Occupational lungs disease

Prepared By:
RN Arpana Bhusal
BNS
7/24/2022 3

 Introduction
 Definition
 Classification
 Clinical features
 Types
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 Diagnostic tests
 Treatment
 Prevention
 Complication
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 Occupational lung diseases are lung problems that
are made worse in certain work environments.
They are caused by long-term exposure to certain
irritants that are breathed into the lungs. These
lung diseases may have lasting effects, even after
the exposure ends.
 Most occupational lung diseases are caused by
repeated, long-term exposure, but even a severe,
single exposure to a hazardous agent can damage
the lungs. Occupational lung diseases are
preventable. Smoking can increase both the
severity of an occupational lung disease and the
risk of lung cancer.
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 Among the occupational diseases, silicosis is the
major cause of permanent disability and mortality.
It is caused by inhalation of dust containing free
silica or silicon dioxide.
 Particles between 0.5 to 3 micron are the most
dangerous because they reach the interior of the
lungs with case.
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 Occupational lung disease are usually defined as
diseases arising out of or in the course of
employment in lungs.
(or)
 Damage to the lung caused by dust or fumes or
noxious substances inhaled by the workers in
certain specific occupations is known as
“occupational lung diseases”.
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Occupational disease are grouped as under:
 Diseases due to physical agents ( heat, cold, light,
pressure, noise)
 Diseases due to chemical agents ( Gases, dusts)
 Diseases due to biological agents (anthrax,
encephalitis, fungal infections)
 Diseases of psychological origin (hypertension,
peptic ulcer)
 Occupational cancer (cancer of skin, lung)
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 Chronic cough
 Dyspnea on exertion
 Fatigue
 Loss of appetite
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 Chest pain
 Acute silicosis patients may also have fever and
experience rapid, unintended weight loss
 Impairment of total lung capacity(TLC)
 Shortness of breath
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Pneumoconiosis
1. Asbestosis
2. Silicosis
3. Coal miner’s lung/coal worker’s pneumoconiosis
4. Bagasosis
5. Bysinosis
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 The term‘Pneumoconiosis’ was coined by Zenker
to define a group of lung diseases caused by
inhalation of dust that are breathed in and then
deposited deep in lungs causing damage
 It can be defined as the non-neoplastic reaction of
lungs to inhaled minerals or organic dust and the
resultant alteration in their structure excluding
asthma, bronchitis and emphysema.
 It is also known as “ Black lung disease”
 Usually, pneumoconiosis apears 20–30 years after
constant exposure to offending agents (metal
mining of gold, silver, lead, copper).
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 Hx:
-History of working around coal, asbestos, or silica,
lungs disease related symptoms,
-chest X-ray :X-ray abnormalities: we can diagnosed
by having a routine X-ray during the time of
employee.
 Pathology: Alveolar macrophages engulf
offending agents, causing inflammation and
fibrosis of the lung parenchyma in
pneumoconiosis.
 Respiratory insufficiency is the ultimate
consequence of the pneumoconioses.
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 Signs and symptoms: dyspnea, shortness of
breath, cough, sputum production, cor pulmonale,
and clubbing.
 Chest x-ray findings include small irregular
opacities, interstitial densities, ground glass
appearance, and honeycombing.
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 Asbestosis is an occupational lung disease caused
by prolonged inhalation of asbestos dust. The
result is lung parenchymal fibrosis which results in
respiratory compromise.
 Signs and symptoms: exertional dyspnea and
reduced exercise tolerance, cough and wheezing
(especially among smokers), chest wall pain, and
ultimately respiratory failure.
 History of exposure to asbestos is needed to
consider the diagnosis.
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 On chest x-ray, diffuse or local pleural thickening,
pleural plaques, and calcifications at the level of
the diaphragm are seen. Pleural effusions are
commonly seen, and the interstitial lungs process
associated with asbestosis usually involves the
lower lung fields.
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 For diagnosis a lung biopsy is usually needed; the
classic barbell-shaped asbestos fiber is found.
