Occupational Lung Diseases Hypersensitivity Pneumonitis, Asbestosis, Silicosis

dr.Sinatra Gunawan,MK3,SpOk Occupational Lung Diseases Hypersensitivity Pneumonitis, Asbestosis, Silicosis Penyaji Materi : dr.Sinatra Gunawan,MK3,SpOk Referensi : Amer Rassam MD1, Gerry San Pedro MD2, Daniel Banks MD1. Department of Internal Medicine LSUHSC-Shreveport

Occupational Lung Disease OLDs have been recognized for centuries. Lung illness was realized to be part of miner’s life even in the 16th century. Governments of many countries have implemented formal policies of workers’ compensation. The relationship between exposure at work and disease is underestimated.

Occupational Lung Disease Although OLDs are thought to be preventable, they continue to occur. The magnitude of the problem is underestimated due to long latency. Wearing protective respiratory devices is an unrealistic expectation. The most notorious failures of OLD have occurred in reported epidemics of silicosis in the American workplace.

Occupational Lung Disease Inhaled Dusts

Occupational Lung Diseases Hypersensitivity pneumonitis Organic dusts (Byssinosis) Inorganic dusts (Asbestosis, Silicosis, Berylliosis, and Coal worker’s pneumoconiosis)

Hypersensitivity pneumonitis General Immune mediated granulomatous reaction Reaction to organic antigen Not many people get it Poorly-formed granulomas are typical It has a wide range of causes

Hypersensitivity pneumonitis Causes Moldy hay (thermophilic actinomycetes) “farmer’s lung” Pet birds “bird fanciers lung” Grain dusts Isocyanates Air conditioning system

Hypersensitivity pneumonitis Clinical Acute, subacute, and chronic forms Recurrent chest infiltrates with fever & WBC Slowly progressive pulmonary fibrosis Diagnosis by history Serum precipitins are non-specific CXR – Recurrent infiltrates “fleeting” Treatment - remove pt from offending antigen

Byssinosis Inhalation of cotton, flax, or hemp dust Not immune related Early stage - Occasional chest tightness Late stage – Regular chest tightness towards the end of the 1st day of the workweek “Monday chest tightness” Frequency of symptoms slowly increases

Mineral Dust Pneumoconiosis Nonfibrogenic Iron, Zirconium, Tin, Barium, and Aluminum Striking CXR – Dense nodular opacities No symptoms, physical findings, or impairment.

Mineral Dust Pneumoconiosis Fibrogenic Asbestosis Silicosis Berylliosis Coal worker’s pneumoconiosis