicotine in a slower and safer way than cigarettes
  • NRT doesn’t contain tar, CO or carcinogens
  • NRT reduces withdrawal symptoms (irritability, depression, craving)
  • very few people become addicted to NRT
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12
Q

Other treatments for smoking cessation:

A
  • Buproprion (Zyban)
  • Varenciline (champix)
  • Hypnosis
  • Acupuncture
  • NICE smoking cessation guidelines 2018
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13
Q

Other treatments for smoking cessation: Buproprion (Zyban):

  • what
  • how does it work
  • not suitable for
A
  • anti-depressant
  • increases dopamine levels
  • people with a history of depression
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14
Q

Other treatments for smoking cessation: Varenicline (champix):

A
  • binds to neuronal nicotinic Ach receptors
  • partial agonist
  • the most effective treatment for smoking cessation
  • currently unavailable in the UK and Europe because of safety concerns
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15
Q

Order of effectiveness of smoking cessation therapies:

Buproprion, NRT, Varenicline

A

Varenicline, Buproprion, NRT

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16
Q

Occupational Lung Diseases: estimated incidence

A

20,000/year self - reported cases

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17
Q

Prevalence of occupational lung diseases:

A

130 cases/100,000 workers

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18
Q

Estimated deaths per year in the UK due to occupational lung diseases.

A

12,000 deaths/year

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19
Q

Occupational lung diseases have a long

A

latency
decades from last exposure to symptoms of disease

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20
Q

Improved health and safety measures in recent decades linked to occupational lung diseases.

A
  • asbestos banned
  • wearing of masks
  • employers are held accountable
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21
Q

Type of occupational Lung Disease (3)(0)(2)(3):

A
  • Occupational asthma
  • Malignant:
    • Lung cancer
    • Mesothelioma
  • Pneumoconiosis (mineral dust):
    • coal workers lung
    • asbestosis
    • silicosis
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22
Q

Death caused by lung disease and % graph

A
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23
Q

Occupational history in relation to occupational lung diseases:

A
  • detailed history of ALL occupations, right from the beginning
  • Exposure to ALL material: type, duration, intensity, temporal relationship to onset of symptoms (improvement away from workplace?), availability of masks
  • history of lung disease
  • smoking history
  • symptoms at work
  • symptom improvement from workplace?
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24
Q

What is the most common occupational lung disease?

A

Occupational asthma

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25
Q

Incidence of occupational asthma

A

3000 cases a year

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26
Q

What % of adult-onset asthma has an occupational cause?

A

10-15%

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27
Q

Occupational asthma (3):

A
  • can develop for the first time when individual is exposed to irritant or sensitisor
  • Work- exacerbated asthma: pre-existing asthma made worse at work
  • characterised by breathlessness and wheeze in the work place, which improves when away from that environment
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28
Q

Causes of Occupational Asthma:

A
  • health care workers: latex
  • Cleaners: sodium hydrochloride, ammonia, chlorine
  • Hairdressers: hair spray, solvents
  • Painters and decorators: solvents, acetone, toluene
  • Bakers: flour
  • Farmers: mushrooms

ETC

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29
Q

Features of occupational or work related asthma:

A
  • symptoms occur in the workplace
  • symptoms improve away from the work place
  • reduced peak flow and spirometry at work
  • identify allergen: not always possible

Challenge testing:
- check spirometry after exposure to the product
- check spirometry after exposure to placebo
- may need occupational respiratory specialist to diagnose

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30
Q

Management of occupational asthma:

A
  • identify allergen/agent causing bronchoconstriction is possible

Workplace measures (6):
- health and safety review by employers
- appropriate masks FFP3
- adequate ventilation
- remove individual from area with increased risk
- re-deploy
- may be eligible for compensation if employer is negligent

Personal Measures (2):
- smoking cessation
- optimum asthma management

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31
Q

Pneumoconiosis definition

A

Lung fibrosis occurring as the result of inhalation of a variety of inorganic particles and mineral dust particles at work.

