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Chemical Worker's Lung Follow-up

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

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.[6] 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.

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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.

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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.

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Complications

Complications may include the following:

  • Pulmonary fibrosis
  • Lung nodules (benign or malignant)
  • Bronchial hyperreactivity
  • Right heart disease (eg, pulmonary hypertension, cor pulmonale)
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Prognosis

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.

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Patient Education

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.

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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.

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