Occupational Lung Disease

Chanak Trikhatri

Definition of Sarcoidosis

Sarcoidosis a disease of unknown origin that causes small lumps (granulomas) due to chronic inflammation in body tissue. Sarcoidosis is an inflammatory disease that affect multiple organs in the body but mostly lungs lymph node. In people with sarcoidosis, abnormal masses or nodules called granulomas consisting of inflamed tissues form in certain organs of the body

Epidemiology

• Women are more vulnerable then men• The disease is 10-17 times more common in

African – American than in Caucasians• People of Scandinavian, German, Irish, or

Puerto Rican are more prone

• common in women. In the United States, the disease is 10 times

• more common in African Americans (40 cases per 100,000) than

• in Caucasians (5 cases per 100,000), and the disease usually begins

• in the third or fourth decade of life (American Thoracic

• Society, 1999).

Risk Factor

• Age: 20-40 years• Sex: female are slightly more likely to develop

the disease • Race : African-American, • Family history

Etiology

• Idiopathic• Type of autoimmune disease • How sarcoidosis spread in the body is still

being studied • Genetic predisposition • Some microorganisms bateria virus dust and

chemical

Pathophysiology

Clinical Manifestations

• Persistent dry cough fatigue and shortness of breath

• Hemoptysis, congestion • Anorexia, fatigue, and weight loss. • fever, and granulomatous lesions of the skin• Tender reddish bumps or patches on the skin• Red and teary eyes or blurred vision• Swollen painful joints• Enlarged lymph node of axilla, groin, neck chest

Cont…• Hoarse voice • Pain in hand feet and other bony area due to the

formation of the cyst • Chest pain, wheezing• Kidney stone formation • Enlarged liver • Arrhythmias, pericarditis, heart failure • Hearing loss, meningitis, seizures or psychiatric

disorder

Diagnostic Findings

• History Taking • Physical Examination • Chest x-rays are used to assess pulmonary adenopathy and

pulmonary infiltration looks cloudiness • The chest x-ray may show hilar adenopathy and

disseminated miliary and nodular lesions in the lungs. • CT scan to provide more detail picture of the lungs and

lymph node• A mediastinoscopy or transbronchial biopsy (in which a

tissue specimen is obtained through the bronchial wall) may be used to confirm the diagnosis.

• Biopsy

Cont….• Lung function tests – to measure the rate, volume and efficiency of

breathing and ability to deliver oxygen to the circulation system• Blood tests – to assess general health, as well as kidney and liver function• Electrocardiogram – to investigate abnormal activity or size of heart

tissue• Positron emission tomography (PET) – to pinpoint affected areas to help

in the selection of tissue for biopsy• Magnetic resonance imaging (MRI) – to investigate involvement of heart

and central nervous system tissue• Eye examination – to detect eye involvement and evade serious vision

deterioration• Urine dipstick test – to investigate signs of abnormalities the kidneys

Cont… • In rare cases, an open lung biopsy is performed.

Diagnosis is confirmed by a biopsy that shows noncaseating granulomas.

• Pulmonary function test results are abnormal if there is restriction of lung function (reduction in total lung capacity).

• Arterial blood gas measurements may be normal or may show reduced oxygen levels (hypoxemia) and increased carbon dioxide levels (hypercapnia).

• Bronchoscopy to inspect the bronchial tubes and to extract a biopsy

Medical Management

• Treatment generally fall into two categories, 1) maintanence of good health practices and 2)drug treatment

• Getting regular check up • Eating well balanced diet with variety of fresh

fruits and vegetables • Drinking enough fluid everyday • Getting 6-8 hour sleep everyday• Exercise to manage weight • Quitting smoking

Medical Management contd…

• Corticosteroid therapy because of its anti-inflammatory effect, which relieves symptoms and improves organ function.