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32
Q

Examples of inorganic particles that cause pneumoconiosis (8):

A
  • coal
  • asbestos
  • siderosis: iron and steel
  • talc
  • beryllium
  • tin
  • barium
  • cobalt
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33
Q

What has been put in place to prevent pneumoconiosis occurring?

A
  • strict regulations in place
  • employers liable and can be prosecuted
  • compensation for those affected
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34
Q

Pathophysiology of pneumoconiosis (3)(2):

A
  • inert dust particles 1-4 micrometers get lodged in airways
  • concentration needed to causes disease depends on the dust:
    • high concentration of coal dust leading to Coal Worker’s Pneumoconiosis
    • lower concentration of silica or asbestos needed for fibrosis to develop
  • Pulmonary macrophages fill with dust leading to inflammation and fibrosis
35
Q

Coal Worker’s Pneumoconiosis:

  • common because?
  • deaths per year?
  • less common now?
  • -
  • Progressive —— Fibrosis
  • What type of lung disease?
A
  • was common in areas with coalmines
  • 140 deaths/year
  • less common now as fewer coalmines
  • uncomplicated coal-worker’s pneumoconiosis
  • progressive massive fibrosis: can lead to death:
    • activation of alveolar macrophages (carbon-laden)
    • progressive fibrosis leading to scarring causing stiff lungs
    • restrictive lung disease
36
Q

Progressive Massive Fibrosis causes (3):

A
  • breathlessness
  • cough
  • weight loss
  • can lead to death
37
Q
A

Progressive Massive Fibrosis:
- shows extensive areas of fibrosis in the upper lobes

38
Q

Silicosis: Which occupations are at risk? (7)

A
  • Slate workers
  • Potters
  • Knife grinders
  • Hard rock miners (gold, tin, iron, uranium)
  • Sand-blasting
  • Stone-cutting
  • Foundry workers

Exposure to SILLICA

39
Q

How many deaths per year due to silicosis?

A

10-20 deaths per year in the UK

40
Q

Silicosis: Fibrotic Lung Disease:

A
  • causes Fibrotic Lung Disease
  • activation of macrophages
  • restrictive lung function deficit
  • eggshell calcification of lymph nodes
  • risk factor for developing TB and lung cancer
41
Q

Management of Pneumoconiosis:

A
  • prevent or reduce further exposure in workplace:
    • PPE
    • Washing of face,body and clothing after
      exposure = can affect other people in house like secondary smoking
  • stop smoking
  • monitor lung function
  • Symptomatic Treatment:
    • cough
    • dyspnoea
    • Long term oxygen therapy
  • no specific treatment or cure for the disease itself
42
Q

Asbestos Related Lung Disease: Benign (3):

A
  • calcified pleural plaque
  • benign pleural effusion
  • benign pleural thickening
43
Q

Asbestosis

A

Pulmonary Fibrosis caused by asbestos: fibers clumping into lumps causing irritation

44
Q

Asbestos Related Lung Disease: Malignant (2):

A
  • mesothelioma (cases expected to peak in 2020 reflecting latency period of 20-40 years)
  • lung cancer (increased risk 7x in non-smoker, 9x in smoker)
45
Q

benign asbestos

Arrows point to?

A

if they have pleural plaques very unlikely to develop cancer

46
Q

If a CT shows pleural plaques, then patient has been exposed to

A

asbestos

47
Q

If a patient with pleural plaques, pleura becomes irritated and hence has a pleural effusion, why do we worry?

A
  • exposure to asbestos
  • anyone exposed to asbestos with a pleural effusion is at risk of mesothelioma
48
Q

Latency period of asbestos related lung diseases?

A

20-40 years

49
Q

Which of the three benign conditions of asbestos related lung disease, do we have to investigate to make sure it is not malignant?

