Internal Medicine

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

1080 Occupational Pulmonary Disease

■Pneumoconioses

➣Bronchoscopy, BAL/Bx usually not necessary

➣Asbestosis:

CXR: increased basilar interstitial markings

International Labor Office (ILO) classification used to grade

pleural plaques are marker of exposure

chest CT: similar findings with increased sensitivity

■PFTs: decreased FVC, TLC, DLCO (comorbid conditions may com-

plicate interpretation)

➣Silicosis:

CXR: upper lung nodules, egg shell calcification of hilar nodes

(ILO classification)

chest CT: similar findings with increased sensitivity

PFTs: decreased FEV 1 ,FEV 1 /FVC; possibly reduced FVC, TLC,

DLCO

➣Coal workers pneumoconiosis:

CXR: increased interstitial markings (ILO classification)

PFTs: decreased DLCO, FVC

➣Hypersensitivity pneumonitis:

CXR:

acute HP-infiltrate

chronic HP-increased interstitial markings, fibrosis

PFTs: chronic HP-decreased DLCO

Bronchoscopy/BAL/biopsy: increased CD8+lymphocytes,

granulomas

differential diagnosis

■Occupational Asthma

➣nonoccupational asthma

➣work-aggravated asthma (asthma exacerbated by exposures at

work but not caused by exposures at work)

➣bronchitis

➣emphysema

➣vocal cord dysfunction

➣cardiac disease

■Pneumoconioses

➣other pneumoconioses

➣hypersensitivity pneumonitis

➣other interstitial lung diseases

■Hypersensitivity pneumonitis