Chemical Worker's Lung Clinical Presentation

Updated: Dec 24, 2019
  • Author: Shakeel Amanullah, MD; Chief Editor: John J Oppenheimer, MD  more...
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Presentation

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 medical history should include the onset and timing of the patient’s chest symptoms, past medical history, review of systems, current medications, family history, and personal habits, including use of tobacco, alcohol, and recreational drugs. The components of a detailed occupational history include current, past, and longest held jobs; job description(s); and symptoms during or after exposure to specific fumes, dusts, and chemicals. Information on nonoccupational exposures, particularly those associated with particular hobbies or recreational activities, should be elicited. [14]  

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 Examination

Findings at lung examination are generally nonspecific and often occur late in the course of chronic occupational pulmonary diseases. For interstitial diseases, inspiratory crackles on auscultation reflect later stages of fibrosis and may be accompanied by digital clubbing and findings of right heart failure. For occupational airways diseases, physical examination findings are often normal. Wheezing may be a sign of large airways obstruction, and end-inspiratory squeaks may be heard in patients with bronchiolitis. 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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