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Chemical Worker's Lung Clinical Presentation

  • Author: Shakeel Amanullah, MD; Chief Editor: Ryland P Byrd, Jr, MD  more...
 
Updated: Jan 14, 2015
 

History

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.

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Physical

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.

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Causes

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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Contributor Information and Disclosures
Author

Shakeel Amanullah, MD Consulting Physician, Pulmonary, Critical Care, and Sleep Medicine, Lancaster General Hospital

Shakeel Amanullah, MD is a member of the following medical societies: American College of Chest Physicians

Disclosure: Nothing to disclose.

Coauthor(s)

Klaus-Dieter Lessnau, MD, FCCP Clinical Associate Professor of Medicine, New York University School of Medicine; Medical Director, Pulmonary Physiology Laboratory; Director of Research in Pulmonary Medicine, Department of Medicine, Section of Pulmonary Medicine, Lenox Hill Hospital

Klaus-Dieter Lessnau, MD, FCCP is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Medical Association, American Thoracic Society, Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Ryland P Byrd, Jr, MD Professor of Medicine, Division of Pulmonary Disease and Critical Care Medicine, James H Quillen College of Medicine, East Tennessee State University

Ryland P Byrd, Jr, MD is a member of the following medical societies: American College of Chest Physicians, American Thoracic Society

Disclosure: Nothing to disclose.

Additional Contributors

Sat Sharma, MD, FRCPC Professor and Head, Division of Pulmonary Medicine, Department of Internal Medicine, University of Manitoba; Site Director, Respiratory Medicine, St Boniface General Hospital

Sat Sharma, MD, FRCPC is a member of the following medical societies: American Academy of Sleep Medicine, American College of Chest Physicians, American College of Physicians-American Society of Internal Medicine, American Thoracic Society, Canadian Medical Association, Royal College of Physicians and Surgeons of Canada, Royal Society of Medicine, Society of Critical Care Medicine, World Medical Association

Disclosure: Nothing to disclose.

Acknowledgements

Gilbert E D'Alonzo Jr, DO Director of New Drug Development Center, Fellowship Director, Professor, Department of Medicine, Division of Pulmonary Diseases, Temple University School of Medicine

Disclosure: Nothing to disclose.

References
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