Occupa&onal
lung
disease
Topic
review
R2
Thundon
A
Wipa
case
F
53
yr
No
signicant
history
and
smoking
Progressive
dyspnea
for
3
m,
dry
cough
occasionally,
wt
loss
3
kgs
Fine
crepita&on
BL,
other
WNL
Ini&al
W/U
sputum
nega&ve
for
TB,
bact,
fungus
and
cytology
CXR
as
shown
She
was
sent
to
medical
school
to
further
W/U
Addi&onal
history
:
she
had
worked
in
mine
for
20
yrs
What
s
yr
provisional
Dx?
A.
silicosis
B.
asbestosis
C.
mesothelioma
D.
lung
cancer
E.
occupa&onal
asthma
Occupa&onal
lung
disease
How
to
diagnosis
??
Is
it
common
??
Diagnosis
occupa&onal
disease
is
oWen
hard
due
to.
1. Indierrent
from
general
disease
2. Late
latent
interval
3. Mul&factor
4. underdetectable
from
doctor
and
pt
5. Exposure
dose
CLUE!!@@
-Usually
chronic
process
-More
prevalent
in
workers
-Environment
-Usually
involved
lung,
skin
-Relevant
factor
eg
smoking,
extent
of
exposure,
protec&ve
equipment
Occupa&onal
lung
disease
Pneumoconiosis
Inorganic
inhalant
Restric&ve
lung
paaern
Inhala&on
of
dust
oWen
in
mine
Hypersensi&vity
Organic
inhalant
Alveoli&s
Extrinsic
Allergic
Alveoli&s
(EAA)
pathology
Pneumoconiosis
Asbestos
bodies,
surround
with
ferri&n
and
hemosiderin
Hypersensi&vity
Inters&&al
inamma&on,
primarily
lymphocyte
including
noncasea&ng
granuloma
pneumoconiosis
S&S
Progressive
dyspnea
Chronic
produc&ve
cough
Physical
Exam
not
spacic
Rt
sided
HF
History
Occupa&on
Interna&onal
Labor
Oganiza&on
pneumoconiosis
Coalworkers
pneumoconiosis
Asbestosis
Silicosis
Bauxite
brosis
Berylliosis
Siderosis
Byssinosis
Silicosiderosis
Labrador
lung
silicosis
Most
common
occupa&onal
lung
disease
in
Thailand
Severe
and
high
mortality
, , ,
, ,
In
doubt
diagnosis
always
exclude
TB
!!!
silicosis
Clinical
feature
1. Chronic
simple
silicosis
2. Progressive
massive
brosis
3. Accelerated
silicosis
4. Acute
silicosis
silicosis
Chronic
simple
silicosis
Most
common
feature
Slow
progressive
5-10
yr
aWer
exposure
CXR
:Diuse
round
opaci&es,
predominate
upper
lobe
,
egg
shell
calcica&on
hap://www.breader.com/diagram-teaching-les/index.html
silicosis
Progressive
massive
brosis
Consequently
from
chronic
simple
silicosis
Mass
like
lesion
silicosis
HRCT
:
small
nodular
opacity,
lymph
node
calcica&on
air
trapping
Restric&on
paaern
LFT
silicosis
DLCO
:
decrease
Polyclonal
ac&va&on
of
humoral
immunity
Eg.
Ig,
circula&ng
immune
complex,
RF,
ANA
silicosis
Associated
disease
Pulmonary
TB
CNTD
eg.
SSC
Lung
cancer
Treatment
Suppor&ve
Stop
smoking
and
working
Find
out
TB
Disease
associated
with
asbestos
, , ,
No
reported
case
in
Thailand
3
clinical
feature
1. Benign
pleural
disease
2. Asbestosis
3. mesothelioma
Asbestosis
Expose
for
15
yrs
at
least
Restric&ve
paaern
Decrease
DLCO
CXR
:
inters&&al
paaern
involve
pleura
prominent
lower
lung,
round
atelectasis,
comet
tail
DDX
:
ILD
esp
IPF
need
&ssue
for
pathology
Treatment
:
suppor&ve
Asbestosis
CXR
:
inters&&al
paaern
involve
pleura
prominent
lower
lung,
round
atelectasis,
comet
tail
Occupa&onal
asthma
Clue
from
another
asthma
!!
History,
working,
onset
Work
related
asthma
1. Occupa&onal
asthma
2. Reac&ve
airway
dysfunc&on
syndrome
(RADS)
3. Pre
exis&ng
asthma
work
aggrava&ng
asthma
Occupa&onal
asthma
Expose
some
agent
at
least
14
days
Clinical
indierent
from
asthma
Incidence
2-3
%
of
all
asthma
pt
, , , ,
Occupa&onal
asthma
Diagnosis
Clinical
+
reversible
airway
obstruc&on
methacholine
challenge
test
diurnal
varia&on
PEF
>
20%
No
preexis&ng
asthma
Serial
peak
expiratory
ow
rate
(PEF)
Oasys
II
(www.occupa&onalasthma.com
)
Occupa&onal
asthma
Occupa&onal
asthma
Treatment
Indierent
from
asthma
Prognosis
Reversible
aWer
ceasing
exposure
6-12
m
FEV1
return
to
normal
12
m
Take
home
meal
Chronic
process,
dicult
to
diagnosis
Silicosis
is
the
most
common
in
Thailand
Typical
CXR
should
be
remember
Another
clue
is
exposure
Suppor&ve
Thank
you