 No specific treatment is offered. Patients with
asbestos exposure should strongly be advised to
stop smoking since their risk of lung cancer is 75
times higher than that of the normal population.
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 Silicosis is an occupational lung disease caused by
inhalation of silica dust in lung parenchyma tissue
reaction to it. It is seen in individuals who work in
mining, quarrying, tunneling, glass and pottery
making, and sandblasting.
 Silicon dioxide or silica is the most abundant
compound in the earth’s crust, where it is mostly
found in the crystalline form known as quartz.
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 Mining
 Tunnelling
 Stone masonry
 Sand blasting
 Fettling and foundry work
 Ceramics
 Brick-making
 Silica flour manufacture
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 Silicosis causes similar symptoms to asbestosis
except the acute form of silicosis, which is caused
by massive exposure that causes lung failure in
months.
 Pathology: Silica enters and cause inflammatory
reactions with pathologic lesions being the hyaline
nodule.
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 There are 3 key elements to diagnosis of silicosis :
Patient history should reveal exposure to sufficient silica
dust to cause this illness.
Chest X-Ray revealing findings consistent with silicosis. In
silicosis there are nodules (1–10 mm) seen throughout the
lungs that are most prominent in the upper lobes.
There are no underlying illnesses that are more likely to
causing the abnormalities
 Physical examination is usually unremarkable unless there
is complication. PFT may reveal air flow limitation,
restrictive defects, ↓diffusion capacity, mixed defects or
may be normal
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 Silicosis is an irreversible & progressive condition with
no cure. There is no effective therapy for silicosis. Death
occurs usually because of progressive respiratory
insufficiency
 Treatment options currently focus on alleviating
symptoms & preventing complications including
stopping further exposure to silica & other lung irritants,
including tobacco smoking, cough suppressants,
antibiotics for bacterial lung infection, ATT for those
with active TB,
-chest physiotherapy to help bronchial drainage of mucus,
-O2 administration to treat hypoxemia, bronchodilators to
facilitate breathing.
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 Lung transplantation to replace damaged lung
tissue is the most effective treatment.
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 Coal miners are exposed to dust that contains mixture
of coal, mica and silica in varying proportions
 Coal- workers’ pneumoconiosis is virtually confined to
underground coal-miners, it may occur in any place
where a worker is exposed to high levels of coal dust in
poorly ventilated conditions. Thus it has been
described in coal trimmers, loading coal in the holds of
ships, and in men and women sorting coal on surface
screens.
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 The risk of development and progression of coal
miner’s lung (CWP) is related:
 the amount of coal dust exposure
 higher rank (hardness) of coals
 and increased silica content of inhaled dust.
 Simple CWP is seen in 12% of all miners.
 Patients clinically present as they would with any
other occupational lung disease.
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 On chest x-ray, small round densities are seen in
the parenchyma, usually involving the upper half
of the lungs.
 Complicated or progressive massive fibrosis is
diagnosed by the presence of larger densities from
1 cm in diameter to the entire lobe.
 Increased levels of IgA, IgG, C3, antinuclear
antibodies (ANA), and rheumatoid factor are also
seen.
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 Bagasse is the residue after sugar is
extracted from cane. It is a fibrous material
used in the manufacture of paper, board sand
building materials
 Typically it becomes contaminated with
thermophilic actinomycetes when lying in the
hot and humid conditions where sugarcane is
processed.
 Although the disease commonly affects
workers handling the bagasse it may also
occur wherever mouldy material is imported
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 Byssinosis is a lung disease caused by
occupational exposure to dust from cotton,
hemp or flax.
or
 Byssinosis is a term applied to a complex of
symptoms associated with the manufacture of
cotton, flax, jute dust and hemp
 Other names for byssinosis include Monday fever,
brown lung disease, mill fever or cotton workers'
lung.
 Up to one-third of people exposed to cotton dust
for the first time develop an acute airway
reaction.
