occupational lung disease

1. OCCUPATIONAL
LUNG
DISEASE
Dr Varoon
R2 Medicine F unit
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Definition of occupational diseases
Paragraph 6(1) of Recommendation No. 121 defines
occupational diseases as follows:
Each Member should, under prescribed
conditions, regard diseases known to arise
out of the exposure to substances and
dangerous conditions in process, trades or
occupations as occupational diseases.

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Definition of occupational diseases
The Protocol of 2002 to the Occupational Safety and
Health Convention, 1981 (No.155) specifies -
occupational diseases as any disease
contracted as a result of an exposure to risk
factors arising from work activities.

4. OCCUPATIONAL LUNG DISEASE
Coal Worker’s Pneumoconiosis (black
lung)
Silicosis
Asbestosis
Hypersensitivity Pneumonitis (allergic
reaction)
Toxic chemicals
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5. OBJECTIVES
 Etiology/Pathology
 Epidemiology
 Clinical Presentation
 Clinical Course/Prognosis
 Diagnostic Studies
 Clinical Interventions/Therapeutics
 Patient Education/Health Maintenance
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6. HISTORY
 Age
 Gender
 Smoking HISTORY
 Patient and spouse /family
 Duration of Symptoms
 Hobbies
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7. FURTHER HISTORY
 Occupational History
 Environmental Exposures
 Work
 Home
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8. OTHER RISK FACTORS
 Duration and Type of Exposure
 Smoking
 Particle Size
 Ventilation of workspaces
 Usage of protective equipments
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PNEUMOCONIOSIS

11. PATHOPHSIOLOGY OF PNEUMOCONIOSIS
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13. COAL WORKER’S PNEUMOCONIOSIS
 Types:
 Simple Coal Worker’s Pneumoconiosis
 Complicated Coal Worker’s Pneumoconiosis
Appearance of nodules on chest xray 1cm in diameter
to entire lobe (upper half most common)
 CAPLAN SYNDROME/RHEUMATOID
PNEUMOCONIOSIS
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14. COAL WORKERS PNEUMOCONIOSIS
EPIDEMIOLOGY
 Location - Coal mines
 Type of Coal Dust
 Anthracite (50%)
 Bituminous(20%)
 Lignite
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15. COAL WORKERS PNEUMOCONIOSIS
PRESENTATION
 Simple Coal workers pneumoconiosis -
Asymptomatic
 Complicated Coal workers pneumoconiosis
 Cough
 Dyspnea
 Decreased Lung Function : RESTRICTIVE
PATTERN
 RIGHT VENTRICULAR Failure in Late stages
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16. COAL WORKERS PNEUMOCONIOSIS - COURSE
 Variably Progressive
 Worse With:
 High Level Exposure
 Long Duration
 Smoking
 Caplan Syndrome (positive RF or dx of
RA)
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17. COAL WORKERS PNEUMOCONIOSIS -
DIAGNOSTICS
 Complete blood counts
 Sputum Culture if Infection Suspected
 Chest xray – reticular opacities
 Pulmonary Function Tests
 Chest CT
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18. CHEST X RAY
Nodules :
p type : < 1.5mm
q type : 1.5mm to 3mm (most
common)
r type : 3 to 10mm
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19. COAL WORKERS PNEUMOCONIOSIS - RETICULAR
CXR
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20. COAL WORKERS PNEUMOCONIOSIS - CT
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21. COAL WORKERS PNEUMOCONIOSIS -
TREATMENT
 Stop the exposure
 Supportive treatment required
 Nasal o2
 Nebulization
 Bronchodilators
 Monitor Progression
CXR every 5 Years
 Smoking Cessation
 Immunizations
 Monitor for Secondary Infection
 Change in workplace
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22. ASBESTOS
 Mineral silicates : chrysolite, amosite,
anthophyllite, crocidolite.
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24. ASBESTOSIS
 Diffuse interstitial fibrosing disease
directly proportional to intensity and
duration of exposure.
 Pleural plaques, pleural thickening,
pleural effusion.
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25. ASBESTOSIS
 Latency 10-30 years
 Earliest sign : repetitive end inspiratory
crackles over lung bases or axillae.
 Progressive Dyspnea on Exertion
 Pulmonary function ; restrictive pattern
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26. ASBESTOSIS PLAQUES
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27. ASBESTOSIS HRCT
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28. ASBESTOSIS MANAGEMENT
 Smoking Cessation
 Prevention of Further Exposure
 Oxygen : Nasal o2 or NRBM
 Prompt Treatment of Respiratory Infections
 Immunizations
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29. ASBESTOSIS
 LUNG CANCER : 15-19YRS OF LATENCY
 MESOTHELIOMAS : PLEURAL AND
PERITONEAL
NOT ASSOCIATED WITH SMOKING
1-2 YRS OF EXPOSURE
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30. SILICOSIS
 Pneumconiosis Secondary to Inhlation
of Crystalline Silica Dust
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31. TYPES OF CRYSTALLINE SILICA
 Quartz (most common)
 Granite (30% silica)
 Slate (40% silica)
 Sandstone (virtually pure silica)
 Cristobalite (quite toxic)
 Tridymite
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33. SILICOSIS TYPES
 Chronic (10-30 YRS OF LATENCY)
 Accelerated (WITHIN 10YRS OF
EXPOSURE)
 Acute Silicosis ( 10 MONTHS OF
EXPOSURE)
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34. PRESENTATION – ACUTE SILICOSIS
 Dyspnoea on exertion
 Dry Cough
 Pleuritic Pain
  Appetite
 Fatigue
 Rapid Progression
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35. SILICOPROTEINOSIS
 Acute Silicosis
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36. HRCT MULTIPLE SMALL NODULES WITH IHTER
AND INTRALOBULAR THICKENING :
CRAZY PAVING
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37. CHRONIC SILICOSIS
 Small Round Pulmonary Nodules
 Upper Lung Zones
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39. PROGRSSIVE MASSIVE FIBROSIS
 Larger Opacities (>10 mm diameter)
 Mid-Upper Zones
 Hilar Adenopathy
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40. TREATMENT - SUPPORTIVE
 Bronchodilators
 Nasal O2
 Infection Control
 Immunizations
 TB Awareness : because silica is cytotoxic to
alveolar macrophages
 Lung Transplant
 Prevention 40