• Symptomatic treatment, corticosteroid therapy is useful for patients with ocular and myocardial involvement, skin involvement, extensive pulmonary disease that compromises pulmonary function, hepatic involvement, and hypercalcemia.

• Other cytotoxic and immunosuppressive agents

Prognosis• The prognosis for patients with sarcoidosis is relatively

positive and it is not usually fatal, with the overall death rate remaining less than 5% without treatment.

• In fact, most individuals do not require treatment at all as their symptoms do not significantly inhibit daily life activities and will improve spontaneously within two to five years. However, approximately 1 in 3 people will require treatment and certain complications can lead to vast changes in the prognosis of the condition.

Complication

• Irrversible damage to the tissue between the air sac

• Breathing difficulties • Inflammation of eye eventually blindness• Rarely it casuse cataract and glaucoma • Kidney failure and imbalance calcium metabolism • Arrhythmias, • Facial paralysis due to facial nerve damage

PneumoconiosesDiseases of the lungs occur in numerous occupations as a result of exposure to organic and inorganic (mineral) dusts and noxious gases (fumes and aerosols). The effects of inhaling these materials depend on the composition of the substance, its concentration, its ability to initiate an immune response, its irritating properties, the duration of exposure, and the individual’s response or susceptibility to the irritant.

Cont…In other word pneumoconioses is group of lung diseases caused by inhaled dust particles. It is disease characterized by fibrosis and caused by the chronic inhalation of mineral dusts especially sillica, abestos Pneumoconiosis refers to a non-neoplastic alteration of the lung resulting from inhalation of mineral or inorganic dust (eg, “dusty lung”). The most common pneumoconioses are silicosis, asbestosis, and coal workers’ pneumoconiosis.

Cont…

Smoking may compound the problem and may increase the risk of lung cancers in people exposed to the mineral asbestos. Key aspects of any assessment of patients with a potential occupational respiratory history include job and job activities, exposure levels, general hygiene, time frame of exposure, amount of respiratory protection used, and direct versus indirect exposures.

Epidemiology

• Number of death due to silicosis 160 per year • 1000-2000 hospitalize in US• Coal workers pneumoconiosis 700 death

5000-7000 hospitalize before (national institute for occupational safety and health)

Cause • Silicosis: from silica crystals • Asbestosis: from asbestos• Coal worker: from coal dust • Berylliosis: from beryllium• Bauxite fribrosis: from bauxite dust• Talcosis: from talc (hydrated magnesium silicate)• Siderosis: from iorn oxide • Tanosis: from tin oxide• Baritosis: from barium sulfate • Byssinosis: from cotton • Mixed dust pneumoconiosis: from mixture of cobalt and

other metals

Pathophysiology

Contd…

Clinical Manifestations

• Due to decreased oxygen circulating in the blood respiratory and heart failure

• Cough • Shortness of breathe• Chest pain• Bluish coloration of the skin • Swelling of the feet• Liver enlargment • Black lungs after 15-20 years exposure in coal mine • Fibrosis nodules• Clubbing finger • Decrease lungs functions

Cont…

• Anorexia, weight loss, and malaise• Early physical findings include bibasilar fine,

end-inspiratory crackles • Cor pulmonale and respiratory failure• Those who smoke or have a history of

smoking, Malignant mesotheliomas may also occur.

• These are rare cancers of the pleura or peritoneum

Diagnosis • History taking type of exposure duration

ventilation of the work place • Physical examination • Lungs functions tests • Chest X-ray (small round opaque area)• CT scan• Bronchoscopy to test the types of particles and

also called bronchoalveolar lavage• Lungs biopsy to determine the type of lungs

diseaes

Medical Management

• Management is directed at controlling infection and treating the lung disease.

• When oxygen– carbon dioxide exchange becomes severely impaired, continuous oxygen therapy may help improve activity tolerance.

• The patient must be instructed to avoid additional exposure to asbestos and to stop smoking.

