[03.10] CMD - Occupational & Environmental Disease V2.1.pdf

5 to 7 percent

What is the estimated percentage of global fatalities attributable to work-related illnesses and occupational injuries?

2.3 million

How many occupationally-related deaths occur each year worldwide?

2.0 million

How many of the annual work-related deaths are specifically attributable to occupational diseases rather than injuries?

Lung cancer, malignant mesothelioma, COPD, asthma, interstitial lung disease ILD, and tuberculosis TB

What are six examples of respiratory morbidity and mortality represented by occupational lung diseases?

6 percent

What is the estimated percentage of lung cancer incidence in developed nations attributable to occupational exposures?

10 percent

What is the estimated percentage of lung cancer incidence in developing nations attributable to occupational exposures?

A condition affecting the lungs that arises as a direct result of workplace exposures

What is the clinical definition of Occupational Lung Disease OLD?

Prevention and workplace safety measures

To what does the specific identification of OLD shift the clinician's and workplace's focus?

Greater than 10 percent

What percentage of chronic lung diseases in adults do occupational exposures cause?

Pneumoconiosis, occupational asthma, hypersensitivity pneumonitis, and occupational lung cancer

What are the four most common categories of occupational lung disease?

Sensitizer-induced, irritant-induced, and work-exacerbated asthma WEA

What are the three subcategories of occupational asthma?

Farmer's lung

What is a classic example of hypersensitivity pneumonitis?

Latency

What key characteristic of OLD refers to the delayed onset where symptoms take decades to develop after initial exposure?

Dose-response relationship

What key characteristic of OLD describes how higher and more prolonged exposure to hazardous substances increases disease risk and severity?

Genetic predispositions, pre-existing lung conditions, smoking habits, and overall health status

What four host factors can modify an individual's susceptibility to workplace exposures?

Trachea, lower bronchi, and lung parenchyma

In which three respiratory regions do smaller particles deposit more readily as shown in the particle size graph?

Respirable fraction

What is the term for the portion of airborne particles that can penetrate into the deepest gas-exchange regions of the lungs?

0.5 to 6.0 microns

What is the size range of respirable particles that permits deposition in the lung parenchyma and causes pneumoconiosis?

0.5 to 2.5 microns

What particle size range is most likely to be deposited in the alveoli?

Inertial impaction, electrostatic deposition, sedimentation, and diffusion

What are the four methods of particle deposition in the airways?

Physical, chemical, and host factors

What are the three main categories of factors that influence the effects of inhaled particles?

Crystalline silica, silicates, talc, kaolin, diatomaceous earth, mica, and mixed dusts

What are seven examples of non-fibrous inorganic mineral dusts?

Asbestos and mineral fibers

What are two examples of fibrous inorganic mineral dusts?

Coal and graphite

What are two carbonaceous inorganic mineral dusts?

Beryllium, tin, cobalt, indium, and barium

What are five metals associated with occupational interstitial lung disease?

PVC fumes, paraquat, and diisocyanates

What are three toxic and inflammatory chemical agents associated with occupational lung injury?

Fungi, bacteria, plant and animal proteins

What are three examples of organic dusts associated with occupational lung disease?

Zenker in 1866

Who coined the term pneumoconiosis and in what year?

Pneuma meaning air, wind, or lung, and Konis meaning dust

What are the Greek origins and meanings of the word pneumoconiosis?

Proust in 1874

Who defined pneumoconiosis as dusty lungs and in what year?

The accumulation of dust in the lungs and the tissue reactions to its presence

What is the ILO definition of pneumoconiosis?

An aerosol composed of solid inanimate particles

How is dust defined under the ILO framework?

Asthma, bronchitis, and emphysema

What three obstructive airway diseases are excluded from the definition of pneumoconiosis?

Fibrosis and inflammation

What are the two pathological features of pneumoconiosis with the former predominating?

527,500 cases

What was the global prevalence of pneumoconiosis in 2021?

62,866.45 cases

What was the number of global incident cases of pneumoconiosis in 2021?

21,000 deaths

Approximately how many deaths are caused by pneumoconiosis globally each year?

18,322.53 deaths

What was the global mortality count from pneumoconiosis in the year 2021?

Silica, asbestos, coal mine dust, beryllium, and hard metal

What are five common mineral and metal exposures associated with pneumoconiosis?

Construction

Which Philippine industry has the highest number of at-risk workers at 138,704?

Mining and Quarrying

Which Philippine industry has 26,834 at-risk workers?

Cement, concrete products, and articles of concrete

Which Philippine manufacturing sub-sector contains 10,563 at-risk workers?

Ingestion and deposition of the particle

With what initial cellular events does the pathogenesis of pneumoconiosis start?

Macrophages

What primary cellular defense of the lung is activated and injured by toxic inhaled dust particles?

Mitochondrial damage, reactive oxygen species ROS production, and DNA damage

What three intracellular events are caused by particles in macrophages?

Myofibroblast to fibroblast proliferation and fibrotic response

What is the downstream effect of epithelial cell injury and the release of cytokines and growth factors?

Occupational history, objective radiographic evidence, pulmonary function, and exclusion of alternative diagnoses

On which four clinical pillars is the diagnosis of occupational ILD typically based?

Medical history, physical examination, chest X-ray, chest CT scan, and pulmonary function test

What are the five steps in the recommended evaluation for pneumoconiosis?

Dyspnea, decreased exercise tolerance, and non-productive cough

What are the three main clinical presentations of symptomatic pneumoconiosis?

Tachypnea and end-inspiratory crackles

What are two physical exam findings in advanced stages of pneumoconiosis?

