occupational lung disease and pollution Flashcards
(21 cards)
what are occupational lung diseases? 5
- Range of lung diseases caused by exposures in the workplace
- Typically, long latency stats reflect previous working conditions
COPD - malignant diseases lung cancer (asbestos and non-asbestos related), mesothelioma
- occupational asthma
- pneumoconiosis (mineral dust) coal worker’s lung, asbestosis, silicosis
how do we take an occupational history? 2
- detailed history of exposure type of material, duration, intensity, temporal relationship to onset of symptoms
- symptoms improvement away from workplace
what is pneumoconiosis? 3
- coal workers pneumoconiosis140 deaths a year, UK coalfields
- uncomplicated CWP mild disease
- progression of massive fibrosis activation of alveolar macrophages, progressive scarring causing stiff lungs
what is silicosis? 8
- slate workers (wales)
- potters
- knife grinders
- hard rock miners
- sand blasting
- foundry workers
- Fibrotic lung disease activation of macrophages, restrictive lung function deficit, eggshell calcification of lymph nodes
- Risk factor for TB and lung cancer
how do we treat pneumoconiosis? 5
- Prevent further exposure
- Stop smoking
- Monitor lung function
- Symptomatic treatment cough, dyspnoea, cor pulmonale
- No specific treatment or cure for the disease itself
what is asbestos? 3
- Used in building, power stations, ship building, railways and cars in the 1930-70s
- Occupation history is vital
- Risk of washing contaminated clothes
descrie benign asbestos and the lung? 4
- Pleural plaques (marker of exposure)
- Benign pleural effusion
- Pleural thickening (with subsequent restriction on lung function)
- Asbestosis interstitial lung disease-restrictive lung function with reduction in forced vital capacity and reduced gas transfer
describe malignant asbestos and the lung? 7
- Lung cancer
- Mesothelioma:
- Malignancy of pleura and peritoneum caused by asbestos
- Pleural plaques on previous CXR
- Persistent unexplained chest pain
- Weight loss
- Breathless/ unilateral pleural effusion
how do we diagnose someone with occupational asthma? 6
- is it really asthma? differentials= COPD, heart failure, interstitial lung disease
- risk factors= atopy, rhinitis, smoking
- recognition of a high risk job
- co-workers similarly affected?
- recent changes in products used and task undertaken?
- preventative measures= ventilation, masks
describe high molecular weight allergic occupational asthma? 4
- Proteins, polysaccharides
- Sensitisation with latency period (weeks-years)
- IgE-dependent
- Skin prick/allergy testing four, animals, latex, enzymes
describe low molecular weight allergic occupational asthma? 3
- Mechanism poorly understood
- Usually, independent IgE
- Limited utility of skin prick/allergy testing isocyanates, metals, dyes
what is irritant induced/ non allergic asthma?
- Direct effect on airways, not immune mediated, occurs without pre-existing asthma
describe acute irritant induced/ non allergic asthma? 8
- Reactive airways dysfunction syndrome (RADS)
- Develops within hours of a single, very high exposure to an irritant
- Caustic vapours
- Ammonia
- Fire/smoke
- Chlorine
- Tear gas
- Floor sealants
describe subacute irritant induced/ non allergic asthma?
- Insidious onset of asthma symptoms after multiple moderate/high exposure incidents
what is a toxin?
naturally occurring poison produced within living cells and organisms
what is a pollutant?
any substance that contaminates the environment
what is exposure a function of? 5
- Concentration
- Duration
- Intensity
- Route
- Metabolism of toxin
what can affect susceptibility? 3
- Genetic factors
- Co-morbidity/ underlying diseases that augment clinical impact of toxic load
- Environmental factors heat waves, cold snaps, smog’s
name some vehicle exhaust pollutants? 4
- Nitrogen oxide
- Sulphur dioxide
- Carbon monoxide
- Particulate matter
why are nitrogen oxides dangerous? 3
- Associated with COPD and asthma related morbidity and mortality
- Augments response to inhaled allergens
- Increases likelihood that URTI will cause wheezing in children
describe particulate matter and asthma? 3
- PM potentiates risk of airborne allergens causing atopic sensitisation
- Affects airway cilia, mucous production, oxidative stress to cell DNA and induction of epithelial apoptosis
- Promotes airway inflammation and increased IgE production
