Internal Medicine

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

Occupational Pulmonary Disease 1079

➣Hypersensitivity pneumonitis (HP):

fungi, thermophilic actinomycetes, animal products, certain

chemicals

acute or chronic

Signs & Symptoms

■Occupational asthma:

➣chest tightness, dyspnea, cough, wheezing, prolonged expiration

➣often worse during, after work day; better after days away

■Pneumoconioses:

➣dyspnea, crackles (esp basilar in asbestosis)

■Hypersensitivity pneumonitis:

➣fever, productive cough, dyspnea, rales

tests

Laboratory

Basic Blood Studies

■occupational asthma, pneumocomioses: normal

■hypersensitivity pneumonitis: elevated WBC, ESR, HP antibody

panel (low sensitivity)

Specific Diagnostic Tests

■Occupational asthma:

➣Peak flow (to document temporal relationship to work): cheap,

done by patient

ideally 4 times per day (after waking, noontime, after work,

before bedtime)

do≥2 weeks when working and≥1 week when not working

➣Spirometry

reproducible

gold standard in diagnosing obstruction

➣Challenge testing (aerosol bronchoprovocation)

nonspecific (methacholine or histamine)

safe, done commonly

documents nonspecific bronchial hyperresponsiveness

confirms diagnosis of asthma

following hyperresponsiveness over time can be helpful

specific (the suspected agent)

some regard as gold standard in diagnosing OA

more common in Europe, Canada than in U.S.

more risks than nonspecific bronchoprovocation