Environmental and occupational disorders are an important aspect of clinical medicine. Physicians, employers, employees, and the general public need to be aware of epidemiological and clinical findings of these disorders and how to treat and prevent them. Environmental pulmonary diseases result from inhalation of various pollutants and the lungs are continually exposed. Pathologic processes can involve the airways, interstitium, and pleurae. Guidelines for diagnosing an occupational lung disorder include exposure to a known hazardous agent, appropriate latency between exposure and symptoms, symptoms consistent with the exposure-related disorder, and no other more likely explanation for signs and symptoms. Prevention focuses on reducing exposure through administrative controls, engineering controls, product substitution, and respiratory protection.

1. Environmental andEnvironmental and
Occupational DiseasesOccupational Diseases

2. The environmentalThe environmental
and occupationaland occupational
disordersdisorders
are an important aspect of clinical medicine. It isare an important aspect of clinical medicine. It is
important that physicians, employers, employeesimportant that physicians, employers, employees
and the general population become aware of theand the general population become aware of the
epidemiological and clinical findings associatedepidemiological and clinical findings associated
with these disorders, and how to treat and preventwith these disorders, and how to treat and prevent
them.them.

3. EnvironmentalEnvironmental
pulmonary diseasespulmonary diseases
result from inhalation of dusts, allergens, chemicals,result from inhalation of dusts, allergens, chemicals,
gases, and environmental pollutants. The lungs aregases, and environmental pollutants. The lungs are
continually exposed to the external environment andcontinually exposed to the external environment and
are susceptible to a host of environmental diseases.are susceptible to a host of environmental diseases.
Pathologic processes can involve any part of thePathologic processes can involve any part of the
lung, including the airways (occupational asthma,lung, including the airways (occupational asthma,
reactive airways dysfunction syndrome, toxicreactive airways dysfunction syndrome, toxic
inhalations), interstitium (pneumoconioses,inhalations), interstitium (pneumoconioses,
hypersensitivity pneumonitis), and pleuraehypersensitivity pneumonitis), and pleurae
(asbestos-related diseases).(asbestos-related diseases).

5. Sponsored
Medical Lecture Notes – All Subjects
USMLE Exam (America) – Practice

15. Depending on long actionDepending on long action
occupational hazardsoccupational hazards
allocate:allocate:
 Acute occupational diseases - arise suddenly afterAcute occupational diseases - arise suddenly after
disposabledisposable (during one working day)(during one working day) actions of highactions of high
concentration occupational hazards.concentration occupational hazards.
 Subacute occupational diseases (intoxications) - arise inSubacute occupational diseases (intoxications) - arise in
conditions of periodic action occupational harmfulconditions of periodic action occupational harmful
factors in current concerning a short time interval.factors in current concerning a short time interval.
 Chronic occupational diseases - result from long regularChronic occupational diseases - result from long regular
action on an organism occupational hazards.action on an organism occupational hazards.

16.  Diseases that arise under influence of chemicalDiseases that arise under influence of chemical
factors.factors.
 The Diseases caused by influence of industrialThe Diseases caused by influence of industrial
aerosols.aerosols.
 The Diseases, caused to actions of physical factors.The Diseases, caused to actions of physical factors.
 The Diseases, caused to actions of biological factors.The Diseases, caused to actions of biological factors.
 The Diseases connected with a physical overstrainThe Diseases connected with a physical overstrain
and an overstrain of separate bodies and systems.and an overstrain of separate bodies and systems.
 Allergic diseases.Allergic diseases.
 Malignant new growths (a professional cancer).Malignant new growths (a professional cancer).
The LIST of OCCUPATIONALThe LIST of OCCUPATIONAL
DISEASESDISEASES
(The decision Ministry of Ukraine from(The decision Ministry of Ukraine from
08.11.2000. 1662).№08.11.2000. 1662).№

17. CLASSIFICATION ofCLASSIFICATION of
OCCUPATIONAL DISEASESOCCUPATIONAL DISEASES
(In a basis put etiological factor).(In a basis put etiological factor).
1.1. Professional illnesses from action of chemical substances, acute and chronicProfessional illnesses from action of chemical substances, acute and chronic
occupational intoxications.occupational intoxications.
2.2. Professional illnesses that are caused by the dust factor: silicosis.Professional illnesses that are caused by the dust factor: silicosis.
3.3. Professional illnesses from action ionizing radiation (radiation sickness).Professional illnesses from action ionizing radiation (radiation sickness).
4.4. Professional illnesses from action of noise and vibration (sensoneuralProfessional illnesses from action of noise and vibration (sensoneural
deafness, vibrating illness).deafness, vibrating illness).
5.5. Professional illnesses caused by adverse meteorological factors:Professional illnesses caused by adverse meteorological factors:
overheatings, convulsive illness.overheatings, convulsive illness.
6.6. Professional illnesses connected with changes of atmospheric pressure.Professional illnesses connected with changes of atmospheric pressure.
7.7. Professional illnesses caused by an overstrain and traumatism.Professional illnesses caused by an overstrain and traumatism.
8.8. Professional infectious and parasitic illnesses.Professional infectious and parasitic illnesses.

