Internal Medicine

0521779407-16 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:18

1078 Obstructive Sleep Apnea Occupational Pulmonary Disease

complications and prognosis

Complications

■Sleepiness may lead to decreased job performance or reduced qual-

ity of life

■If sleepiness while driving or sleep-related auto accidents present,

check local DMV reporting requirements

■Cardiovascular risk subject of ongoing study

■W/o treatment, excess risk of MI or CVA may approach 5–10% over

6–8 y

Prognosis

■Prognosis excellent, particularly for pts compliant on CPAP, & those

w/ curative surgery

OCCUPATIONAL PULMONARY DISEASE

STEPHEN F. WINTERMEYER, MD, MPH

history & physical

■Focused history critical

■Ask what patients do at work and what materials they handle

History

■Occupational asthma (OA):

➣>250 known causative agents

➣common: isocyanates, latex, western red cedar

➣low chronic exposure leads to gradual (latent) sensitization

➣heavy acute exposure leads to immediate symptoms (reactive

airways dysfunction syndrome/RADS)

■Pneumoconioses (“dusty lungs”):

➣Asbestosis:

pipe fitters, plumbers, ship builders

latency: >15 y

➣Silicosis:

sand blasters, highway workers

latency: variable, typically >10 y

➣Coal workers pneumoconiosis (CWP, black lung):

coal workers, graphite workers

latency: variable