Breathing Diseases

Occupational lung and respiratory diseases are among the leading causes of work-related health problems in the United States. Inhalation of toxic agents and improper ventilation conditions are the major risk factors.

Coughing, shortness of breath, wheezing, chest pain or tightness, and abnormal breathing patterns are the most common symptoms of lung and respiratory diseases and can occur after repeated and long-term exposures to irritants and/or sensitizers on the job. Contrary to a popular misconception, coal miners are not the only ones at risk for occupational lung disease or disease of the respiratory tract. Working in a car garage, for example, or in a textile or electronics factory can result in exposure to hazardous substances or agents that may lead to a lifetime of respiratory and lung problems if not properly diagnosed and treated.

RISK FACTORS

Certain occupations, because of the nature of their location, the kind of work, or the environment are more at risk for occupational lung and respiratory diseases than others. The major causal factors include the inhalation of irritant chemical vapors and gases, organic and inorganic dusts, sensitizing agents and toxic fumes which adversely affect both the upper and lower respiratory tracts. Workers who smoke are at greater risk for certain types of lung disease if they are exposed to irritants in the workplace. Poor ventilation, closed-in working areas, or lack of proper respiratory protection can increase the probability of illness. “Some agents,” says Dr. Christine Oliver, Pulmonary and Critical Care Medicine, Department of Medicine at the Massachusetts General Hospital, Boston, “can cause upper respiratory tract irritation resulting in irritation of the nose and/or throat with cold-like symptoms, such as a runny nose and scratchy throat. Viral infections and allergies produce similar manifestations, but you should become suspicious of a work-related illness if problems occur at work or are worse at work”. Asthma, allergies, bronchitis, persistent cough producing mucus or sputum, as well as more serious conditions such such as pulmonary fibrosis, chronic obstructive pulmonary disease, emphysema and lung cancers are principal lung and breathing diseases.

DIAGNOSIS

Because respiratory symptoms caused by toxic exposure are nonspecific, recognizing their potential relationship to a toxic agent is essential to proper diagnosis and treatment. Factors affecting treatment may be determined on the basis of the age of the patient, overall health, extent of the disease, tolerance for specific medications or therapies, and expectations for the course of the disease. “Eliciting the occupational history is the most important step to determine the nature and the severity of the occupational respiratory disease,” adds Dr. Oliver. “Specific information about the type, level, duration of exposure is needed. This information must be complemented by additional diagnostic tests, such as chest radiography or tomography, pulmonary function tests (measurements of gas ex-change in the lung and airways or bronchial hyperreactivity), and other laboratory and microscopic examinations of lung ttissue, pleural fluid, and lung lavage.”

PREVENTION

Occupational lung and respiratory diseases will progress in the face of continuing exposure and often even after exposure ceases. Thus, prevention of exposure is key to reducing morbidity and/or mortality. “It is mandatory,” says the specialist, “to abstain from habits, such as smoking, that are inherently toxic to the lungs and exacerbate respiratory effects of workplace and environmental exposure. But it is also necessary to take active steps to reduce workplace exposure to toxic agents.” The National Heart, Lung and Blood Institute recommends taking further preventive measures, including the use of proper protective devices, such as facial masks or respirators, when around airborne irritants and dusts, the substitution of somewhat toxic with nontoxic substances, factory engineering changes to improve ventilation in the workplace, and adoption of wet-down procedures to reduce dust levels. “If these measures are not effective or if the exposure is to a substance to which the person may be sensitized,” concludes Dr Oliver, “removal from the worksite is the only therapeutic option to avoid serious damage to the respiratory tract.”

[W  bidmc.org  nhlbi.nih.gov]

Published in the hard-copy of Work Style Magazine, Fall 2013