1
Q
Can enter throat
A
Inhalable fraction
Irritation
2
Q
Particle goes past bronchus
A
Thoracic fraction
ACUTE DZ
3
Q
Particle reaches alveoli
A
Respirable fraction
CHRONIC DZ
4
Q
Low water solubility
Bronchiole, alveoli
A
NO2, Phosgen
5
Q
Medium water solubility
Trachea, Bronchi
A
Ozone
6
Q
High water solubility
A
Ammonia, Chlorine, Sulfur dioxide
NOSE, PHARANX, LARYNX
7
Q
Upper airway exposure
S/s
A
Short lived
Burning Couching Sputum Sneezing Difficulty breathing Bronchospasm Hemoorrhage
8
Q
Occupational lung dz
Had asthma but made worse by exposure
A
CAUSED or EXACERBATED by exposuer
9
Q
Factors resulting in pathology
A
Size Solubility Concentration Duration of Exposure Host Factors
10
Q
Upper airway exposure
Agents
A
Ammonia
Chlorine gas
11
Q
Upper airway exposure
Treatment
A
- remove from area
- Irrigation
- Supplemental O2
- secure airway
- racemic Epi
- +/- steroid
12
Q
Lower Airway Disease
*Chonic sequelae (Sulfur dioxide, NO) *DOE *+/- early inspiratory crackle *CXR = possibly normal *PFTs= possibly obstructive
(Ex. Burn pits)
?
A
Bronchiolitis Obliterans (BO)
13
Q
Lower Airway Dz - BO
DX
A
Biopsy
14
Q
Lower Airway Dz - BO
Tx
A
Systemic steroid = but little help
15
Q
*Chronic sequelae of irritant gas exposure
*fever, dry cough, DOE
*Late inspiratory crackle
*CXR = bilat patchy infiltrate
*PFT = restrictive,
*DLCO (CO gas exchange test) = low
??
A
Bronchiolitis Obliterans Organizing Pneumonia (BOOP)
16
Q
Bronchiolitis Obliterans Organizing Pneumonia (BOOP)
DX
A
Lung biops
17
Q
Bronchiolitis Obliterans Organizing Pneumonia (BOOP)
Tx
A
Systemic steroid
18
Q
- asthma-like short-term (often single), high intensity exposure
- Onset= hours to a day (NOT LONG AGO)
- Acute damage, desquamation of airway epithelium
- Cough, Wheeze, SOB
??
A
Reactive Airway Dysfunction Syndrome (RADS)
19
Q
Reactive Airway Dysfunction Syndrome (RADS)
Tx
A
Bronchodialators
S/s last for months or permanently
20
Q
*asthma induced/exacerbated by exposures in the workplace
A
Occupational Asthma (OA) / Work Related Asthma
21
Q
Occupational Asthma (OA) / Work Related Asthma
Types
A
W/ latency
- high molecular weight
- low molecular weight
W/o latency (irritant asthma/RADS)
22
Q
- chronic daily exposure
- Upper airway irritation
- rhinorrhea
- eye itching
- wheezing
- SOB
- IMPROVE W/ leaving workplace
?
A
Occupational Asthma (OA) / Work Related Asthma. W/ LATENCY
23
Q
Occupational Asthma (OA) / Work Related Asthma
Risks
A
Atopy, smoking
24
Q
Occupational Asthma (OA) / Work Related Asthma
Path
A
High mol weight
- IgE attacks (classic hypersensitivity)
- -plants, animal products, insects–
Low mol weight
- IgE against (LMW + Protein)
- -Diisocyanates, anhydrides, wood dust
25
Occupational Asthma (OA) / Work Related Asthma
Dx
* asthma Dx
* onset after entering work
* associate to work
* Association between s/s + work
* 1-2: tests associated between particle + s/s
26
Occupational Asthma (OA) / Work Related Asthma
Tx
* avoid exposure
* protective devices
* usual asthma meds not so helpful (CONTINUOUS EXPOSURE)
* continuous exposure may cause damage
27
* Monday morning fever + chest tightness
* s/s seem to improve upon repeated workers
* may go chronic
*cotton processing workers
Byssinosis
28
20-30 years of coal exposure
* parynchymal disease
* coal macule --> coal nodule
Coal workers Pneumoconiosis (CWP)
29
Coal workers Pneumoconiosis (CWP)
Type of coal
Antracite>Bituminous
30
Coal workers Pneumoconiosis (CWP)
* Asymptomatic
* CXR = W/ small (less than 1cm) nodules in UPPER PART OF LUNG
Simple
Coal workers Pneumoconiosis (CWP)
Tx = stop work
31
Coal workers Pneumoconiosis (CWP)
DX
*Hx of work in mine
* Historically - needed biopsy
* think cancer? (PMF) = biospsy
* nodules = bleeding w/ biopsy
32
CXR: small nodule, 1st in upper lobes, then diffuse
PFT: decline in FEV1, FVC; decline in DLCO/hypoxia (advanced)
Coal workers Pneumoconiosis (CWP)
33
Coal workers Pneumoconiosis (CWP)
Tx
Nothing, stop work
Surveil
Vaccinate
34
inhalation/reaction of silia dust
Silicosis
35
* Small round nodular densities in upper lobes
* slow progression w/ PMF exposure
* over decade of exposure to silia
Chronic (classic) silicosis
36
* 5-10 years high concentration exposure
* fast progression
* Autoimmune dz
Accelerated SIlicosis
37
* few months - 5 years massive silica exposure
* acute dyspnea
* diffuse lung involvement (lower)
* Rapid progression to respiratory failure/death - no TX but ventilator
Acute Silicosis
38
```
DOE
Cough sputum
Chronic hypoxic failure
PMF
*up risk of cancer (class 2A)
```
General s/s?
