Occupational Lung Disease

Question 1

Give examples of occupational lung diseases.

Answer 1

Acute bronchitis and pulmonary oedema

Pulmonary fibrosis

Occupational asthma

Hypersensitivity pneumonitis

Bronchial carcinoma

Coal-worker’s pneumoconiosis

Silicosis

Asbestosis

Byssinosis

Berylliosis

Question 2

What is Coal worker’s pneumoconiosis?

Answer 2

A common dust disease in countries that have or have had underground coal-mines.
Results from inhalation of coal dust particles over 15-20 years.

They are ingested by macrophages which die, and release their enzymes to cause fibrosis.

Question 3

What are the two syndromes that can happen due to inhalation of coal?

Answer 3

Simple pneumoconiosis

Progressive massive fibrosis

Question 4

Clinical features of CWP.

Answer 4

Asymptomatic often but co-existing chronic bronchitis is common.

A CXR may show many round opacities 1-10 mm especially in the upper zone.

Question 5

Management of CWP

Answer 5

Avoid exposure to coal dusts

Treat co-existing chronic bronchitis

Claim compensation

Question 6

What is progressive massive fibrosis?

Answer 6

Due to progression of CWP.

Question 7

Clinical features of PMF.

Answer 7

Progressive dyspnoea

Fibrosis

Eventually cor pulmonale.

Cough with black sputum

Question 8

CXR findings in PMF.

Answer 8

Bilateral upper-mid zone fibrotic masses (1-10 cm) going from the periphery and develop towards the hilum.

Question 9

What is Caplan’s syndrome?

Answer 9

Association between rheumatoid arthritis, pneumoconiosis and pulmonary rheumatoid nodules.

Question 10

What is silicosis?

Answer 10

Caused by inhalation of silica particles.

Silica particles are very fibrogenic and only a small amount is needed in order to causes serious fibrosis.

Question 11

Jobs that can cause silicosis.

Answer 11

Metal mining

Stone quarrying

Sandblasting

Pottery and ceramic manufacturing

Question 12

Clinical features of silicosis.

Answer 12

Progressive dyspnoea

Silicosis can predispose to TB

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

Spirometry shows a restrictive pattern.

Question 13

Management of silicosis.

Answer 13

Avoid silica

Claim compensation

Question 14

Effects of asbestos on lungs.

Answer 14

Asbestos bodies

Pleural plaques

Effusion

Bilateral diffuse pleural thickening

Mesothelioma

Asbestosis

Asbestos-related carcinoma of the bronchus.

Question 15

What is asbestosis?

Answer 15

Caused by inhalation of asbestos fibres.

Asbestos was used to fire proof, pipe lag, eletrical wire insulation and roofing felt.

This causes fibrosis of the lungs.

Question 16

Clinical features of asbestosis.

Answer 16

Similar to other fibrotic lung diseases with progressive dyspnoea, clubbing and fine end-inspiratory crackles.

Also causes pleural plaques, risk of bronchial adenocarcinoma and mesothelioma.

Question 17

Management of asbestosis.

Answer 17

Treat symptoms.

Claim compensation.

Question 18

What is byssinosis?

Answer 18

Due to cotton dust.

Symptoms start on the first day back at work after a break.

The symptoms improve as the week progresses.

Symptoms such as chest tightness, cough and SOB.

Individuals with asthma particularly vulnerable.

No changes on CXR.

Question 19

What is berylliosis?

Answer 19

Beryllium-copper alloy used in aero-space industry, atomic reactors and many electrical devices.

Can cause a systemic illness with a clinical pciture similar to that of sarcoidosis.

Progressive dyspnoea with pulmonary fibrosis.