A
  • benign pleural effusion
  • benign pleural thickening
50
Q

Treatment for asbesotsis?

A

None, trials going on

Can’t give antifibrotics

51
Q

Asbestos fibers

A
  • natural fiber from hydrated magnesium silicates: ampibole and serpentine
  • Serpentine: white asbestos (chrysotile), curly fibers
  • Amphiboles: blue asbestos (crocidolite), stiff fibers, 50 micrometers length
52
Q

If a person has been exposed to asbestos and smokes, is coughing up blood, what are we worried about?

A

Lung cancer

53
Q

Which type of asbestos fibers are more harmful and what can it cause?

A
  • Amphiboles (blue, stiff) are more harmful than serpentine asbestos (white, curly)
  • causes mesothelioma
  • causes asbestosis
54
Q

Examples of occupations with risk of asbestos exposure:

A
  • plumbers
  • car mechanics
  • shipyard workers
  • carpenters
  • merchant navy
  • construction workers
  • electricians
  • roofers
  • power plant workers
  • blacksmiths
  • firefighters
  • builders
  • laggers
  • chemical industry
55
Q

Properties of Asbestos (7):

A
  • Non-inflammable, even at high temperatures
  • Insulation: heat, electricity, sound
  • High tensile strength
  • Durable
  • Flexible
  • Versatile
  • Cheap
56
Q

When was asbestos banned worlwide?

A

It wasn’t.
Banned in the UK in 1977.
Be aware patients that worked in other countries may have also been exposed, even if much younger.

57
Q

Symptoms and Signs of Mesothelioma(4):

A
  • persistent chest pain
  • breathlessness
  • weight loss
  • unilateral pleural effusion (exudate)
58
Q

Mesothelioma can affect the peritoneum, which is an

A

extension of the pleura into the abdomen

59
Q

Mesothelioma imaging labelled

A
60
Q

Management of Mesothelioma:

A
  • surgery
  • radiotherapy (not very effective)
  • chemotherapy (not very effective)
  • Symptomatic Management:
    • pain
    • dyspnoea
    • nutrition
  • Palliative care
61
Q

Mesothelioma has a —– prognosis

A

poor

62
Q

Mesothelioma is a restrictive disease of the airways.

True or False? Why?

A

False
Thickening of the pleura
Restricts VENTILATION

63
Q

Rapid inhalation of powders and solvents can result in

A
  • pneumonitis: inflammation of lungs
  • bronchitis: inflammation of bronchi
  • pneumonia
  • pneumothorax: burst your alveoli by inhaling rapidly and causes pneumothorax
64
Q

Why do many young people sniff glue and solvents?

A
  • cheap
  • easily obtainable
65
Q

How many deaths from inhaling solvent, sniffing glue and paint thinners between 1983 and 2000?

A

1700 deaths

66
Q

Crack cocaine and heroin, which are snorted through the nostrils can cause ——- and destroy the —— ——–.

A
  • epistaxis (bleeding from the nasal cavity)
  • nasal cartilage
67
Q

Illegal Drugs and effect on lungs:

  • cannabis
  • cocaine
  • amphetamines and heroin
  • insufflation of poppers, amyl nitrates and toluene
  • use of aerosol propellant gases with a plastic bag held over the mouth
A
  • cannabis (class B): nasal issues, pulmonary toxicity, cough, bronchoconstriction, repeated infections
  • cocaine is addictive, hence people may be dependant, can cause bronchoconstriction and repeated chest infections
  • inhalation of crack cocaine can lead to pulmonary toxicity and epistaxis
  • Inhalation of amphetamines and heroin is carried out by 2%
  • insufflation of poppers, amyl nitrites and toluene can damage the lungs
  • the use of aerosol propellant gases with a plastic bag held over the mouth has a high risk of hypoxia, aspiration, suffocation and respiratory arrest
68
Q

Environmental Causes of Respiratory Disease:

