The Pneumoconioses

1
The Pneumoconioses

• Lung Diseases Caused by the Inhalation of Organic
  Dusts

2
Patient History

• You must know the following regarding any patient
  with a possible pneumoconiosis
• Duration of exposure
• Intensity of exposure
• Where employed
• Other related pulmonary history

3
Coal Workers Pneumoconiosis

• Common name--Black Lung
• Cause--inhalation of coal(Carbon) dust
• Pathology--repeated inhalation causes mucociliary
  escalator to fail--dust bypasses conduction
  airways and enters gas exchange
  airways--macrophages cannot digest coal dust,
  hence, macrophages die---and chronic inflammatory
  reaction of a-c membrane occurs

4
CWP--result of chronic inflammation of a-c
membrane

• Deposition of protein at site of reaction
• This causes what is known as interstitial
  fibrosis
• CWP is usually seen in apical portions of the
  lung
• Many of these patients also have TB
• This disease is NOT treatable...but is preventable

5
CWP

• Nodule and macule formation seen on radiograph as
  well as interstitial fibrosis
• Early, this lung disease appears as COPD
• Palliative treatment w/supplemental O2
• Bronchodilators and steroid therapy are often
  used as well to promote reversal of airways
  restriction and bronchial hygiene

6
CWP--who gets it

• Underground miners
• Families of miners when exposed to their
  dust-filled clothing

7
Silicosis

• Inhalation of silicon dioxide or free silica
• Etiology is similar to CWP with interstitial
  fibrosis formation
• Usually affects apical lung zones
• After exposure, the reactive process in the lung
  will continue for as long as six months after
  stopping exposure

8
Silicosis

• Is not treatable
• BUT, IT IS PREVENTABLE

9
Silicosis--who gets it

• Sandblasters
• Coal miners
• Chippers and caulkers in shipyards
• Foundry workers using sand castings

10
Asbestosis

• Fibers are needle-like in their appearance
• Once inhaled, macrophages cannot digest
• Inflammatory reaction at a-c membrane
• Interstitial fibrosis develops
• Commonly seen in the basilar lung zones
• These particles can break through alveolar
  membrane and be carried to all other organ
  systems, including pleural space

11
Asbestosis--who gets it

• Combined w/smoking--pleural mesothelioma
• Brake shoe workers
• Auto mechanics
• Asbestos miners
• Asbestos workers

12
Byssinosis

• Etiology is the inhalation of cotton dust
• Common name-- Brown Lung
• Commonly affects upper and middle lung zones
• These patients have decreased FEV1s on Monday
  mornings
• Pathology similar to the other pneumoconioses

13
Typical Evaluative Studies of Pneumoconises

• Progressively decreasing PO2s and Sats
• PFTs demonstrate restrictive airways disease
• Decreases in RV, FRC and TLC
• Decreases in expiratory flow rates due to
  decreased lung volumes and not necessarily
  airways obstruction

14
Typical Evaluative Studies of Pneumoconises

• Many of these patients have COR PULMONALE (R
  heart failure) secondary to increased pulmonary
  vascular resistance

15
Other Pneumoconioses

• Bauxite workers disease (Aluminum ore)
• Talcosis
• Tungsten workers disease
• Carbide workers disease