Upper Respiratory Tract Diseases in Workplace

Characteristics of upper resp. tract NNNNares to larynx TTTTasks: AAAAir conditioning (T and humidity) FFFFiltering (particles > 5-20μm) MMMMicrobial defense MMMMechanical CCCChemical SSSSpecific: IgA NNNNon-specific: lysozyme and lactoferrin SSSSensation OOOOdor perception (olfactory nerve) IIIIrritant perception (trigeminal nerve) pppphonation

Response mechanisms in upper airway  Allergic response  Mast cell degranulation  Rhinorrhea  Inflammation  congestion  Neurogenic reflex  Triggerd by irritants  Parasympathetic response  Axonal response

Occupational diseases  Allergic rhinnitis  Irritant rhinnitis  Non-allrgic rhinnitis  Sinusitis  Sensory alterations

Allergic rhinnitis  Frequency: 20% of general population  Types  Seasonal  Perrenial (more common in workplace)  Symptoms:  Rhinorrhea  Congestion  Sneezing  Itching  ± eye and chest symptoms

 signs  Pale and boggy nasal mucosa  Sticky secretions

Occupational causes  Commonly-encountered allergens  Pollens in gardeners  Specific allergens  HMW compounds  Animal antigens  Plant antigens  Insect antigens  Latex  LMW compounds  TDI  Acid anhydrids  Colophony  Work-induced or work-aggravated

Attention Causes of allergic rhinitis are the same as asthma

 Paraclinic  CBC  Eosinophilia  Increased serum IgE  Nasal smear  Eosinophilia  Skin prick test (gold standard)  Nasal peak flow measurement (across- shift)

Treatment  Allergen avoidance  Engineering controls  Personal protective devices  Reassignment  Medical therapy:  Systemic antihistamines  Nasal steroids  Nasal Cromolyn sodium  Nasal ipratropium bromide (esp. vasomotor symptoms)

Irritant rhinitis  Most common place of irritation  Causes  Combustion products  VOCs  Chromic acid  RUDS  Rhinitis after a sudden high exposure to irritants

Irr. rhinitis  Symptoms: nasal congestion, rhinorrhea  Signs: erythema and erosion in nasal mucosa  Paraclinic: no paraclinic test  DDx: allergic rhinnitis  Irritation rather than sneezing and itching  High prevalence among co-workers  Dramatic improvement when not exposed

 Treatment:  Reduction of exposure  Saline nasal lavage  Topical streoid or ipratropium bromide

Non-allergic rhinitis  Vasomotor rhinitis  Augmented nasal reactivity to non-specific physical stimuli  Low humidity  Rapid changes of temperature  Excessive air motion  Gustatory rhinitis  Ingestion of spicy foods  Bright-light rhinitis

Occupational sinusitis  Seen in:  Spice workers  Vegetable picklers  Grain and flour workers  Most common:  Sinusitis after complication of rhinitis

Occupational laryngeal pathology  Hoarseness due to:  Overuse of voice  Chemical irritants  Laryngeal SCC due to:  Asbestos  Smoking  Ethanol  Leather ant textile workers  Gasoline and diesel oil  Laryngeal stricture due to:  Smoke inhalation injury  Vocal cord dusfunction  Stridor, hoarseness, shortness of breath, globus  Acute irritant exposures