Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Tobacco Worker's Lung Clinical Presentation

  • Author: Roger B Olade, MD, MPH; Chief Editor: Ryland P Byrd, Jr, MD  more...
 
Updated: Jun 03, 2014
 

History

A comprehensive history of exposure to tobacco mold and leaves should be obtained. Workers not using masks during their working period are 5 times more likely to develop this disease.[6] Longer duration of work is associated with an increased risk of disease. In a 2009 study, those working with tobacco for more than 10 years were twice as likely to develop the disease compared with those working in the field less than 5 years.[6]

Tobacco worker’s lung, as with most hypersensitivity pneumonitis syndromes, has acute, subacute, and chronic presentations.

In acute presentations, patients develop abrupt onset of fever, cough, chills, myalgias, headache, and malaise about 4-6 hours following exposure to tobacco plants and molds. These symptoms are self-limited, resolving in 12 hours to several days once the patient avoids the inciting agent. The symptoms may recur with reexposure.

Patients who have had long-term exposure to tobacco plantations usually have insidious onset of cough, exertional dyspnea, fatigue, and weight loss. Disabling and irreversible respiratory findings due to pulmonary fibrosis may occur late in the course of the disease. Removing patients from tobacco exposure results in only partial improvement.

Next

Physical

Physical examination reveals the following:

  • Tachypnea
  • Diffuse fine rales
  • Wheezing
  • Weight loss
  • Digital clubbing
  • Fever
  • Evidence of cor pulmonale
Previous
Next

Causes

Major causative antigens include the following:

  • Aspergillus species
  • Scopulariopsis brevicaulis
  • Rhizopus nigricans [7]
Previous
 
 
Contributor Information and Disclosures
Author

Roger B Olade, MD, MPH Medical Director, Genesis Health Group

Roger B Olade, MD, MPH is a member of the following medical societies: American College of Occupational and Environmental Medicine, American College of 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.

Jazeela Fayyaz, DO Pulmonologist, Department of Pulmonology, Unity Hospital

Jazeela Fayyaz, DO is a member of the following medical societies: American College of Physicians, American Thoracic Society

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

Gregg T Anders, DO Medical Director, Great Plains Regional Medical Command , Brooke Army Medical Center; Clinical Associate Professor, Department of Internal Medicine, Division of Pulmonary Disease, University of Texas Health Science Center at San Antonio

Disclosure: Nothing to disclose.

References
  1. Huuskonen MS, Husman K, Jarvisalo J, et al. Extrinsic allergic alveolitis in the tobacco industry. Br J Ind Med. 1984 Feb. 41(1):77-83. [Medline].

  2. Blanco-Romero LE, Vega LE, Lozano-Chavarría LM, Partanen TJ. CAREX Nicaragua and Panama: Worker exposures to carcinogenic substances and pesticides. Int J Occup Environ Health. 2011 Jul-Sep. 17(3):251-7. [Medline].

  3. Pauly JL, Paszkiewicz G. Cigarette smoke, bacteria, mold, microbial toxins, and chronic lung inflammation. J Oncol. 2011. 2011:819129. [Medline]. [Full Text].

  4. Yanev I, Kostianev S. Respiratory findings in tobacco industry workers. Chest. 2004 Feb. 125(2):802. [Medline].

  5. Camarena A, Juárez A, Mejía M, Estrada A, Carrillo G, Falfán R, et al. Major histocompatibility complex and tumor necrosis factor-alpha polymorphisms in pigeon breeder's disease. Am J Respir Crit Care Med. 2001 Jun. 163(7):1528-33. [Medline].

  6. Rahman M. Health Hazards And Quality Of Life Of The Workers In Tobacco Industries: Study From Three Selected Tobacco Industries At Gangachara Thana In Rangpur District Of Bangladesh. Internet J Epidemiol. 6(2):[Full Text].

  7. Zhang Y, Chen J, Chen Y, Dong J, Wei Q, Lou J. Environmental mycological study and allergic respiratory disease among tobacco processing workers. J Occup Health. 2005 Mar. 47(2):181-7. [Medline].

  8. Huuskonen MS, Jarvisalo J, Koskinen H, Kivisto H. Serum angiotensin-converting enzyme and lysosomal enzymes in tobacco workers. Chest. 1986 Feb. 89(2):224-8. [Medline].

  9. Swami S, Suryakar AN, Katkam RV, Kumbar KM. Absorption of nicotine induces oxidative stress among bidi workers. Indian J Public Health. 2006 Oct-Dec. 50(4):231-5. [Medline].

  10. Ghosh T, Barman S. Respiratory problems of workers in the zarda industry in Kolkata, India. Int J Occup Saf Ergon. 2007. 13(1):91-6. [Medline].

  11. Kokkarinen JI, Tukiainen HO, Terho EO. Effect of corticosteroid treatment on the recovery of pulmonary function in farmer's lung. Am Rev Respir Dis. 1992 Jan. 145(1):3-5. [Medline].

  12. Curwin BD, Hein MJ, Sanderson WT, Nishioka MG, Buhler W. Nicotine exposure and decontamination on tobacco harvesters' hands. Ann Occup Hyg. 2005 Jul. 49(5):407-13. [Medline].

  13. Braun SR, doPico GA, Tsiatis A, Horvath E, Dickie HA, Rankin J. Farmer's lung disease: long-term clinical and physiologic outcome. Am Rev Respir Dis. 1979 Feb. 119(2):185-91. [Medline].

  14. [Guideline] Tarlo SM. Cough: occupational and environmental considerations: ACCP evidence-based clinical practice guidelines. Chest. 2006 Jan. 129(1 Suppl):186S-196S. [Medline].

 
Previous
Next
 
High-resolution CT scan of lungs shows ground-glass opacification seen in an acute phase of tobacco worker's lung.
Giant cells are a characteristic feature of acute tobacco worker's lung, which is a form of hypersensitivity pneumonitis.
High-resolution CT (HRCT) scan shows a ground-glass appearance and reticulonodular opacities in subacute phase of hypersensitivity pneumonitis (HP) secondary to moldy hay.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.