Chemical Worker's Lung Clinical Presentation
- Author: Shakeel Amanullah, MD; Chief Editor: Ryland P Byrd, Jr, MD more...
Occupational exposure is the most important part of the history.
Initially, a temporal relationship may exist between onset of symptoms and work. Subsequently, patients may have more prolonged symptoms, even in the absence of recent exposure. At times, the exposure is subtle and difficult to elicit, thus requiring particular alertness and environmental investigation on the part of the physician.
The clinical presentation may be acute, subacute, or chronic, depending on the frequency, intensity, and duration of inhalational exposure, and perhaps on host and other factors determining immunopathogenesis. In the acute form, respiratory symptoms may include cough (with or without sputum), dyspnea, wheeze, chest pain, or chest tightness. Constitutional symptoms, such as myalgia, lassitude, and headaches, may also be present. Patients with underlying lung disease tend to present earlier and with the more severe symptoms.
Findings may include wheezing, cyanosis, rales and dullness to percussion in the presence of pleura effusion. Signs of pulmonary arterial hypertension like an elevated jugular venous pressure (JVP), loud P2, pedal edema, and an enlarged liver maybe seen.
The list of chemicals asociated with lung disease continues to increase.
Traditionally the implicated industries included the manufacture polyurethane foam, molding, insulation, synthetic rubber, and packaging materials and include toluene diisocyanate (TDI)[2, 3, 4, 5] and trimellitic anhydride. However, with the development of newer chemical agents and with the novel use of excisting agents the industries being associated with lung disease continue to expand.
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