Chemical Worker's Lung Follow-up
- Author: Shakeel Amanullah, MD; Chief Editor: Ryland P Byrd, Jr, MD more...
Further Outpatient Care
Industries known to be associated with lung disease should have routine screening of all workers who may become exposed to the offending agent.
This should include repeated questionaires, spirometry, complete pulmonary function tests (PFTs), and, if needed, appropriate imaging studies.
If concerning symptoms or findings are found, referral to a pulmonologist or occupational health physician is recommended.
Complete PFTs should be done at the time of employment, spirometry and complete PFTs during employment, and after termination of employment. This becomes extremely important in patients with pre-existing lung disease.
The authors recommend using lower limit of normal (LLN) criterion, FEV1/FVC less than LLN as determined by NHANES LLN values, to define obstruction rather than a less than 70% predicted criterion. Adopting this strategy may identify earlier progression of lung disease.
The authors also recommend using longitundinal trending changes in FEV1. If a decline in FEV1 greater than 15% is noted from the workers pervious best, this indicates the need for a complete PFT (even if within the normal limits), and a repeat complete PFT be performed in 4-6 weeks. If the results are persistent, then specialist consultation is recommended as objective testing such as high-resolution CT chest may be indicated.
If a workplace lung disease is suggested, the physician should strongly recommend avoidance of further exposure. Use of protective gear may not always prevent exposure; thus, total avoidance of further exposure by alternative employment or change of work responsibilities is recommended.
Further Inpatient Care
Admitted patients may have acute exacerbation of asthmalike symptoms, fever with bilateral infiltrates, or end-stage lung disease. Inpatient management is similar to that of other patients with lung disease.
Inpatient & Outpatient Medications
Steroids, either inhaled or systemic, may be helpful. Supplemental oxygen for 18-24 hours per day increases survival rates in patients with advanced lung disease and a PO2 of less than 60 mm Hg. Bronchodilators are used for patients with respiratory symptoms and airway obstruction.
Complications may include the following:
Lung nodules (benign or malignant)
Right heart disease (eg, pulmonary hypertension, cor pulmonale)
Avoiding exposure to the offending toxin or toxins is essential. A change of occupation may be necessary. The ultimate prognosis is related to the specific exposure.
Advise patients that administration of pneumococcal vaccine (q3-5y) and influenzal vaccines (annually) are indicated with lung disease. For additional information on flavoring substances, see the NIOSH Pocket Guide to Chemical Hazards.
Hart JE, Garshick E, Dockery DW, Smith TJ, Ryan L, Laden F. Long-term ambient multipollutant exposures and mortality. Am J Respir Crit Care Med. 2011 Jan 1. 183(1):73-8. [Medline]. [Full Text].
Bodner KM, Burns CJ, Randolph NM, Salazar EJ. A longitudinal study of respiratory health of toluene diisocyanate production workers. J Occup Environ Med. 2001 Oct. 43(10):890-7. [Medline].
Clark RL, Bugler J, McDermott M, Hill ID, Allport DC, Chamberlain JD. An epidemiology study of lung function changes of toluene diisocyanate foam workers in the United Kingdom. Int Arch Occup Environ Health. 1998 May. 71(3):169-79. [Medline].
Kay S. Toluene diisocyanate and lung function. Food Chem Toxicol. 1985 Mar. 23(3):411-3. [Medline].
McKerrow CB, Davies HJ, Parry Jones A. Symptoms and lung function following acute and chronic exposure to tolylene diisocyanate. Proc R Soc Med. 1970 Apr. 63(4):376-8. [Medline].
Berkow R, Beers MH, Fletcher AJ. Lung and airway disorders. In: The Merck Manual of Medical Information, Home Edition, Section 4, Chapter 39. Merck. Available at http://www.merck.com/mmhe/sec04.html.
Akpinar-Elci M, Kanwal R, Kreiss K. Bronchiolitis obliterans syndrome in popcorn plant workers. Am J Respir Crit Care Med. 2002. 165:A526.
Ali BA, Ahmed HO, Ballal SG, Albar AA. Pulmonary function of workers exposed to ammonia: a study in the Eastern Province of Saudi Arabia. Int J Occup Environ Health. 2001 Jan-Mar. 7(1):19-22. [Medline].
American Lung Association. Fact Sheet: Occupational Lung Disease. September 2000. American Lung Association. Available at http://www.lungusa.org/diseases/occupational_factsheet.html.
Atis S, Tutluoglu B, Levent E, Ozturk C, Tunaci A, Sahin K, et al. The respiratory effects of occupational polypropylene flock exposure. Eur Respir J. 2005 Jan. 25(1):110-7. [Medline].
Barhad B, Pilat L, Teculescu D. Recent progress in the study of occupational lung diseases in Romania. Br J Ind Med. 1975 May. 32(2):164-8. [Medline].
Brooks SM, Lockey JE, Harber P. Occupational Lung Diseases 1. Clin Chest Med. 1981. 2:171-300.
Craighead JE. Enviromental and occupational aspects of pulmonary disease. Saldana MJ, ed. Pathology of Pulmonary Disease. Philadelphia, Pa: Lippincott-Raven; 1994. 883-8.
Hashimoto M, Sato K, Heianna J, Hirano Y, Omachi K, Izumi J. Pulmonary CT findings in acute mercury vapour exposure. Clin Radiol. 2001 Jan. 56(1):17-21. [Medline].
Kreiss K, Gomaa A, Kullman G, Fedan K, Simoes EJ, Enright PL. Clinical bronchiolitis obliterans in workers at a microwave-popcorn plant. N Engl J Med. 2002 Aug 1. 347(5):330-8. [Medline].
Lees PS. Chromium and disease: review of epidemiologic studies with particular reference to etiologic information provided by measures of exposure. Environ Health Perspect. 1991 May. 92:93-104. [Medline].
Lockey J, McKay R, Barth E. Bronchiolitis obliterans in the food flavoring manufacturing industry. Am J Respir Crit Care Med. 2002. 165:A461.
Mikoczy Z, Welinder H, Tinnerberg H, Hagmar L. Cancer incidence and mortality of isocyanate exposed workers from the Swedish polyurethane foam industry: updated findings 1959-98. Occup Environ Med. 2004 May. 61(5):432-7. [Medline].
Olin AC, Alving K, Toren K. Exhaled nitric oxide: relation to sensitization and respiratory symptoms. Clin Exp Allergy. 2004 Feb. 34(2):221-6. [Medline].
Osinubi OY, Gochfeld M, Kipen HM. Health effects of asbestos and nonasbestos fibers. Environ Health Perspect. 2000 Aug. 108 Suppl 4:665-74. [Medline].
Parmet AJ, Von Essen S. Rapidly progressive, fixed airway obstructive disease in popcorn workers: a new occupational pulmonary illness?. J Occup Environ Med. 2002 Mar. 44(3):216-8. [Medline].
Peters JM. Studies of isocyanate toxicity. Proc R Soc Med. 1970 Apr. 63(4):372-5. [Medline].
Weill H. Disaster at Bhopal: the accident, early findings and respiratory health outlook in those injured. Bull Eur Physiopathol Respir. 1987 Nov-Dec. 23(6):587-90. [Medline].
Zock JP, Sunyer J, Kogevinas M, Kromhout H, Burney P, Anto JM. Occupation, chronic bronchitis, and lung function in young adults. An international study. Am J Respir Crit Care Med. 2001 Jun. 163(7):1572-7. [Medline].