What is pneumoconiosis?
A common dust disease in countries that have or have had underground coal mines. It resluts from inhalation of coal dust particles over 15-20 years. These particles are ingested by macrophages, which die and release enzymes, leading to pulmonary fibrosis
What are the main causes of pneumoconiosis?
- Coal
- Silica
- Beryllium
What is silicosis?
Restrictive lung disease caused by inhalation of silica particles, which are very fibrogenic
What jobs may be associated with the development of silicosis?
- Metal mining
- Stone quarrying
- Snadblasting
- Pottery/ceramic manufacture
What are features of pneumoconiosis?
Often asymptomatic
- Dyspnoea
- Cough
- Chest tightness/wheezing
- Clubbing
What respiratory problem commonly co-exists with pneumoconiosis?
Bronchitis
How might you investigate someone with suspected pneumoconiosis?
- PFTs
- CXR/CT
What might you see on CXR in someone with pneumoconiosis?
Many round opacities, especially in the upper zones
How would you manage pneumoconiosis?
- Avoid dust exposure
- Stop smoking
- Treat co-exisitng bronchitis
- Consider pulmonary rehab
- Consider supplemental oxygen therapy
Can those with pneumoconiosis claim compensation?
Yes (industrial injuries act)
What are clinical featurs of silicosis?
Progressive dyspnoea
What respiratory infection is found more commonly in those with silicosis?
TB
What might you find on CXR in someone with silicosis?
- Diffuse miliary or nodular pattern in upper and mid-zones
- Egg shell calcificaiton of hilar nodes
What is caplan’s syndrome?
A combination of rheumatoid arthritis (RA) and pneumoconiosis that manifests as intrapulmonary nodules, which appear homogenous and well-defined on chest X-ray
What spirometric defect will someone with silicosis have?
Restrictive
How would you manage someone with silicosis?
- Avoid silica
- Stop smoking
- Manage complications - O2 requirement etc.
Can those with silicosis claim compensation?
Yes (Industrial injuries act)
What can coal worker’s pneumoconiosis progress to?
Progressive massive fibrosis - causes progressive dyspnoea, fibrosis and cor pulmonale
What is asbestosis?
Asbestosis is diffuse interstitial fibrosis of the lung as a consequence of exposure to asbestos fibres
What are the main abnormalities caused by asbestos inhalation?
- Plaques
- Diffuse pleural thickening
- Benign pleural effusions
- ROunded atelectasis
What are the main forms of asbestos?
- Chrocidolite
- Amosite
- Chrysilate
What is the most fibrogenic asbestos fibre type?
Chrocidolite
What is the least fibrogenic asbestos fibre type?
Chyrsolite
What is the most common asbestos fibre?
Chrysolite
What are features of asbestosis?
- Progressive Dyspnoea
- Cough
- Clubbing
- Fine end inspiratory crackles
What investigations would you consider doing in someone with suspected asbestosis?
- CXR
- PFTs
- HRCT
- BA Lavage/biopsy
What might you see on CXR in someone with asbestosis?
- Lower zone linear interstitial fibrosis -> spreads to entire lung
- Pleural thickening
- Plaques
How would you manage someone with asbestosis?
- Stop smoking
- Consider pulmonary rehab and oxygen therapy
- Consider lung transplant
Are those with asbestosis eligible to claim compensation?
Often able to - Industrial injuries act
What is mesothelioma?
Malignant mesothelioma is an aggressive epithelial neoplasm arising from the lining of the lung, abdomen, pericardium, or tunica vaginalis.
It is one of the few cancers related directly to an environmental exposure; asbestos is the chief causative agent.
What are clinical features of malignant mesothelioma?
- Chest pain
- Dyspnoea
- Weight loss
- Cough
- Finger clubbing
- Recurrent pleural effusion
- Signs of mets - Lymphadenopathy, Hepatomegaly, bone pain, abdo pain/obstruction
Is compensation available for those with mesothelioma?
Often yes - Industrial injuries act
What investigations would you consider doing in someone with suspected mesothelioma?
- Bloods - FBCs, U+E’s, LFTs
- Imaging - CXR, CT scan, PET scan
- Specific - thoracocentesis, pleural biopsy, PFTs
How can pathological confirmation of mesothelioma be obtained?
- Thoracocentesis
- Pleural biopsy
What might you see on CXR in someone with mesothelioma?
- Unilateral pleural effusion
- Irregular pleural thickening
- Reduced lung volumes
- Parenchymal changes related to asbestos exposure (e.g., lower zone linear interstitial fibrosis)
How is diagnosis of mesothelioma made?
Thoracoscopy specimen on histology
How would you manage someone mesothelioma?
- Consider if operable
- Pemetrexed and cisplatin
- Palliative procedures - Pleurodesis, indwelling drains, radiotherapy
What is the prognosis of mesothelioma?
Very poor - Overall, the median survival is 10 to 15 months