Medical Management

• Corticosteroid without oxygen • Advice to quit smoking • Dust control regulations • Worker should go for regular check up• The worker should provide the protective

environment• Lobectomy surgical management

Nursing Management

Nursing assessment : - Breath sounds, breathing pattern and respiratory

status.- Pain or discomfort while breathing.- Sputum – color, viscosity, amount, signs of blood.- Fatigue, weakness, anorexia, weight loss, night sweats,- Low grade fever.- Cough and chest pain.

Contd….

Nursing diagnosis: Ineffective airway clearance related to pain with coughing , inability to cough, abnormal respirations

CONTD….

Nursing Intervention - Assess cough, sputum ( color,

consistency, amt, presence of blood)- Encourage fluids (3-4lday)- Humidify inspired air.- Semi-fowler’s position- Postural drainage.

CONTD…

Nursing Diagnosis: Pain r/t chest expansion secondary to lung infection/inflammation

Nursing Intervention:- Assess pain level - Evaluate effectiveness of pain relief measures

- Instruct use of splinting techniques - Administer analgesics as ordered

.

Nursing Diagnosis: Activity intolerance r/t general weakness, respiratory difficulty, fever, severity of illness

- Encourage rest periods.- Prioritize necessary tasks.- Assist with activities as needed.- Keep equipments close by.- Encourage active ROM exercises 3 times a day.

General considiration• Requires close monitoring because the condition

could quickly change to a life threatening situation• Frequent assessment of the patient’s status is

necessary to evaluate the effectiveness of treatment.• Implementing the medical plan of care, the nurse

considers other needs of the patient positioning is important.

Contd…

• Turn the patient frequently to improve ventilation and perfusion in the lungs and enhance secretion drainage.

• Closely monitor the patient for deterioration in oxygenation with changes in position.

• The patient is extremely anxious and agitated because of the increasing hypoxemia and dyspnea.

CONTD• Eye care is important as well because the patient

cannot blink, increasing the risk of corneal abrasions.

• Neuromuscular blockers predispose patients to the development of deep venous thrombi, muscle atrophy, and skin breakdown

• Nursing assessment is essential to minimize the complications related to neuromuscular blockade.

TEACHING ABOUT PREVENTION• The occupational health nurse serves as an

employee advocate, making every effort to promote measures to reduce the exposure of workers to industrial products.

• Dust control includes ventilation, spraying an area with water to control dust, and effective and frequent floor cleaning.

• Air samples need to be monitored.

• Toxic substances should be enclosed and placed in restricted areas.

• Workers must wear or use protective devices (facemasks, hoods, industrial respirators) to provide a safe air supply when a toxic element is present.

• Employees who are at risk should be carefully screened and followed.

Contd…

• Asbestos and toxic dusts and substances may be transferred to others through the handling of clothing or shoes that have been exposed.

• The Right to Know law stipulates that employees must be informed about all hazardous and toxic substances in the workplace.

• Specifically, they must be educated about any hazardous or toxic substances they work with, what effects these substances can have on their health, and the measures they can take to protect themselves.

Contd…

Prognosis• The outlook for this disease depends on the specific type of

pneumoconiosis, the length of exposure to mineral dust, the level of exposure and whether the patient is a smoker.

• In the long term, people with asbestosis and talc pneumoconiosis have an increased risk of lung cancer and malignant mesothelioma (cancer of the membranes lining the lungs and abdominal cavity). The risk of lung cancer is especially high in smokers with asbestosis.

• Because male workers fill most of the jobs that carry high risks of pneumoconiosis, the majority of deaths from pneumoconiosis occur in men.

Complication

• Silicosis: tuberculosis in 25% patient, massive pulmonary fibrosis, autoimmune disease like rheumatic arthritis and scleroderma, lung cancer

• Coal worker’s: pulmonary fibrosis, digestive system cancer

• Asbestosis: massive pulmonary fibrosis, lungs cancer, cancer of the peritonieum

Thank you