Occupational lung diseases an overview 22:07:2013

Transcription

1 Occupational lung diseases an overview 22:07:2013 IIT MUMBAI

2 52/M Non smoker Worked in a bakery for > 30 years C/O Productive cough and exertional breathlessness since 2 years Treated with AKT on multiple occassions due to Xray changes with no relief No h/o HT/DM/IHD

3 Radiology: PMF

4 NEEDLE SHAPED (SILICA) BIREFRINGENT CRYSTALS IN SAMOSA PATTI (Polarising microscopy) DEPT. OF PATHOLOGY, K.E.M. HOSPITAL

5 ILO 2010 RESPIRATORY DISORDERS Occupational diseases by target organ systems 2.1. Respiratory diseases Pneumoconioses caused by fibrogenic mineral dust (silicosis, anthraco silicosis, asbestosis) Silicotuberculosis Pneumoconioses caused by non fibrogenic mineral dust Siderosis Bronchopulmonary diseases caused by hard metal dust Bronchopulmonary diseases caused by dust of cotton (byssinosis), flax, hemp, sisal or sugar cane (bagassosis) Asthma caused by recognized sensitizing agents or irritants inherent to the work process Extrinsic allergic alveolitis caused by the inhalation of organic dusts or microbially contaminated aerosols, arising from work activities Chronic obstructive pulmonary diseases caused by inhalation of coal dust, dust from stone quarries, wood dust, dust from cereals and agricultural work, dust in animal stables, dust from textiles, and paper dust, arising from work activities Diseases of the lung caused by aluminium Upper airways disorders caused by recognized sensitizing agents or irritants inherent to the work process p Other respiratory diseases not mentioned in the preceding items where a direct link is established scientifically, or determined by methods appropriate to national conditions and practice, between the exposure to risk factors arising from work activities and the disease(s) contracted by the worker Diseases of the lung caused by aluminium Upper airways disorders caused by recognized sensitizing agents or irritants pp y y g g g inherent to the work process Other respiratory diseases not mentioned in the preceding items where a direct link is established scientifically, or determined by methods appropriate to national conditions and practice, between the exposure to risk factors arising from work activities and the disease(s) contracted by the worker

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8 Table 2. Prevalence of some of the occupational lung diseases studies carried by National Institute of Occupational Health Industry Morbidity Prevalence (%) Slate Pencil5 Silicosis 54.5 Agate Polishing6 38 Stone Quarries7 21 Potteries Stone Crushing9 12 Coal Mines10 (Underground) Coal workers pneumoconiosis 2.84 Other respiratory morbidities 45.4 Coal Mines10 (Open Cast) Coal workers pneumoconiosis 2.1 Other respiratory morbidities 42.2 Asbestos mine & mill11 Asbestosis 11 Asbestos Textile workers12 9 Asbestos cement Textile Mills (Blow Room)14 Byssinosis 30 Textile Mills (Card Room)14 38 Jute Mills15, 16 Byssinosis and other chronic 48.8 obstructive lung diseases

9 Occupation related Incidence of Silicosis i in Flour mill workers 30.4% flour mill workers had Silicosis s

10 Indian J Occup Environ Med Sep Dec; 15(3): doi: / PMCID: PMC Incidence of silicosis in flourmill workers Amita Athavale, Aparna Iyer, Debasis Sahoo, Kapil Salgia, Abhijit Raut, 1 and Neeti Kanodra 2 Department of Chest Medicine and E.P.R.C, Seth G.S. Medical College and K.E.M. Hospital, Parel, Mumbai, India 1 Department of Radiology, Seth G.S. Medical College and K.E.M. Hospital, Parel, Mumbai, India 2 ICMR Student Research Fellow, Seth G.S. Medical College and K.E.M. Hospital, Parel, Mumbai, India Abstract Background: Silicosis is an ancient occupational illness reported in silica mill workers, agate stone workers, slate pen workers and mining industry. However its association in flour mill workers has not been established.

11 BRONCHOSCOPY:BAL,TBLB

12 Diagnostic modalities available for studying health effects of air pollution.

13 Occupational respiratory diseases Dust Toxic Gases Silica dust SO2 Asbestos dust NOx Coal dust Biologic reaction Inflammatory reaction Neoplastic Asbestos, nickel, iron Chronic Obstructive Pulmonary Disease Synergism with tobacco Allergic reaction occupational ASTHMA Organic dusts Cotton Wood dusts Flour Particulate matter within the range of 1 5 μm s penetrate deepest into the lung!

14 ASTHMA AT WORK PLACE

15 Personal monitor Portable lung function Indoor particulate monitor Equipment Used PULMONARY FUNCTION TESTING LAB Chest Medicine & EPRC

16 Occupation related Traffic police survey Obstructive Restricitve Mixed SAO Normal Obstructive Restricitve Mixed SAO Normal PFT in traffic police in Smokers PFT in traffic police in non-smokers

17 34 yrs GARDENER, WATERED PLANTS WITH TREATED WASTEWATER

18 THERAPEUTIC BAL UNDER GA

19 Dust induced interstitial lung disease in the tropics Jindal, Surinder K. MD; Aggarwal, Ashutosh N. MD; Gupta, Dheeraj MD Abstract Inhalation of dusts is an important cause of interstitial lung disease in the tropical countries such as India. While dusts of organic origin, such as the cotton dust causing byssinosis, generally cause bronchial orbronchiolar involvement and hypersensitivity pneumonitis, inorganic metallic dusts cause progressive pulmonary fibrosis. Silicosis, coal workers' pneumoconiosis, and asbestosis are the three most commonly recognized forms of pneumoconiotic pulmonary fibrosis. Pulmonary tuberculosis is an important complication seen in up to 50% of patients of silicosis in some reports from India. The presentation is generally chronic, although acute and accelerated forms of silicosis are known when the exposures are heavy. Breathlessness, dry cough, and general constitutional symptoms are commonly seen. Patients with silicotuberculosis or other forms of infection may also have significant expectoration, hemoptysis, fever, and rapid progression. Respiratory failure and chronic cor pulmonale occur in the later stages. The diagnosis is easily established if the occupational history is available. Dense nodular opacities on chest roentgenograms, which may be large in patients with massive pulmonary fibrosis, are characteristic. Emphysematous changes generally appear in advanced stages or in patients who smoke. Bronchoalveolar lavage and/or lung biopsy may occasionally be required to establish or exclude other causes of interstitial lung disease. Treatment is largely palliative, although a variety of drugs including corticosteroids and procedures such as whole lung lavage have been tried. None of these methods has yet been found successful in the treatment. Preventive safety steps, including removal of the patient from the site of exposure, are the only effective strategies to control disease progression.

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21 ORGANIC DUST

22 Risk of tuberculosis infection and disease associated with work in health care settings [State of the Art Series. Occupational lung disease in high and low income countries, Edited by M. Chan Yeung. Number 5 in the series] Authors: Menzies, D.; Joshi, R.; Pai, M. Source: The International Journal of Tuberculosis and Lung Disease, Volume 11, Number 6, June 2007, pp (13)

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24 HISTORY OF ALL PAST & PRESENT OCCUPATIONS

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26 ASBESTOS

27 Asbestos vs Silica

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35 Impairment assessment

36 Notifiable diseases

37 Legislation

38 Add years to life. Life to years

39 PNEUMOCONIOSIS

40 Prevention is the key Pre employment health check Health education Periodic health check Ensuring use of protective gear Early diagnosis & treatment

41 PROTECTIVE GEAR :FIT TEST

42 Educate to Ensure CULTURAL SOCIAL ECONOMICAL