Occupational lung disorders

Question 1

What conditions can exposure to dusts, gases, vapours, fumes at work can lead to?

Answer 1

Acute bronchitis and pulmonary oedema
Hypersensitivity pneumonitis
Pulmonary fibrosis from inhaling inorganic dust
Occupational asthma
Bronchial carcinoma due to asbestos, polycyclic hydrocarbons and radon in mines.

Question 2

What is occupational asthma?

Answer 2

asthma induced by sensitisation (allergy) to an agent inhaled at work

Question 3

What causes asbestosis?

Answer 3

Inhalation of asbestos fibres

Question 4

Which asbestos is most fibrogenic?

Answer 4

Blue is most
Brown is intermediate
White is least

Question 5

Which asbestos fibre is the most common?

Answer 5

White

Question 6

What jobs are associated with asbestos exposure?

Answer 6

builders, plumbers, electricians

Question 7

Describe the clinical presentation of asbestosis?

Answer 7

Long latency period.

Similar to other fibrinolytic conditions
Progressive dyspnoea
Clubbing 
Fine end inspiratory crackles 
Pleural plaques 
Increased risk of bronchial adenocarcinoma and mesothelioma

Question 8

How is diagnosis made for asbestosis?

Answer 8

Typical Xray + history of exposure

Question 9

How is asbestosis managed?

Answer 9

No curative treatment

Symptomatic treatment + compensation

Question 10

Asbestos can cause a mesotheliom, a
tumour arising from mesothelial cells of pleura peritoneum and pericardium

How would this present?

How is this treated?

Answer 10

Presents with a dull, diffuse and progressive chest pain and a pleural effusion

Treatment is with chemo or debunking therapy—> prognosis is poor.

Question 11

What causes coal worker’s pneumoconiosis (CWP)?

Answer 11

Caused by inhalation of coal dust particles

Question 12

Pathophysiology of CWP?

Answer 12

These are ingested by macrophages, which die – release their enzymes, causing fibrosis

Question 13

Clinical presentation of CWP?

Answer 13

Asymptomatic

Co-existing chronic bronchitis is common

CXR – many round opacities in upper zone

Question 14

Management?

Answer 14

Avoid coal dust exposure
Treat co-existing chronic bronchitis
Claim compensation in UK (Industrial Injuries Act)

Question 15

What causes silicosis?

Answer 15

inhalation of silica particles which are very fibrogenic

Jobs associated with silica exposure incl. – Metal mining, stone quarrying, sand blasting, pottery/ceramic manufacture

Question 16

Clinical features of silicosis?

Answer 16

Progressive dyspnoea

Increased incidence of TB

CXR show diffuse miliary or nodular pattern in upper and mid-zones + egg-shell calcification of hilar nodes

Spirometry – restrictive ventilator defect

Question 17

Who gets Byssinosis?

Answer 17

Cotton Mill workers

Most likely due to endotoxins in bacteria in the raw cotton – causes constriction of airways of lung

Question 18

Clinical presentation of Byssinosis?

Answer 18

Symptoms start on first day back at work then improve throughout weak

Tightness in chest, cough and breathlessness in 1h of being in dusty areas of mill

No CXR changes

Question 19

What is Berrylliosis?

Answer 19

Beryllium-copper alloy is used in aerospace industry, in atomic reactors and in electrical devices

When beryllium is inhaled, causes a systemic illness similar to sarcoidosis

Progressive dyspnoea with pulmonary fibrosis