brand logo

Occupational lung diseases are caused by workplace inhalation of chemicals, dusts, or fumes. They include asbestosis, silicosis, coal workers’ pneumoconiosis (CWP), and occupational asthma. These diseases have nonspecific respiratory symptoms and are only identified if an occupational history is taken. Asbestosis typically is diagnosed 20 to 30 years after peak exposure, often when pleural plaques are noted on chest x-ray (CXR). Asbestosis is associated with an increased cancer risk, which is higher in smokers. Silicosis results from exposure to silica dust from sand, stone, and quartz. It is a fibrotic lung disease with acute, chronic, or accelerated presentations; CXR findings show interstitial fibrosis or nodular opacities. Silicosis increases risk of mycobacterial and fungal infections. In CWP, patients may present with mild symptoms and CXR findings showing small fibrous nodules; progressive massive fibrosis may develop, and there is a risk of mycobacterial and fungal infections. Occupational asthma (OA) can occur de novo from inhaling sensitizers that induce immunoglobulin E-mediated airway reactions, or from inhaling irritants such as smoke, dust, and fumes. OA also can be due to sensitizers/irritants aggravating preexisting asthma. There are no cures for these occupational lung diseases, so prevention, including elimination/control of workplace exposures, and early diagnosis are key.

Case 1. Mr Henry is a 72-year-old man with a history of hypertension, hyperlipidemia, and chronic obstructive pulmonary disease. He comes to your office to establish care and discuss a recurrent cough. He has been noticing the recurrent dry cough and increasing shortness of breath over the past few months. He reports no fevers, chills, nausea, or vomiting. He states he has tried drinking more water and taking oral antihistamines without much success. Currently, he is retired after working in a Navy shipyard for most of his career. He has smoked cigarettes since his teens, currently approximately 1 pack/day. He reports no recent travel or exposure to others with similar symptoms. Pulmonary function tests done in your office show a restrictive pattern. You obtain a chest x-ray (CXR), which shows pleural plaques and increased interstitial markings in the lower lung lobes.

Asbestosis

Asbestos is a crystalline mineral found throughout the world. It is a tiny, flexible, durable fiber that has strong resistance to heat and chemicals. Asbestos became a frequently used substance during the early 1900s as an insulator and heat retardant. However, the dangers associated with inhaling asbestos were not clear until the 1940s, and not widely known until the 1970s, leading to many workers experiencing occupational exposure over decades.1

After inhalation, asbestos fibers can lead to the development of asbestosis, a restrictive fibrotic lung disease. There is a prolonged period between exposure and diagnosis of asbestosis, typically 10 to 40 years and rarely before 20 years.2,3

Already a subscriber?  Log In

Subscribe

From $335
  • Immediate, unlimited access to all FP Essentials content
  • 60 CME credits/year
  • AAFP app access
  • Print delivery available
Subscribe

Edition Access

$59
  • Immediate, unlimited access to this edition's content
  • 5 CME credits
  • AAFP app access
  • Print delivery available
Interested in AAFP membership? Learn more  Learn More

Continue Reading

Copyright © 2021 by the American Academy of Family Physicians.

This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP.  See permissions for copyright questions and/or permission requests.