Chest X-ray

What is the initial imaging test of choice for evaluating pneumoconiosis?

Chest CT scan

With what imaging modality should abnormal chest X-ray findings of pneumoconiosis be confirmed?

Size, shape, and number of opacities

On what three parameters does the International Labour Organization ILO classification of radiographs rate changes?

Compare patient films with standard reference films

What is the method used in the ILO classification to reduce observer differences?

Decreased forced vital capacity FVC and decreased total lung capacity TLC

What are the typical spirometric and lung volume findings in a restrictive pattern from pneumoconiosis?

Decreased DLCO diffusing capacity of carbon monoxide and hypoxemia

What gas exchange abnormalities are seen in severe pneumoconiosis?

Crystalline silica, most commonly quartz

What specific inhaled agent causes silicosis?

5 million cases

What is the WHO estimate of silicosis cases worldwide?

Silex, meaning flint

What is the Latin origin and meaning of the term silicosis?

Bernardino Ramazzini in 1705

Who first described silicosis, noting that stonecutters' lungs contained heaps of sand, and in what year?

Silicon Si and Oxygen O2, forming SiO2

What is the chemical composition and formula of silica?

25 percent

What percentage of the Earth's crust is made up of silica?

Quartz, cristobalite, tridymite, coesite, stishovite, melanphlogite, and moganite

What are the seven forms of crystalline silica?

Quartz

What is the most common form of crystalline silica?

Diatomaceous earth, vitreous silica, and volcanic glass

What are three amorphous forms of non-crystalline silica?

Stone countertop fabrication, mining, concrete work, sandblasting, quarrying, glass cutting, fracking, dental polishing, and foundry work

What are nine occupational settings associated with respirable crystalline silica exposure?

Polarized light microscopy

What microscopic technique is used to visualize silica quartz crystals in lung tissue?

Less than 1 cm, typically 2 to 4 mm

What is the diameter size of silica crystals seen in lung tissue under polarized light?

Concentrically arranged collagen forming a whorled appearance with peripheral mononuclear cells and fibroblasts

What is the histologic description of a pathognomonic silicotic nodule?

History of silica exposure, chest radiographs showing small opacities, and no other mimicking illness

What three elements are required for a diagnosis of silicosis?

Chronic or simple, accelerated, and acute silicosis

What are the three clinical classifications of silicosis?

Long-term, typically greater than 10 years, to low concentrations of silica

What exposure duration and intensity define chronic or simple silicosis?

Small rounded opacities with an upper lobe predominance and calcified hilar/mediastinal lymph nodes

What are the radiographic features of simple chronic silicosis?

Cough and mild breathlessness, though many patients are asymptomatic

What are the common clinical symptoms of chronic simple silicosis?

5 to 10 years of higher concentration silica exposure

What exposure history is associated with accelerated silicosis?

Progressive Massive Fibrosis PMF

To what severe radiological and clinical entity may accelerated silicosis progress?

High concentrations over weeks to a few years

What exposure profile causes acute silicosis?

Diffuse airspace consolidation radiologically resembling pulmonary edema

What is the radiographic feature of acute silicosis?

Silicoproteinosis

What is the alternative clinical term for acute silicosis?

Pulmonary alveolar proteinosis

What non-occupational disease does acute silicosis radiologically and histologically resemble?

Crazy paving pattern representing ground-glass attenuation with fine intralobular reticulation

What CT chest finding is characteristic of acute silicosis?

Uniform in size, fairly well marginated, 1 to 8 mm in diameter, with an upper lobe predominance

What are the size, border, and location features of nodules in simple silicosis?

Eggshell calcification

What pattern of lymph node calcification is common and suggestive of chronic silicosis?

Coalescence of small nodules forming large opacities greater than 10 mm

What radiographic change marks the progression from simple to complicated silicosis?

Posterior upper lobes bilaterally

Where are the large opacities of complicated silicosis typically located?

Volume loss with elevated hila

What secondary radiographic finding is noted with complicated silicosis?

Mixed obstructive and restrictive pattern with a reduced DLCO

What pulmonary function test findings characterize advanced silicosis?

Chronic bronchitis, emphysema, mineral dust airways disease, lung cancer, renal disease, and autoimmune diseases

What are six non-pneumoconiotic diseases associated with respirable crystalline silica exposure?

Tuberculosis TB

Silicosis increases the risk of which infectious disease by up to 20-fold?

TST greater than or equal to 10 mm

At what tuberculin skin test TST threshold is chemoprophylaxis indicated for silicotic patients after ruling out active TB?

Isoniazid for 6 to 12 months, Rifampicin for 4 months, or Isoniazid plus Rifampicin for 3 months

What are the three chemoprophylaxis regimens for silico-tuberculosis?

Smoking

What habit potentiates the obstructive effect of silica dust and increases COPD mortality?

Systemic lupus erythematosus, systemic sclerosis, and rheumatoid arthritis

What three systemic autoimmune diseases are epidemiologically linked to crystalline silica exposure?

CXR at baseline, after 2 to 3 years, and then every 2 to 5 years

What is the recommended screening schedule for chest X-rays in silica-exposed workers?

Spirometry and symptom questionnaire

What two tests should be performed annually as part of health surveillance for silica-exposed workers?

Lifelong

How long must health surveillance continue for workers exposed to silica?

No specific treatment exists, making prevention of exposure key

What is the definitive medical treatment for silicosis?

Six naturally occurring fibrous silicate minerals

What is asbestos?

Asbesta, meaning unquenchable

What is the Greek origin and meaning of the term asbestos?

Length greater than 5 microns and a length to width ratio of 3:1

What physical dimensions define an asbestos fiber?