19. In special institutions for anIn special institutions for an
establishment of the diagnosis ofestablishment of the diagnosis of
an occupational disease of thean occupational disease of the
patient the main expert onpatient the main expert on
occupational pathology directs areaoccupational pathology directs area
with corresponding documents:with corresponding documents:
1.1. The Copy of a work-record card (for definition of theThe Copy of a work-record card (for definition of the
experience of work in conditions of action of productionexperience of work in conditions of action of production
factors).factors).
2.2. Extracts from out-patient card or the case record whichExtracts from out-patient card or the case record which
display the beginning and dynamics of current of disease.display the beginning and dynamics of current of disease.
3.3. The Sanitary-and-hygienic characteristic of workingThe Sanitary-and-hygienic characteristic of working
conditions (it is made by expert SES in which territory is theconditions (it is made by expert SES in which territory is the
enterprise).enterprise).
4.4. The Medical conclusion of the regional expert onThe Medical conclusion of the regional expert on
occupational pathology.occupational pathology.
5.5. The act about accident on manufacture (form Н-1).The act about accident on manufacture (form Н-1).

20. Prevention of occupational andPrevention of occupational and
environmental respiratory diseaseenvironmental respiratory disease
 Prevention of occupational and environmentalPrevention of occupational and environmental
respiratory disease centers on reducing exposurerespiratory disease centers on reducing exposure
((primary preventionprimary prevention). This includes administrative). This includes administrative
controls (limiting the number of people placed incontrols (limiting the number of people placed in
hazardous conditions), engineering controls (enclosures,hazardous conditions), engineering controls (enclosures,
ventilation systems, safe clean-up procedures), productventilation systems, safe clean-up procedures), product
substitution (using safer, less toxic materials), and use ofsubstitution (using safer, less toxic materials), and use of
respiratory protection devices.respiratory protection devices.
 Medical surveillance is a form ofMedical surveillance is a form of secondarysecondary
preventionprevention. Workers can be offered medical tests that. Workers can be offered medical tests that
identify disease at early states when medical treatmentidentify disease at early states when medical treatment
might help reduce long-term consequences.might help reduce long-term consequences.

21. Many clinicians erroneously assume that a patient whoMany clinicians erroneously assume that a patient who
has used a respirator or respiratory protection devicehas used a respirator or respiratory protection device
(dust mask or gas mask) has been well protected. While(dust mask or gas mask) has been well protected. While
respirators do afford a degree of protection, especiallyrespirators do afford a degree of protection, especially
in situations in which fresh air is provided by tank or airin situations in which fresh air is provided by tank or air
hose, the benefit is limited and idiosyncratic. Whenhose, the benefit is limited and idiosyncratic. When
recommending use of a respirator, clinicians shouldrecommending use of a respirator, clinicians should
consider several factors. Workers with cardiovascularconsider several factors. Workers with cardiovascular
disease may be unable to perform jobs that requiredisease may be unable to perform jobs that require
strenuous work, especially if they must wear a self-strenuous work, especially if they must wear a self-
contained breathing apparatus (tank). Respirators thatcontained breathing apparatus (tank). Respirators that
are tight-fitting and that require the wearer to draw airare tight-fitting and that require the wearer to draw air
through filter cartridges can increase the work ofthrough filter cartridges can increase the work of
breathing, especially troublesome for patients withbreathing, especially troublesome for patients with
asthma, COPD, or interstitial lung disorders.asthma, COPD, or interstitial lung disorders.

24. Guidelines for the Diagnosis ofGuidelines for the Diagnosis of
an Occupational Lung Disorderan Occupational Lung Disorder
1.1. Exposure to an agent known to cause anExposure to an agent known to cause an
occupation disorderoccupation disorder
2.2. Appropriate latency from exposure to onset ofAppropriate latency from exposure to onset of
symptomssymptoms
3.3. Syndrome consistent with the knownSyndrome consistent with the known
exposure-related disorderexposure-related disorder
4.4. No other more likely explanation of the signsNo other more likely explanation of the signs
and symptomsand symptoms

25.  First, there should be an exposure to a known documentedFirst, there should be an exposure to a known documented
hazardous agent. Not all pungent smells or white powders arehazardous agent. Not all pungent smells or white powders are
toxic. Analysis of the substance can be helpful. Product labelingtoxic. Analysis of the substance can be helpful. Product labeling
requirements have resulted in a marked improvement inrequirements have resulted in a marked improvement in
knowledge of exposures and can be useful.knowledge of exposures and can be useful.
 Second, the timing of exposure and onset of symptoms shouldSecond, the timing of exposure and onset of symptoms should
be appropriate. A twenty-year latency period is usually requiredbe appropriate. A twenty-year latency period is usually required
before asbestosis can be diagnosed, thus an exposure from a fewbefore asbestosis can be diagnosed, thus an exposure from a few
days previously would not result in a detectable abnormaldays previously would not result in a detectable abnormal
finding.finding.
 Third, the clinical syndrome should be consistent with theThird, the clinical syndrome should be consistent with the
syndrome related to the exposure. Finally, there should be nosyndrome related to the exposure. Finally, there should be no
other more likely explanation for the signs and symptoms.other more likely explanation for the signs and symptoms.
 This fourth criterion is important because of the occurrence ofThis fourth criterion is important because of the occurrence of
cigarette smoking and associated abnormalities. These criteriacigarette smoking and associated abnormalities. These criteria
serve as general guidelines and are helpful in most patient orserve as general guidelines and are helpful in most patient or
worker evaluations.worker evaluations.