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 people with asthma and is associated with
increased bronchial reactivity
 A sensation of oppression in the chest or
difficulty in breathing on the first day of the
working week. As light rise in temperature
with cough and wheeze. The symptoms
usually occur after about 2–4h of exposure.
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 Textile workers(1ststage of processing of
cotton)
 Smoking
 Impaired lung function
 History of respiratory allergy
 Bronchitis
 Asthma
 Infections
 Exposure >20 years
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 Byssinosis is common among textile workers,
who often inhale significant amounts of
cotton dust.
 Cotton dust may stimulate inflammation that
damages the normal structure of the lung.
 It causes the release of histamine, which
constricts the air passages.
 As a result, breathing becomes difficult.
 Over time the dust accumulates in the lung,
producing a typical discoloration that gives
the disease its name BROWN LUNG DISEASE.
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 Tightness in the chest
 Wheezing
 Coughing
 Dyspnea
 Fever
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 Muscle and joint pain
 Shivering
 Tiredness
 Dry cough
The condition is worse at the beginning of the
week or upon acute exposure after a period
away from the work environment. Hence the
other common name for byssinosis –Monday
fever.
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 Detailed medical history
 Physical examination
 Pulmonary function test
 Chest X-ray
 CT scan
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 Appearance of the Patient
Weight loss is present in the chronic form of
the syndrome.
 Vital Signs
Fever and tachypnea are often present.
 Auscultation
Diffuse fine bi basilar crackles over lower
lung fields often are present.
 Extremities
Clubbing is observed in 50% of patients with
the chronic form of the syndrome. Muscle
wasting is also observed in the chronic form of
the syndrome.
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 Byssinosis is generally not serious.
 But if left untreated it can lead to chronic
illnesses such as emphysema and chronic
bronchitis.
 When exposure of fiber stops, the illness will
clear up.
 In case of long time exposure there is
irreversible damage to lungs.
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 In acute settings patients are encouraged to
consider alternate occupations or at least
reduce the exposure in the work
environment.
 Smokers should be encouraged to stop
smoking.
 Physical activity and breathing exercises may
help in management.
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 Bronchodilators help to relax and widen
(dilate) the airways.
 Bronchodilators include beta-adrenergic
drugs (both those for quick relief of
symptoms and those for long-term control),
anti cholinergics, and methyl xanthines.
 Corticosteroids are given only in severe
cases.
 Immuno modulators and Antihistamines can
also be used.
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 Oxygen therapy is given in case of hypoxia -
diminished blood oxygen levels (oxygen
saturation levels of <92%).
 Nebulizers used in chronic byssinosis.
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 Steaming of raw cotton to reduce particle
formation.
 Quit smoking.
 Wear protective gears.
 Increase ventilation.
 Avoid long term exposure.
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 History & physical examination
 Chest x-ray –snow storm appearance in the lung
fields.
 CT Scan
 Sputum test –helps to evaluate other lung diseases,
like TB
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 There is no cure for silicosis right now. Treatments
can help to reduce symptoms.
 Medications-inhaled steroids reduce lung mucus.-
Bronchodilators help to relax breathing passages.
 Oxygen therapy
 Lung transplant –if you have advanced lung
damage
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 Limit the time exposed to silica.
 Use respirators that protect you from inhaling
silica
 Stop smoking.
 Avoid secondhand smoke and areas with lot of
dust, air pollution and allergens.
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 SILICOTUBERCULOSIS –Silica is cytotoxic to
alveolar macrophages so patients are at risk of
tuberculosis.
 Autoimmune disorder –rheumatoid arthritis,
scleroderma.
 Malignancy
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 Mandal G.N, Textbook of medical surgical nursing
(adult nursing) published by Makalu publication
house, 3rd edition, page no. 66-67
 Brunner and siddarth, Textbook of Medical-
Surgical Nursing, 13th edition, page no. 573-582,
605
 https://www.google.com/search?client=firefox-b-
d&q=pneumonia 2078/03/09@8pm
 https://www.google.com/search?q=occupational+l
ung+disease&client 2078/03/11@11am
7/24/2022 69

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