Occupational Lung Disease
Pulmonary Disease From Environmental Exposure to Toxic Substances
Feb 22, 2009
Of all the different types of work-related illness or injury, occupational lung disease comprises a large proportion of such cases. This type of pulmonary disease occurs as a result of environmental exposure to toxic substances. It can have a major impact on certain workers and the healthcare costs required to manage this condition.
Causes and Pathophysiology
Occupational lung disease has a variety of causes and encompasses specific clinical entities according to the causative factor. Examples include, but are not limited to, the following:
- Coal Worker's Pneumoconiosis: Also known as black lung disease, coal worker's pneumoconiosis is caused by inhaling coal dust. Particles of carbon are embedded within interstitial lung tissue, causing scarring (fibrosis).
- Silicosis: Silicosis is lung disease that occurs due to silicate crystals. This is often seen in individuals who work in places such as quarries, mines, and glass factories.
- Berylliosis: Exposure to the metal beryllium results in berylliosis. Industrial settings that increase the risk of berylliosis include the mining and processing of beryllium and the manufacturing of computers, electronics, automobiles, aircraft, and nuclear weapons.
- Byssiniosis: Byssiniosis, also called brown lung disease, is due to inhalation of dust from cotton, hemp, or flax. This type of occupational lung disease primarily involves constriction of the airways (bronchoconstriction).
- Asbestosis: Asbestosis is lung disease caused by the microscopic fibers of asbestos. Typically, this affects the pleura and may lead to a malignant cancer called mesothelioma.
Occupational lung disease can involve fibrosis, inflammation, and/or cancer of the lung. Any portion of the lung, whether it is the airway, interstitial tissue, and/or pleural membrane, can be affected.
Clinical Manifestations and Diagnosis
The symptoms and signs of occupational lung disease can vary depending on the causative agent and the severity of disease. Byssiniosis, for example, is characterized by difficult breathing (dyspnea) that occurs immediately after exposure and fades with time. Coughing may accompany dyspnea with asbestosis or berylliosis. In some cases, patients may have no symptoms or have dyspnea progress over many years, as with coal worker's pneumoconiosis and silicosis.
In general, the diagnosis of a specific occupational lung disease requires a relevant occupational history and a x-ray or computed tomography (CT) scan of the chest that demonstrates lung disease. Usually, abnormalities on chest imaging appear throughout the lungs and cannot pinpoint the specific occupational lung disease without the context from the patient history.
Treatment and Prevention
The treatment of occupational lung disease depends on the degree of lung damage and the clinical presentation. It may entail supplemental oxygen to correct low blood oxygen, pulmonary rehabilitation to retrain the muscles of breathing, corticosteroids to suppress lung inflammation, and/or lung transplantation to replace a severely diseased lung.
Prevention can help to a certain extent. Patients should take any possible measures, such as using respiratory masks, to minimize his or her exposure to the offending agent. On a public health level, workplace safety regulations that regulate toxic substances should be enforced. Each method alone may not dramatically reduce occupational lung disease but can have a potential benefit when used in conjunction with all other means of prevention.
References
- American Lung Association - Occupational Lung Disease Fact Sheet
- Merck Manual - Environmental Pulmonary Diseases
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