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Upper Respiratory Tract Diseases in Workplace

Upper Respiratory Tract Diseases in Workplace. Characteristics of upper resp. tract. Nares to larynx Tasks: Air conditioning (T and humidity) Filtering (particles > 5-20 μ m) Microbial defense Mechanical Chemical Specific: IgA Non-specific: lysozyme and lactoferrin Sensation

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Upper Respiratory Tract Diseases in Workplace

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  1. Upper Respiratory Tract Diseases in Workplace

  2. Characteristics of upper resp. tract • Nares to larynx • Tasks: • Air conditioning (T and humidity) • Filtering (particles > 5-20μm) • Microbial defense • Mechanical • Chemical • Specific: IgA • Non-specific: lysozyme and lactoferrin • Sensation • Odor perception (olfactory nerve) • Irritant perception (trigeminal nerve) • phonation

  3. Response mechanisms in upper airway • Allergic response • Mast cell degranulation • Rhinorrhea • Inflammation • congestion • Neurogenic reflex • Triggerd by irritants • Parasympathetic response • Axonal response

  4. Occupational diseases • Allergic rhinnitis • Irritant rhinnitis • Non-allrgic rhinnitis • Sinusitis • Sensory alterations

  5. Allergic rhinnitis • Frequency: 20% of general population • Types • Seasonal • Perrenial (more common in workplace) • Symptoms: • Rhinorrhea • Congestion • Sneezing • Itching • ± eye and chest symptoms

  6. signs • Pale and boggy nasal mucosa • Sticky secretions

  7. Occupational causes • Commonly-encountered allergens • Pollens in gardeners • Specific allergens • HMW compounds • Animal antigens • Plant antigens • Insect antigens • Latex • LMW compounds • TDI • Acid anhydrids • Colophony • Work-induced or work-aggravated

  8. Attention Causes of allergic rhinitis are the same as asthma

  9. Paraclinic • CBC • Eosinophilia • Increased serum IgE • Nasal smear • Eosinophilia • Skin prick test (gold standard) • Nasal peak flow measurement (across-shift)

  10. Treatment • Allergen avoidance • Engineering controls • Personal protective devices • Reassignment • Medical therapy: • Systemic antihistamines • Nasal steroids • Nasal Cromolyn sodium • Nasal ipratropium bromide (esp. vasomotor symptoms)

  11. Irritant rhinitis • Most common place of irritation • Causes • Combustion products • VOCs • Chromic acid • RUDS • Rhinitis after a sudden high exposure to irritants

  12. Irr. rhinitis • Symptoms: nasal congestion, rhinorrhea • Signs: erythema and erosion in nasal mucosa • Paraclinic: no paraclinic test • DDx: allergic rhinnitis • Irritation rather than sneezing and itching • High prevalence among co-workers • Dramatic improvement when not exposed

  13. Treatment: • Reduction of exposure • Saline nasal lavage • Topical streoid or ipratropium bromide

  14. Non-allergic rhinitis • Vasomotor rhinitis • Augmented nasal reactivity to non-specific physical stimuli • Low humidity • Rapid changes of temperature • Excessive air motion • Gustatory rhinitis • Ingestion of spicy foods • Bright-light rhinitis

  15. Occupational sinusitis • Seen in: • Spice workers • Vegetable picklers • Grain and flour workers • Most common: • Sinusitis after complication of rhinitis

  16. Occupational laryngeal pathology • Hoarseness due to: • Overuse of voice • Chemical irritants • Laryngeal SCC due to: • Asbestos • Smoking • Ethanol • Leather ant textile workers • Gasoline and diesel oil • Laryngeal stricture due to: • Smoke inhalation injury • Vocal cord dusfunction • Stridor, hoarseness, shortness of breath, globus • Acute irritant exposures

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