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Tables
Environmental
and Occupational Lung Diseases
Gary R. Epler, M.D.
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Table 1. CLASSIFICATION
OF THE OCCUPATIONAL LUNG DISORDERS
| General Agent |
Examples |
Disorder |
| Mineral dusts
|
Asbestos
Silica
coal
|
Pneumoconiosis
|
| Metal dusts
|
Iron
Tin
Barium
Vanadium
Cadmium
Nickel
Chromic salts
Platinum salts
Cobalt
Cobalt
Beryllium
|
"Inert
dust" pneumoconiosis
"Inert dust" pneumoconiosis
"Inert dust" pneumoconiosis
Irritant bronchitis
Bronchitis, pneumoconiosis
Asthma
Asthma
Asthma
Asthma, Giant cell pneumonitis
Granulomatous pneumonitis
|
| Biological
dusts |
Spores
Mycelia
Bird droppings
|
Hypersensitivity
pneumonitis
Hypersensitivity pneumonitis
Hypersensitivity pneumonitis |
| Manufactured
fibers |
Mineral wool
Glass fiber
Ceramic fiber
|
Irritant effects
Irritant effects
Irritant effects |
| Toxic fumes
|
NO2
SO2
Chlorine
Ammonia
|
Airways inflammation,
ARDS
ARDS, bronchiolitis abliterans
Airways inflammation
Airways inflammation
|
| Asthmatic
agents |
|
|
| High molecular
weight |
Flour
Dander
|
Asthma
Asthma |
| Low molecular
weight |
Isocyanates
Epoxy resins |
Biphasic asthma
Asthma |
| lnfections
|
Viral
Bacterial
Fungal
|
Specific infection
Specific infection
Specific infection |
| Carcinogens
|
Asbestos
Arsenic
Chromium
Coke oven fumes
Nickel
Halo ethers
Radon prodigy
|
Lung cancer
and mesothelioma
Lung cancer - copper smelting
Lung cancer - smelting process
Lung cancer - steel making
Lung cancer - smelting processing
Lung cancer - engineered out the process
Lung cancer - uranium mining |
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Table 2. Guidelines
for the Diagnosis of an Occupational Lung Disorder
Exposure to an
agent known to cause an occupation disorder
Appropriate latency from exposure to onset of symptoms
Syndrome consistent with the known exposure-related disorder
No other more likely explanation of the signs and symptoms
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Table 3. Pulmonary
Symptom Questions
Degree of dyspnea
(1-4), how long?
Walking up a slight hill
Walk slower on level ground than peers of the same age
While talking or dressing
Stop after 100 yards
Amount of cough,
how long?
Daily cough
Morning cough throughout the day
Four to six times/day, 4 or more days/week
Cough, 3 consecutive months or more
Sputum or phlegm
production, how long?
Phlegm from the chest
Morning phlegm or throughout the day
Two times/day, 4 or more days/week
Phlegm, 3 consecutive months or more
Wheezing, how long?
With colds
Occasionally apart from colds
Most days or nights
Wheezing associated with dyspnea
Related to the workplace
Hemoptysis
Blood-streaked sputum
Bright red blood-clots
Cigarette smoking
Age started
Packs per day
Age stopped
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Table 4. Pulmonary
Occupational Exposure Questions
Year and place
of birth
Summer jobs
Military service-branch of jobs
First job-title and description
Subsequent jobs
Spouse and children jobs
Hobbies
Home environment
If hazardous exposure elicited
Type of exposure
Year first exposed
Level of exposure
Total years exposed
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Table 5. Chest Physical
Examination
Respiratory distress
at rest
Finger clubbing or cyanosis
Lymphadenopathy
Chest excursion
Intensity of breath sounds
Early inspiratory crackles
Late inspiratory crackles
Wheezing
Cardiac examination
Liver or spleen enlargement
Pedal edema
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Table 6. Chest Radiographs
and Imaging Studies
For the airflow
disorders
Hyperinflation
Flat hemidiaphragms
Retrosternal airspace
Bullous lesions
For the interstitial
disorders
Lung volumes
Type of opacities - nodular, linear or reticular-nodular
Location of opacities
Severity of opacities
Honeycombing
Other features
Pleural findings
Eggshell calcification
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Table 7. Pulmonary
Function Testing
Screening studies
FVC-forced vital capacity
FEV1-forced expiratory volume in 1 second
FEV1/FVC -ratio
Dsb-single breath diffusing capacity
Confirmatory studies
TLC - total lung capacity
RV - residual volume
RV/TLC - ratio
Additional studies
Rest and exercise, arterial blood gases
Rest and exercise, oxygen saturation
Specific inhalation challenge study
Methacholine inhalation challenge
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Table 8. Beryllium
Sources of Exposure
Beryllium production
Beryllium extraction process
Beryllium powders
Beryllium uses
Research laboratories
Beryllium copper foundries
Precious metals foundries
Beryllium ceramics
Nuclear plant machine shops
Grinding beryllium products
Welding and laser cutting
Aircraft industries
Dental laboratories
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Table 9. Toxic Fume
Exposure
Nitrogen dioxide
Silo exposures
Nitric acid exposure
Acetylene welding
Explosives
Refueling missiles
Astronauts
Ice hockey
Sulfur dioxide
Pulp/paper industry
Smelting
Mining
Laboratories
Ammonia
Cleaning agents
Chlorine
Swimming pools
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| Table
10. Hypersensitivity Pneumonitis Causative Agents |
| Agents |
Exposures/Diseases |
|
Thermoactinmycetes spores |
Farmers
Humidifiers
Air conditioners
|
Fungi mycella
Altemana
Cephelosporium
Penicillium
Pullularia
Trichosporon |
Moldy wood chips
Stagnant water
Cheese workers
Sequoiosis and saunas
Summer house dust |
|
Animal proteins |
Pigeon and parakeet droppings
Rat urinary proteins |
Insect proteins
|
Moldy grain-millers
|
|
Chemicals |
Humidifier water
Isocyanates-plastics industry |
|
Drugs |
Gold, procarbazine, and amiodarone |
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|
Table 11. OCCUPATIONAL ASTHMA AGENTS |
| High
Molecular Weight Agents |
Animal dander
Birds
Insects
Marine
Flour and grains
Enzymes
Latex |
Farmers
Petshops
Grain workers
Oyster workers
Bakers
Detergent workers
Health care providers |
| Low
Molecular Weight Agents |
Anhydrides
Dyes
Isocyanates
Antibiotics
Fluxes
Metals
Wood dust
Formalin
Amines |
Plasters,
epoxy, resins
Cloth dyeing
Polyurethane, auto paint
Pharmacy workers
Electronic workers
Plating, polishing
Carpenters, sawmill workers
Undertakers, hospital staff
Lacquer, solderers |
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Table 12. Pulmonary
Impairment and Disability Evaluation
Degree of dyspnea
Amount of cough and sputum, wheezing
Smoking age started, pack, age stopped
Past pulmonary illnesses
Concurrent medical conditions
Medications
Occupational and environmental exposures
Chest physical examination findings
Chest roentgenogram
Pulmonary function studies
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| Table
13. Rating of Impairment by pulmonary function |
| |
Mild |
Moderate |
Severe |
| FVC1
%Pred |
60-79 |
40-59 |
40 or less
|
|
FEV1, %Prod |
60-79 |
40-59 |
40 or less |
|
FEV1/FVC% |
60-69 |
40-59 |
40 or less |
|
Dsb1 %Pred |
60-79 |
40-59 |
40 or less |
|
EXVO2, mL/kg |
20-24 |
16-19 |
15 or less |
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