1 / 34

Occupational lung disease

Occupational lung disease. A. H. Mehrparvar, MD Occupational Medicine department Yazd University of Medical Sciences. Introduction. Respiratory tract a common site of occupational injury Two sites: Airways Parenchyma Site of injury depends on: Gas solubility Particle size. Evaluation.

aeckenrode
Download Presentation

Occupational lung disease

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Occupational lung disease A. H. Mehrparvar, MD Occupational Medicine department Yazd University of Medical Sciences

  2. Introduction • Respiratory tract a common site of occupational injury • Two sites: • Airways • Parenchyma • Site of injury depends on: • Gas solubility • Particle size

  3. Evaluation • History • Physical exam • Pulmonary function tests: • Spirometry • Body plethysmography • DLCO • Imaging: • Chest X ray • HRCT

  4. Acute inhalational injury • Short-term exposure to high concentration of gases, fumes, or mists • Generally as an accident • Irritation of membranes • Chemical pneumonitis • ARDS • Chmicals: • Formaldehyde • Cadmium salts • chlorine

  5. Signs and symptoms • Upper respiratory tract irritation • Cough • Stridor • Hoarseness • Wheezing • PFT: normal, obstructive, mixed • Chest X ray: normal to pulmonary edema

  6. Occupational asthma • Reversible airway obstruction, with airway inflammation and bronchial hyperresponsiveness as a consequence of occupational exposures

  7. Types of asthma • Sensitizer-induced • Type 1 immune reaction (IgE) • Latent period for sensitization • In a percent of workers • Irritant-induced • RADS • Without latency • Exposure to a high concentration • In most workers

  8. Diagnosis • History: • Hx of dyspnea (exertional), cough, in an episodic mode, night symptoms • Physical exam • wheezing • PFT • Spirometry: normal or obstructive • BD test: mostly responsive • Chest X ray • Not helpful

  9. Treatment • Reduction or elimination of exposure • Beta agonists • corticosteriods

  10. Hypersensitivity pneumonitis • Immunologically mediated inflammatory disease of lung parenchyma caused by some organic dusts

  11. Diagnosis • History • Acute: cough, fever, chills, malaise, dyspnea after an acute exposure • Chronic • Physical exam” • Basilar inspiratory crackles • PFT: • Restrictive or mixed pattern, low DLCO • CXray: • normal, reticulonodular pattern, infiltration

  12. Management • Avoidance of exposure • Corticosteroids

  13. Pneumoconiosis • A type of O-ILDs. • Due to inhalation and deposition of mineral dust within lung parenchyma. • Induce tissue reaction • May cause disruption of alveolar architecture or collagen fibrosis.

  14. Common features of all pneumoconioses • Deposition of mineral dusts in lung tissue. • Presence of parenchymal tissue reaction • Positive chest x-ray findings • PFT may be abnormal depending on the stage and severity and complications.

  15. Types of pneumoconioses • Benign: • Asymptomatic • Normal spirometric findings • Collageneous: • Symptomatic • Abnormal spirometric findings

  16. Main clues for diagnosis( usually sufficient for legal compensation) • Sufficient and reasonable exposure. (intensity and duration) • Positive chest x-ray findings (good quality is required) • No other concomitant diseases that mimic pneumoconiosis.

  17. Collagenous pneumoconiosis • Silicosis • Asbestosis • Coal-workers’ pneumoconiosis

  18. Silicosis • A collagenous pneumoconiosis caused by inhalation of respirable (0.2 – 10 µm ) free crystalline silicon dioxide ( SiO2 ). • Chronic diffuse interstitial fibronodular lung disease. • High-dose and long-time inhalation is required. • A strict dose-response relationship is present • Cumulative exposure • Intensity × duration

  19. Sources of exposure • Removal of stone • Hard rock mining • Tunnel drilling • Stone quarrying • Processing stone or sand • Stone crushing • Granite carving

  20. Sources of exposure • Abrasive use of silica or sand • Abrasive blasting • Foundry casting • Knife sharpening • Production of fine silica powder

  21. Sources of exposure • Utilization of sand or silica powder • Glass manufacture • Plastic manufacture • Paint manufacture • Pottery • Ceramic manufacture • Construction work

  22. Silica-induced diseases • Chronic bronchitis • Emphysema • Silicosis • Tuberculosis • Lung cancer • Collagen vascular diseases

  23. Clinical presentation • Chronic simple ( classic ) silicosis • Chronic complicated ( PMF ) silicosis • Accelerated silicosis • Acute silicosis

  24. Chronic simple silicosis • Moderate long-time exposure (at least 10 yr) to less than 30% quartz • Symptoms and signs: • Mostly asymptomatic • Chronic productive cough or DOE due to chronic bronchitis • Progressive DOE and dry cough (late finding) • Ph. exam normal or crackles • PFT: normal or restrictive (mainly) obstructive or mixed pattern • CXRay: small (<1 cm), round nodules predominantly in upper lobes, hilar lymphadenopathy and calcification

  25. Complications • Progressive massive fibrosis • Tuberculosis(3-fold to 20-fold) • Pulmonary and extrapulmonary • Typical and atypical mycobacteria • Immune-mediated • Scleroderma (m/c) • SLE, RA , … • Renal (GN, nephrotic syndrome)(usually in heavy exposure) • Lung cancer • Fungal diseases • Cryptococcus • Blastomycosis • coccidiopmycosis

More Related