Chemical Worker's Lung Treatment & Management

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

Approach Considerations

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. As the management approach is largely supportive, the opportunity to use the hospital admission to educate the patient of the avoidance of future exposure cannot be overemphasized.

Treatment generally involves the following:

  • Oxygen supplementation

  • Bronchodilators

  • Inhaled or systemic steroids

  • Diuretics if pulmonary edema is present

  • Thoracentesis

  • Treatment of pulmonary hypertension

  • Pulmonary rehabilitation

  • Annual flu and pneumococcal vaccination is recommended if indicated

Acute respiratory failure may require non- invasive BiPAP or even invasive mechanical ventilation. On rare occasions depending on the chemical inhaled and the dose intensity transient ECMO support maybe needed. In the presence of chemical induced malignancy, therapy directed to to treat this complication is indicated.

Referral to a pulmonologist is recommended for patients with progressive disease.

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Medical Care

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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Surgical Care

In patients with hypersensitivity pneumonitis (HP) who develop progressive fibrosis, lung transplantation should be considered.  [19]

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Prevention

Avoiding exposure to the offending toxin or toxins is essential. A change of occupation may be necessary. 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.

Longitundinal trending changes in FEV1 may also be used for monitoring. 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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