Occupational lung disease

Occupational Lung Disease
moderator – Dr.N.M srivani M.D
Dr. sri krishna M.D
PRESENTER- Dr. GOUTHAM NARESH

Definition
 Occupational lung disorder has be defined as a
disease arising out of or in course of employment.

Determinants of inhalational exposure
 Particles size of air contaminates
Particles > 10 -15 um diameter do not penetrate beyond the nose and throat.
 Particles are divided into three size fractions on the basis of their size
character and source .
1.Coarse-mode fraction –particles size of 2.5- 10 um contain crustal elements
such as silica, aluminum, and iron. Mostly deposit relatively high in the
tracheobronchial tree.
2.Fine mode fraction –practical size <2.5 um and carried to the lower airways
and get deposited .fine particles are created by burning of fossil fuels or high
temperature industrial process, gases ,fumes.
3. Ultra fine fraction - <0.1 um in size deposit in the lung and they come in
contact with the alveolar walls ,however particles of this size range may
penetrate into the circulation and be carried to extra pulmonary sites.

Classification
•Inorganic ( mineral ) dust/Pneumoconiosis
silica, asbestos, coal , talc, silicates Fe,
barium, tin
•Organic –grain dusts ,cotton , pollens etc
• Immunologic
Allergic alveolitis (hypersensitivity pneumonitis)
Asthma - feathers, enzymes, cotton, platinum

Pneumoconiosis
Pneumoconiosis is defined as the accumulation of dust in the lungs and the
tissue reactions to its presence.

CLASSIFIED
fibrotic
( focal nodular ,diffuse fibrosis)
nonfibrotic
(particle-laden
macrophages,
no fibrosis )1.silicosis -Nodular fibrosis
2.coal worker pneumoconiosis
3.asbestosis --Diffuse fibrosis
4.berylliosis- Granulomatous
reaction
1.siderosis
2.stannosis
3.baritosis

Pathophysiology of pneumoconiosis

COAL WORKER PNEUMOCONIOSIS
• Pathologic entity resulting from deposition of coal dust in the lungs.
• Simple cwp – with prolonged exposure to coal dust for 15 to 20
years ,small rounded opacities develop usually not associated with
pulmonary impairment.
• Complicated cwp – appearance of nodules> 1cm in diameter on
chest radiography usually confined to upper half of the lungs . And it
progresses to PMF that is accompanied by severe lung deficits
causing chronic bronchitis and COPD .
• When exposure is terminated the simple type will not progress; PMF
type will progress

9
CAPLANS SYNDROME
 coal workers with rheumatoid disease may
develop nodules even after relatively low
exposures to dust.
 The lesions are typically subpleural.
 The lesions may grow rapidly, appear in crops(in
contrast to silicotic/CWP nodules that appears
over a period of time) cavitate and produce a
pneumothorax

Professions associated with exposure:
• Mining ,Stonecutting and sand blasting , Glass and cement manufacturing ,
Packing of silica flour and quarrying.
• Prevalence:8/1000 miners .
Silicosis

 clinical forms:
Acute silicosis- it develops with 10 months of silica exposure
Clinical and pathologic features are similar to pulmonary
alveolar proteinosis .it is a quite severe form and is
progressive despite discontinuation of exposure.
 Xray - chest - profuse milliary infiltration or consolidation,
 No silicotic nodules
 HRCT- characteristic pattern-Crazy paving [thickened intra and
interlobar septa producing polygonal shapes ].
 Treatment- whole lung lavage provide symptomatic relief

Clinical manifestations
Simple silicosis-develops with long term (15-20 years) less
intense exposure, without associated impairment of lung
function
xray – chest –variablilly sized ,poorly defined small
nodules predominating in upper lobes . calcification of hilar
nodes producing characteristic feature “EGG shell” pattern.
Egg shell pattern

 HRCT- neumorous small nodules more pronouced on upper lobes a
number of sub pleural loacation
HRCT shows numerous small nodules

