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occupational lung disease

All forms are associated with mucous hypersecretion. Etiology: 1) inorganic dusts a) antimony - pneumoconiosis - storage batteries, solder, ceramics, glass, plastics b) arsenic - lung cancer - manufacture of pesticides, pigments, glass, alloys c) barium & barium salts (BaO, BaSO4, BaCO3) - pneumoconiosis - catalyst, mud drilling, electroplating d) cadmium dust - pneumoconiosis, obstructive airway disease - electroplating, battery manufacture, welding, smeltering, aluminum soldering e) cement dust - obstructive airway disease - construction, manufacture of cement blocks f) chromium & chromium salts (CrO3, CrF2) - lung cancer - corrosion inhibitor pigment, metallurgy, electroplating g) iron dust - pneumoconiosis - steel & foundry workers, welding h) mica - pneumoconiosis - insulation, roofing shingles, oil refining, rubber manufacture i) phosphorous, chlorides, sulfides - obstructive airway disease - manufacture of fireworks, agricultural chemicals, insecticides, pesticides j) rock dusts - pneumoconiosis - miners, tunnelers, quarry workers k) vanadium pentoxide - obstructive airway disease - welding electrodes, additive to steel, by-product in ash from oil burning 2) organic dusts a) coal dust - pneumoconiosis - mining b) coke oven emissions - pneumoconiosis, obstructive airway disease, lung cancer - coke ovens c) graphite - pneumoconiosis, obstructive airway disease - steel manufacture, lubricants, pencils, paints, stove polish d) cotton dust, flax, hemp - obstructive airway disease - manufacture of yarns for linen, rope & cotton, cotton workers, waste fiber processing e) grain dusts - obstructive airway disease - farmers, grain workers, ship workers (carrying grain) f) moldy hay - hypersensitivity pneumonitis - farmers, animal attendants g) diisocyanates (occupational asthma) - spray paint, auto body industry, insulation, - plastic, rubber or polyurethane foam 3) metalworking fluids (toluene diisocyanate) a) used to remove metal turninings & provide cooling b) associated with - lipoid pneumonia - hypersensitivity pneumonitis - occupational asthma c) metalworking fluid itself, fluid additives & contaminating bacteria have been implicated [3,4] d) epidemics have occurred [3,4] History: 1) information about the work process - job title less important that job process, job tasks 2) materials to which a person is exposed - obtain Materials Safety Data Sheets 3) frequency, duration & intensity of exposure 4) non-work related exposures 5) temporal pattern of signs & symptoms - symptoms worse during or after work? - improvement away from work place? 6) coworkers affected with similar process 7) other exposures at home & from hobbies [3] 8) clustering of disease in one geographic area 9) respiratory disease without typical risk factors Clinical manifestations: - rhinitis - reactive airway disease* - asthma - reactive airways dysfunction syndrome - COPD - pleural disease - diffuse parenchymal pulmonary disease - bronchiolitis obliterans - malignancy [3] * may be acute (chlorine gas) or chronic (asbestosis) Special laboratory: - spirometry (FEV1 or peak expiratory flow) before & after workplace exposure useful for diagnosis of occupational asthma [3] - specific inhalation challenge is gold standard for diagnosis Management: - prevention is key - interventions in the workplace to avoid exposure - removal of offending agent from the workplace - removal of worker from offending agent - identifying coworkers who may be at risk [3] - occupational asthma & reactive airways dysfunction syndrome are treated with inhaled glucocorticoids Notes: - Material Safety Data Sheets are a source for identifying exposures in the workplace [3,4]

Related

chemical pneumonitis

Specific

asbestosis bagassosis berylliosis byssinosis coal workers' pneumoconiosis grain fever (organic toxic dust syndrome) hypersensitivity pneumonitis; extrinsic allergic alveolitis; pigeon breeder's lung; bird fancier's lung; farmer's lung; allergic pneumonitis Monday morning sickness occupational asthma progressive massive fibrosis silicosis silo filler's lung suberosis; corkhandler disease; corkworker lung Welder's lung

General

lung disease

References

  1. Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 757-760
  2. Harrison's Principles of Internal Medicine, 13th ed. Isselbacher et al (eds), McGraw-Hill Inc. NY, 1994, pg 1180
  3. Medical Knowledge Self Assessment Program (MKSAP) 16, 17, 18, 19. American College of Physicians, Philadelphia 2012, 2015, 2018, 2022 - Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022
  4. Zacharisen MC, Kadambi AR, Schlueter DP et al The spectrum of respiratory disease associated with exposure to metal working fluids. J Occup Environ Med. 1998 Jul;40(7):640-7 PMID: 9675723