Silicosis
Watch hemoptysis/weightloss (cancer, TB added)
39
* silicosis w/ acceleration
| * Fever, weight loss, producive cough
W/ TB
40
* PFT : possibly before radiographic changes
* down DLCO
* restrictive/obstructive/mixed
* decrease DLCO
* Low PaO2
+ history
DX?
Silicosis
Looks like coal
41
Silicosis
Tx
* Prevention
* complication Tx (TB)
* acute? = whole lung lavage, lung/heart+lung transplant
42
Silicosis path
* Silica in macrophage
* Macrophate release cytokines
* Fibroblasts come
* Release reticulin/form hyalinized collagen fibers
* Nodule
43
* coal exposure
* progressive dyspnea/cough/melanoptysis
* crackles
* clubbing
* Pulmonary fibrosis
Complicated CWP
44
* asbestos exposure
* choronic fibrosing lung dz
* lower lobes (as Base Tosis)
* no PMF
* Smoking AFFECTS
* exposure 20+ yrs or sooner
* trapped in type I cells
Asbestosis
45
* asbestos exposure
* younger (10-15 years)
* fluid in lungs, clears, then reappears other side
* effusion - exudative, bloody
* RISK - diffuse pleural thickening
Benign asbestosis related Pleural effusion
46
* construction/shipbuilding/pipefitting
* cough/sputum
* chest tightness
* wheezing
CXR: reticulonodular pattern in Base (as BASE tosis) , Pleural plaques, interstitial fibrosis/honeycomb
PFT: restrictive pattern
Low DLCO
Asbestosis
47
*parietal lesions = white, raised, focal, irregular
*reaction to mesothelial cells to asbestos
*grow slow, never cancer
PFT : slow FVC delcine
Pleural plaque
48
Round atelectasis
* asymptomatic, maybe Dyspnea, Cough, pain
* surgery
* men
49
* asbestos exposure
* tumor on parietal/visceral pleura, peritoneum
* +/- pleural effusion (+/- large)
* men
*pain, dyspnea, fever, hemoptysis, night sweats weight loss
Mesothelioma
50
Mesothelioma
Tx
Localized = surgery Pleurectomy
Diffuse = chemo/radiation, resection
*8-12 month survival
51
Most dangerous fiber in mesothelioma
Crocidolite fiber
52
Grain dust
COPD like symptoms
Productive cough
Obstructive PFT
53
Flu-like s/s - fever, chills, malaise, mild wheezing
Volatized upon burning
Polymer fume fever
teflon
54
Exposure
Flu-like symtpoms
Resolve quickly
Welding of steel
Metal fume fever
Zinc oxide
55
* exposure: drill bits, cutting tools, tech industry
* bronchiolitis, granulatomous/fibrotic dz
* pulm fibrosis s/s NOT occupation asthma (must differentiate)
Hard metal lung dz
Tungsten carbide, cobalt
Tx: steroid
56
* working in fluorescent light/ computer/electronic industry
* acute relatively large exposure --> tracheo bronchitis
*chronic exposure --> granulomatous parenchymal disease --> like sarcoidosis
CXR: miliary pattern + HILAR LYMPHADENOPATHY + interstitial markings
Berylliosis
Tx: Corticosteroids
Dx: Hz, Lymphocyte Proliferation Test, Beryllium in lung w/ biopsy
57
*farmer's lung/bird fancier's dz/ chemical workers/ many jobs / take care of animals
*inflammatory dz of lung involving alveolar walls + terminal airways w/ repeated exposure (Th1 cell)
*granuloma formation
LAB: IgG antibody
BIOPSY: loose, non-caseating granuloma
??
Hypersensitivity pneumonitis (HP)
58
Hypersensitivty with Th1 cell vs. Th2 cell
Th1 = HP
Th2 = asthma
59
* 4-12 hrs after exposure + abrupt onset of viral-like respiratory s/s
* +/- crackles, tachycardia, tachypnea, fever
* CXR: micronodular interstitial (often lower)
* PFTs: Restrictive, DOWN DLCO
* proteolytic enzyme destruction
Biopsy: non-caseating granulomas
Acute Hypersensitivity pneumonitis (HP)
Tx: avoid allergen, corticosteroids
60
Acute Hypersensitivity pneumonitis (HP)
Progress to:
Subacute :
W/ weight loss
Chronic:
Heart failure s/s
Lung failure s/s = cyanosis, clubbing, crackles, peripheral edema
61
CT : ill-defined nodules
Hypersensitivity pneumonitis (HP)
62
Hypersensitivity pneumonitis (HP)
Tx
* avoid exposure
* steriod
* chronic- nothing/transplant
63
*exposure NO2 from plant matter = bleach smell, reddish brown gas
* Mild exposure: airway irritation, cough, tightness,
* Heavy exposure: p edema, asphyxiation
*sept-october
Silo Filler's Dz
64
Benign Asbestos-related Pleural Effusion (BAPE)
Dx
Thoracentesis + Pleural biopsy
Tumor-free interval of 3 years
65
asbestos body
Yellow-brown on light microscopy
Asbestos fiber in Fe/Ca salt/protein
66
* coal exposure
* coalesces of small nodules to greater than 1 cm (PROGRESSIVE MASSIVE FIBROSIS)
* before death
Complicated Coal Workers Pneumoconiosis (CWP)
67
Coal Worker's Pneumoconiosis + Rheumatoid arthritis
Caplan Syndrome
EKG/Radiology
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