Your Online Health Information Site

Advertisement

Occupational Lung Disease

Introduction

This group of lung diseases is very common in industry, but is occasionally overlooked, particularly if the person is also a smoker.

There are many forms of dust at various work places, some are organic, some inorganic (metal). In the case of exposure to organic substances the resulting lung diseases are called “pneumonitis”.

Some individuals are more sensitive than others and develop a hyper-reactivity through the production of antibodies and sensitization of immune cells to the organic compounds, this is called “hypersensitivity pneumonitis”. In the case of exposure mainly due to nonorganic substances the occupational lung disease is called a pneumoconiosis and this will be discussed below.

 Occupational lung diseases

Name of disease: Description of exposure:
air conditioner lung  similar to farmer’s lung, from mold spores in the air conditioner ducts
asbestosis from longterm exposure to asbestos dust being incorporated into lung tissue
berylliosis  only 2% of persons, exposed to beryllium dust, get it; today mostly in aerospace industry
byssinosis  exposure to cotton, hemp or flax dust causes bronchoconstriction
Caplan’s syndrome  coal dust exposure in patient with rheumatoid disease develops this acute nodular lung disease
coal workers’ pneumonitis (CWP), also called “black lung disease”  about 1 to 2% of coal mine workers exposed to coal dust develop progressive massive fibrosis(PMF)
exposure to irritant gases  accidental exposure to chlorine, sulfur dioxide, nitrogen dioxide, ammonia, hydrogen sulfide and other gases can lead to acute lung damage
humidifier fever  toxins from bacteria, fungi or amebas can cause a flu-like illness with breathing problems
red cedar dust asthma red cedar dust can cause acute asthma and lung fibrosis in sensitized patients
sick building syndrome  air-tight buildings can cause elevated CO2 levels, aggravated by truck exhausts idling near air vents adding noxious gases (nitrogen oxide, carbon monoxide, aldehydes and other irritants)
silicosis  silica dust exposure from pottery work, from mining for silver, gold, copper, hard coal and lead, but also from sandblasting or granite cutting etc. A late complication is malignant mesothelioma.

 

Generally speaking, the further a chemical compound can invade into the airways or lung tissue, the more serious the tissue reaction.

It depends also on the reactivity of the chemical that intrudes and on the concentration and length of exposure. With silicosis special clean-up cells of the lung tissue, called “macrophages”, try to engulf and inactivate the silica particles, but fail and die off. In this process lytic enzymes are released that damage the surrounding lung tissue leading to a fibrotic tissue reaction that narrows the airway passages severely and leads to the end result of a nodular lung fibrosis. A lung biopsy stained with special stains and viewed under polarized light shows these rust colored silica bodies (thanks to library.med.utah.edu for image). Asbestos exposure leads to a diffuse interstitial fibrosis (=asbestosis) and can be detected due to these needle like asbestos fibers (thanks to library.med.utah.edu for image) that can be shown on iron stained histology slides of a lung biopsy as shown here. Unfortunately very little can be done when the damage has occurred after many years of exposure to these substances.

Prevention of exposure to noxious substances is the key to avoiding the devastating effects of lung fibrosis.

There are some substances, which are inert. For instance, exposure to iron oxide, tin or barium dust leads to siderosis, baritosis and stannosis. This lung X-ray picture of a patient with siderosis (thanks to oem.bmj.com for image) looks as if the patient should have breathing problems. However, the patient has absolutely no symptoms and no disability as iron oxide is a substance that is inert with no effect on lung tissue other than showing up on these diagnostic tests. The same is true for baritosis and stannosis.

Here is an overview of a selection of common occupational lung diseases with links to sites that give you more details regarding symptoms, diagnosis and treatment.

Signs and symptoms

Symptoms vary from case to case and within a patient group tend to be more symptomatic after a lengthy exposure (15 to 20 years or more) to high concentrations of dust. At the same time symptoms are much more prominent, if the patient has also been a heavy smoker or has had exposures to other noxious substances that have led to chronic bronchitis or emphysema. The exposure to cigarette smoke also predisposes the patient to lung cancer, the symptoms of which would be overlapping. Generally speaking shortness of breath on exertion and a chronic cough as well as a cyanotic (bluish tinge) skin discoloration are the

hallmarks of this patient group at the later stages. However, a non smoker who has simple nodular silicosis, or simple coal workers’ pneumoconiosis (CWP) would not have any lung symptoms and only show up abnormally on tests such as pulmonary function tests or X-rays. Details about the above mentioned diseases can be found under the various links.

 Occupational Lung Disease

Occupational Lung Disease

Diagnostic tests

A patient who is getting symptoms of coughing up phlegm and getting short of breath when walking uphill on a slight incline where he was asymptomatic before, needs a few screening tests done. Chest X-rays are a starting point along with a thorough examination by a physician to check this patient out who who has had perhaps a 20 year dust exposure working in a coal mine. Such a patient may have this X-ray finding of the lungs. As the findings are rather extensive, further investigations with a CT scan and bronchoscopy have to be done by the lung specialist to rule out lung cancer. In a case where it was thought that the patient was cured from a previously treated tuberculosis, and who was symptom free for years, The patient came down with new symptoms. Chest Xray, CT scan and bronchoscopy were all done. After the biopsy material came back from the pathologist it was noted that the patient had silico-tuberculosis. Exposure to silica dust makes the patient much more vulnerable to contract tuberculosis and it is a much more chronic form of this disease. Silicosis is also associated with malignant mesothelioma, an otherwise rare lung tumor of the pleural surfaces.

Treatment

Unfortunately there is no specific treatment for any of the occupational lung diseases. Treatment is directed at making the patient’s breathing more comfortable, but the overall outlook (prognosis) is not changed. The most important step in the therapy is to convince those who are still exposed to toxic substances for the lungs, to remove this exposure. This includes a stop smoking program and early retirement from the job that caused the disease. It may be that Workers’ Compensation is at least partially liable and depending on the jurisdiction this may involve some possible legal action. A last resort, for those short of breath, is using continuous oxygen.

 

References:

1. Noble: Textbook of Primary Care Medicine, 3rd ed., Copyright © 2001 Mosby, Inc.

2. National Asthma Education and Prevention Program. Expert Panel Report II. National Heart, Lung and Blood Institute, 1997.

3. Rakel: Conn’s Current Therapy 2002, 54th ed., Copyright © 2002 W. B. Saunders Company

4. Murray & Nadel: Textbook of Respiratory Medicine, 3rd ed., Copyright © 2000 W. B. Saunders Company

5. Behrman: Nelson Textbook of Pediatrics, 16th ed., Copyright © 2000 W. B. Saunders Company

6. Merck Manual: Environmental Lung Diseases  (thanks to www.merckmanuals.com for this link)

7. Goldman: Cecil Textbook of Medicine, 21st ed., Copyright © 2000 W. B. Saunders Company

8. Ferri: Ferri’s Clinical Advisor: Instant Diagnosis and Treatment, 2004 ed., Copyright © 2004 Mosby, Inc.

9. Rakel: Conn’s Current Therapy 2004, 56th ed., Copyright © 2004 Elsevier

Last modified: December 2, 2016

Disclaimer
This outline is only a teaching aid to patients and should stimulate you to ask the right questions when seeing your doctor. However, the responsibility of treatment stays in the hands of your doctor and you.