41. BYSSINOSIS
 Cotton dust
 Most pronounced exposure : blowing,
mixing, carding
 Types : Early (occasional) and Late(regular)
 Monday chest tightness
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42. HYPERSENSITIVITY PNEUMONITIS/
EXTRINSIC ALLERGIC ALVEOLITIS
 Types:
 Acute : 6-8hrs after exposure
 Subacute : period of weeks
 Chronic
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43. HYPERSENSITIVITY PNEUMONITIS
EPIDEMIOLOGY
 Farmers: bagasosis, tobacco growers, potato
riddlers lung
 Bird and poultry
 Veterinarians and animal husbandry : feathers
, fur, shells
 Textile workers
 Manufacturers associated with painting,
electronics, chemicals
 Grain and Flour processing
 Ventilation and water related contamination
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44. ACUTE HYPERSENSITIVITY PNEUMONITIS -
PRESENTATION
 Follows 4-6 hours after heavy exposure
 Abrupt Fever/Chills
 Malaise
 Cough
 Chest Tightness
 Dyspnea
 Rales on Examination
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ACUTE HYPERSENSITIVITY PNEUMONITIS
 Investigations
 ESR, RF, CRP, LDH
 Chest xray : nonspecific
 CT Thorax : ground glass appearance
 Bronchoalveolar lavage (BAL)- Lymphocytosis
 PFT’s - Mixed

46. TREATMENT
 Removal of antigen exposure
 Supportive treatment
 No need of steriods in acute hypersensitivity
pneumonitis
 Steroid therapy in case of subacute and
chronic
1mg/kg/d for 7 to 14 days tapered over 6
weeks.
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 Environmental Hygiene
 Protective Devices
 Removal From Exposure
 Steroid Therapy
HYPERSENSITIVITY PNEUMONITIS -
OVERALL PREVENTION/CARE

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 The Inhalation of Gases and
Aerosolized Particles Liberated by the
Burning of Fuel.
TOXIC CHEMICALS : GASES AND VAPOURS

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50.  Occupational asthma : agents in
manufacturing of synthetic polymers, paints
and coatings
 Fluropolymers (teflon) – POLYMER FUME
FEVER fever, chills, malaise, occasional
wheeze.
 Metal fume fever : zinc oxide (welding of
galvanized steel) : self limiting 50

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 Acute : supportive treatment depending
on gases and its injury (thermal,
hypoxic)
 Environmental Hygiene
 Protective Devices
 Removal From Exposure
TOXIC CHEMICALS
OVERALL PREVENTION/CARE

52. ASSESSMENT OF DISABILITY
 Disability : decreased ability to work due
effects of medical conditions
 Disability rating scheme differs with
compensation granting agencies
 Rating based on spirometry, diffusing
capacity, cardiopulmonary exercise testing
(assess maximal oxygen consumption),
methacholine challenge (assess airway
reactivity)
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