 Complicated silicosis-nodular form may progress in the
absence of further exposure with coalescence and formation
irregular masses > 1cm in diameter.
 these masses can become quite large and when this occurs
progressive massive fibrosis term is applied.
 Both restrictive and obstructive pattern may be associated with
PMF.
PMF

 COMPLICATIONS-
SILICOTUBERCULOSIS-silica is cytotoxic to alveolar
macrophages so patients are at increased risk of
tuberculosis.
Autoimmune disorder- rheumatoid arthritis ,
scleroderma
malignancy

Asbestos-related diseases
Benign
Pleural diseases
1.plaques
2.diffuse pleural thickening
3.effusion
4.calcification
Parenchymal diseases
1.Asbestosis [parenchymal
fibrosis caused by asbestos
inhalation]
2.Rounded atelectasis
3.Benign fibrotic masses
4.Transpulmonary bands
Malignancy
1.Malignant mesothelioma
2.Bronchogenic carcinoma

Asbestos-Related Pleural Abnormalities
 Four types of abnormalities:
 Pleural plaques
 Benign asbestos pleural effusions
 Diffuse pleural thickening
 Pleural disease puts patient at risk for other asbestos related diseases –
10% get interstitial fibrosis within 10 years
 Mostly asymptomatic, though some can cause dyspnea or cough
 Latency periods: 10-30 years
(shorter latency is for pleural effusion)
 No specific threpaies
 Pleurectomy in severe cases .

Chest Radiograph Findings:
Asbestos-Related Pleural Abnormalities
 Pleural plaques
 Areas of pleural thickening
 Sometimes with calcification
 Pleural effusions
 Diffuse pleural thickening
 Lobulated prominence of
pleura adjacent to thoracic margin
 (over ¼ of chest wall)
 Interlobar tissue thickening
 Rounded atelectasis
 Rounded pleural mass
 Bands of lung tissue radiating outwards

Parenchymal Asbestosis
 Diffuse interstitial fibrosis with:
 Associated more with crocidolite
 Smokers more prone to disease and XRC interstitial
infiltrates
 Radiographic changes: >10 years
 Latency period: 20-40 years

Lung Carcinoma
 Latency period: 20-30 years
 Bronchogenic Ca: 5x higher incidence in non-smoking asbestos
workers, 90x higher in smoking asbestos workers.
 adeno ca is most common.
 Chrysotile highest risk bronchogenic Ca.

Malignant Pleural
Mesothelioma
 Tumor arises from the thin pleural membrane surrounding the lungs
 Rapidly invasive
 Rare, although incidences are increasing
 Long latency period: Usually 30-40 years

Chest Radiograph Findings:
Mesothelioma
 Pleural effusions
 Pleural mass
 Diffuse pleural
thickening

BERYLLIUM
• Beryllium – is a light weight metal
• Exposure –manufacture of alloys, ceramics, or high
technology electronics , nuclear reactors
• Beryllium may produce
- Acute pneumonitis,
-Chronic granulomatous inflammatory disesase that is
similar to sarcodisis.
- Lung cancer
• Pathogenesis is a result of delayed type
hypersensitivity reaction stimulating proliferation of
T-cells leading to inflammatory ,fibrosis and
granuloma formation.
•

 Clinical features- cough , chest pain, arthralgia's ,fatigue
and weight loss
 BeLPT[beryllium lymphocyte proliferation test ]-blood is drawn and in
the lab, the WBC are separated from the rest of the blood cells and then
mixed with beryllium solution. If the immune system is sensitized to
beryllium, the cells will multiply, producing an abnormal BeLPT result.In
normal individuals cells will not multiply.
 Fiberoptic bronchoscopy with transbronchial lung biopsy is required to
make diagnosis of CBD . Biopsy shows noncaseating granulomas or
monocytic infiltration in lung tissue.

Occupational lung disease

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