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Occupational Lung Disease Jonathan Kass. Cooper University Hospital Robert Wood Johnson School of Medicine UMDNJ at Camden. Occupational Lung Disease. Occupational Lung Disease. Acute HP. Fever Symptoms:Cough, dyspnea, wheeze Exam: crackles > wheezes Leukocytosis Pulmonary infiltrates.
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Occupational Lung DiseaseJonathan Kass Cooper University Hospital Robert Wood Johnson School of Medicine UMDNJ at Camden
Acute HP • Fever • Symptoms:Cough, dyspnea, wheeze • Exam: crackles > wheezes • Leukocytosis • Pulmonary infiltrates
Sub-Acute HP • Afebrile/ Normal WBC • Symptoms:Cough, dyspnea, wheeze • Exam: crackles > wheezes • CXR early: near normal • CXR late: Fibrotic changes
PFT’s HP • Restrictive > Obstructive • Decreased DLCO • Arterial Oxygen desaturation
Diagnosis HP • Clinical symptoms and signs • CXR/CT • PFT • Precipitating Ab’s- not specific • Challenge Testing • Biopsy rarely needed
Treatment of HP • Avoidance of allergenic stimulus • Steroids
Pneumoconiosis • Asbestos • Silica • Coal • Iron • Talc
Asbestos Related Lung Processes • Pleural Plaques • Benign Asbestos Pleurisy • Asbestosis • Malignant Mesothelioma • Corns
Pleural Plaques • Late manifestation > 20 yrs • Usually asymptomatic • When diffuse can have symptoms (restrictive) • Marker of asbestos exposure
Benign Asbestos Pleurisy • Earlier manifestation • Often bloody effusion • Mild symptoms to fever, pain and leukocytosis • Treatment: drainage vs observation
Asbestosis • Dyspnea • Crackles • Interstitial CXR process • Restriction & decreased DLCO
Malignant Mesothelioma • Asbestos or Zeolite • Late manifestation > 30 yrs • Chest pain • Bloody effusion • Treatment: extensive surgery/chemotherapy
Risk of Lung Ca Death per 100,000 man-years Related to Smoking & Asbestos Exposure
Common Silicosis Occupational Exposures • Quarrymen/Miners • Sandblasters/ Stone cutters • Pottery/Glass workers • Foundry workers
Silicosis & Disease • Simple • Complicated (progressive massive fibrosis) • Acute silicoproteinosis • Mycobacterial, nocardia, & fungal • Increased connective tissue disease
Simple Silicosis • Asymptomatic • Upper lobe nodules < 1cm • “Egg shell” calcified lymph nodes • Normal PFT’s
Complicated Silicosis (Progressive Massive Fibrosis) • Late symptoms/normal exam • Coalescence of usually upper lobe nodules to form large shadows • “Egg shell” calcified LN’s, & lobar retraction • Mixed restictive & obstructive PFT’s
Acute Silicoproteinosis • Heavy exposure to fine respirable silica (abrasive blasting) • Similar to alveolar proteinosis • Diffuse alveolar CXR pattern • Restictive PFT’s
Coal Worker’s Pneumoconiosis • Simple • Complicated • Caplan’s Syndrome
Iron (Siderosis) • Radiographic Diagnois: dense small nodules • No symptoms • Normal PFT’s
Silicosiderosis • Hematite: iron oxide & silica • Mixed-Dust Fibrosis • Clinically like silcosis
Talc • Nodules leading to PMF • Pleural calcifications • Foreign body granulomas
Inhalation of Metals • Beryllium • Aluminum • Tungsten Carbide/Cobalt • Tin/Barium • Zinc, Copper, Magnesium
Berylliosis • Previously in fluorescent lighting tubes • Nuclear physics, space program, alloys, x-ray tubes • Similar to Sarcoidosis clinically and radiograpically
Aluminum • Pulmonary Fibrosis (Shaver’s Disease) • Asthma
Tungsten Carbide/Cobalt • Pulmonary Fibrosis (Hard Metal Disease) • Giant Cell Interstitial Pneumonitis • Asthma