Internal Medicine

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

1082 Occupational Pulmonary Disease

■Hypersensitivity pneumonitis:

➣goal: prevent chronic fibrotic changes

➣avoidance of further exposure is critical

➣steroids can be helpful

➣cardiopulmonary rehabilitation

➣follow periodically

specific therapy

n/a

follow-up

■Occupational asthma

➣depends on severity

➣typically q 3–6 mo for 2 y after removal from exposure

➣can do impairment rating 2 y after removal from exposure

■Pneumoconioses (asbestosis, silicosis, coal workers):

➣Exam, CXR/CT, PFTs q 6–12 mo

■Hypersensitivity pneumonitis:

➣acute:

follow frequently until symptoms have resolved

➣chronic:

history, physical, PFTs q 3–6 mo

if stable, annually

complications and prognosis

Complications

■Continued exposure leads to progressive impairment

■Pneumoconioses, HP may cause chronic respiratory insufficiency

■Asbestosis associated with mesothelioma and cancer

■Increased risk of tuberculosis with silicosis > CWP

Prognosis

■Occupational asthma

➣variable

➣best prognosis if diagnosis is made early and patient is removed

from exposure

➣poor prognostic factors

long duration of exposure, symptoms

poor FEV

1

development of non-specific bronchial hyperreactivity

■Pneumoconioses (asbestosis, silicosis, coal workers)

➣variable