A
  • pollutant: a substance that contaminates the environment
  • Toxin: low concentration of a naturally occurring poison produced within an organism, which can cause respiratory or other disease
69
Q

Clinical impact of environmental causes of respiratory disease varies with (7):

A
  • individual susceptibility
  • comorbidities
  • concentration of toxin/pollutant
  • duration
  • intensity (while exercising for example)
  • route (skin vs inhaled)
  • metabolism of toxin
70
Q

Susceptibility to pollutants and toxins are determined by (3)(3):

A
  • genetic factors
  • co-morbidities
  • environmental factors:
    • cold weather
    • heat waves
    • smog
71
Q

Risk of Air Pollution (5):

A
  • increases cardiovascular and respiratory morbidity and mortality
  • adversely affects lung development in children
  • worse in urban areas due to traffic fumes
  • caused by particulate matter
  • Radon in soil, rock and ground water
72
Q

Environmental Pollutants:

A
  • Vehicle exhaled pollutants
  • primary pollutants from fossil fuels: NO, SO2, CO, particulate matter
  • secondary pollutants: from reactions between primary pollutants in the atmosphere
73
Q

Particulate Matter

A
  • soot
  • metals
  • can potentiate effect of airborne allergens
  • can cause atopic sensitisation
  • can trigger asthma exacerbation
74
Q

Environmental Pollutant: NO sources:

A
  • Outdoor Sources: vehicle exhausts, power stations
  • Indoor sources: fuel burning cookers, fireplaces without flue, cigarette smoking
75
Q

Environmental pollutant: The Impact of NO:

A
  • exacerbation of asthma and COPD
  • increased response to inhaled allergens
  • increased risk of infection
  • children are particularly susceptible
76
Q

Environmental Pollutant: Ground Level OZONE: Sources:

A
  • secondary pollutant
  • heat and sunlight along with other volatile organic compounds forms nitric oxide and O3
77
Q

Environmental Pollutant: Ground Level Ozone (O3): Impact:

A
  • increased response to inhaled allergens
  • increased response to inflammation
  • decreased lung function
78
Q

Inhaled allergens and irritants

A
79
Q

Weather and Lung Disease:

A
  • temperature changes associated with asthma and COPD exacerbation
  • inhalation of cold, dry air can cause bronchoconstriction, possible due to the loss of water from the airways
  • breathing hot, humid air can cause bronchoconstriction secondary to vagal mechanisms
  • thunderstorms, increases the concentration of pollen debris and O3, leading to an allergic exacerbation of asthma
  • Damp weather can lead to an increase in dust mites, mould and CO2 levels, which can cause bronchoconstriction
  • Desert dust causes respiratory symptoms, acute exacerbation oof asthma and COPD
  • weather forecasts now warn patients with respiratory disease about high pollen count and thunderstorms, which may help to reduce the risk of exacerbations
80
Q

Which of the following can cause an exacerbation of asthma?

1 = cold air
2 = hot air
3 = thunderstorms
4 = traffic fumes
5 = all of the above

A

5

81
Q

What is the most effective treatment for smoking cessation?

1 = advise and encouragement
2 = Buproprion (Zyban)
3 = hypnosis
4 = NRT
5 = Varenicline (champix)

A

5, however not currently available

82
Q

Which of these statements about occupational asthma is true?

1 = symptoms improve at work
2 = spirometry shows obstruction at work
3 = will not respond to asthma treatment
4 = will not improve by using mask and
ventilation
5 = the allergen can always be identified

A

2

83
Q

Which is the most common occupational lung disease?

1 = asbestosis
2 = asthma
3 = coal worker’s pneumonia
4 = mesothelioma
5 = silicosis

A

2

84
Q

Which of these conditions does not usually cause any symptoms?

1 = asbestosis
2 = progressive massive fibrosis
3 = mesothelioma
4 = silicosis
5 = pleural plaques

A

5

HLB (49 decks)

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