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OCCUPATIONAL LUNG DISEASES

OCCUPATIONAL LUNG DISEASES. B.VIDYASAGAR PROFESSOR OF CHEST DISEASES J.J.M.MEDICAL COLLEGE DAVANGERE-577004,INDIA. Exposure to harmful particles,chemicals, vapours,gases,etc at work will lead to variety of health problems.

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OCCUPATIONAL LUNG DISEASES

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  1. OCCUPATIONAL LUNG DISEASES B.VIDYASAGAR PROFESSOR OF CHEST DISEASES J.J.M.MEDICAL COLLEGE DAVANGERE-577004,INDIA

  2. Exposure to harmful particles,chemicals, vapours,gases,etc at work will lead to variety of health problems. • Different types of particles produce different reactions within the body Allergies-animal dander Lung irritants-chronic exposure to industrial dusts. Cancers-exposure to harmful chemicals Apoptosis-death of cells of the lining mucus membrane of the airways

  3. Occupational exposure

  4. Classification • Occupational lung diseases can be broadly classified on the basis of type of exposure, material of exposure -organic/inorganic. • Exposure to organic dusts: *Cotton dust-Byssinosis *Grain dust-Asthma,COPD *Agricultural dust,fungal spores,vegetable dusts-Hypersensitivity pneumonias *Toxic chemicals & gases-COPD,Lung cancer • Exposure to inorganic dusts: *Silica-mining,quarrying-silicosis *Coal dust-coal workers pneumonias *Asbestos-Asbestosis *Berylium-Beryliosis.

  5. Pneumoconiosis • Pneumoconiosis is the classification of diseases that develop as the result of occupational exposure to dust • Occupational lung diseases develop based on the size & type of the particles inhaled & where the inhaled particles end up.Larger particles are more likely to get stuck in the nose and larger airways but smaller particles can reach the alveoli where they can potentially be absorbed into the bloodstream.

  6. When the inhaled particles come in contact with the wall of the airway,they do not become airborne again.This is called deposition and can occur in one of the 4 ways: • Sedimentation:when gravity causes the particles to settle,tends to occur in larger airways • Inertial impaction: Often occurs in the nose & larger airways,it happens when an airway changes direction. • Interception:This form of deposition occurs with fibrous dust particles(including asbestos fibers) or any other irregular shaped particles.Due to their shape, they often avoid deposition by sedimentation or inertial impaction but are deposited in the walls of the bronchioles which are lined with epithelial cells.

  7. Diffusion:Behaviour of small aerosol particles which encounter and are affected by molecules of air. • Alveolar deposition,the process of particles settling in the alveoli,often occurs with particle diameters of between 1 and 7 microns.During regular breathing(at rest) about 10% of compact particles of 0.5 to 1 micron diameter are deposited in the alveoli with the vast majority being exhaled.

  8. Defence mechanisms • The nose is able to filter majority of compact particles larger than 20 microns & about half of the particles 5microns in diameter.However there is a wide variation in how efficiently an individual is able to filter particles & filtering rates vary depending on breathing rate & whether a person is resting because the mouth lacks these filters which make a person more susceptible to deposition. • The lung features 3 defence mechanisms: 1)mucus,a secretion produced by mucous membranes,that protect epithelial cells by coating foreign particles so that they can be coughed out of the body

  9. 2)cilia,microscopic hair that line the airways ant attempt to brush foreign particles out of the lungs. 3)Macrophages,special cells(alveolar macrophages) that attempt to engulf and digest particles and can signal lymphocytes and other immune system cells to respond to specific pathogens.Human macrophage cells are around 21 microns in diameter and are capable of digesting a number of particles but they cannot digest asbestos fibers which cause the cell to burst.

  10. SILICOSIS • Caused by inhalation of fine free crystalline silicon di oxide(silica) dust,or quartz particles. silica is most fibrogenic dust and causes development of hard nodules which coalesce as the disease progresses.tuberculosis may complicate. • disease progresses even when the exposure to dust ceases,rapid removal from offending site is a must. • prognosis is generally poor.

  11. Case history • MKJ,40yrs,supervisor stone crushing unit,presents with progressive dyspnea, drum stick clubbing,cyanosis at rest, squeaky rales, wheezes bilateral. resting O2 sat 69%, chest pa view nodular coalescing opacities more at mid zones,ct confirms,fnac silicosis,maintained on home oxygen, antibiotics sos.

  12. Case history.2 MVH 27yrs,working as sand blaster,in jeans manufacturing unit,for 5 yrs,presented with progressive breathlessness of 6 months duration,cyanosis at rest,clubbing drumstick,crackles both lung fields,resting SPO2-67%. chest pa view, nodular coalescing opacities both uz’s, mz’s. refused ct,fnac.lost to follow up 6months,ct,fnac done at manipal-silicosis,maintained on home oxygen

  13. BYSSINOSIS • Initial lesion caused by cotton dust inhalation is acute bronchiolitis,associated with signs and symptoms of generalised airflow obstruction,more in keeping with asthma.symptoms tend to recur after the weekend break(Monday morning fever),later continuous. Carding and spinning sections-higher risk • Only pneumoconiosis where chest x-ray may appear normal. • Recovery follows after removal from dust hazard. smokers more at risk. • Many patients might be masquarading as asthma /copd.

  14. Asbestosis

  15. The diagnosis of an occupational lung disease is almost tantamount to an admission of failure in prevention. This is because in most situations, the factor(s) which cause an occupational lung disease are known and therefore worker exposure is preventable. • Prevention is any day better as there is no cure to many a occupational lung diseases

  16. Prevention • Substitution is the best way to prevent hazardous emissions(i.e, replacing hazardous substances with less hazardous ones). • Imposition of rigorous engineering controls is the 2nd best way to prevent airborne exposure.This would include ventilation & process design which does not allow release of gases & toxic particles to air. • Use of protective gear & respirators has been shown to be the least satisfactory method of preventing respiratory exposures. This method is used only when others cannot cope up with the problem or hazard. • All approaches used for reducing exposure to hazardous substances in the workplace should be supported by stringent enforcement of law & thorough periodic review of current legal standards that regulate occupational exposures.

  17. Thank you for patient listening

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