Overview of Occupational Overview of Occupational PneumoconiosisPneumoconiosis

Jack Kinder, M.D.Jack Kinder, M.D.

Basic Function of the OP BoardBasic Function of the OP Board

Evaluate for presence or absence of diseaseEvaluate for presence or absence of disease Determine level of impairmentDetermine level of impairment Protest hearing testimonyProtest hearing testimony

Evaluation of ClaimantEvaluation of Claimant

Work historyWork history Medical historyMedical history X-RayX-Ray PFTsPFTs Physical exam of the chestPhysical exam of the chest

Exposure History - CoalExposure History - Coal

Type of workType of work- Underground- Underground- Surface- Surface

Exposure History - AsbestosExposure History - Asbestos

IndustrialIndustrial Private employmentPrivate employment

Medical HistoryMedical History

RespiratoryRespiratory- Illness - Illness - Surgery- Surgery

MedicationsMedications- Beta Blockers- Beta Blockers- Pulmonary Meds- Pulmonary Meds

X-Ray EvaluationX-Ray Evaluation

Pleural DiseasePleural Disease Parenchymal DiseaseParenchymal Disease

Pulmonary Function TestingPulmonary Function Testing

FVCFVC FEVFEV11

FEVFEV11/FVC Ratio/FVC Ratio

DiffusionDiffusion ABGsABGs

Physical Exam of the ChestPhysical Exam of the Chest

Abnormal breath soundsAbnormal breath sounds Cardiac DiseaseCardiac Disease Chest wall deformitiesChest wall deformities

Special ConsiderationsSpecial Considerations

MalignancyMalignancy Cardiac DysfunctionCardiac Dysfunction TransplantationTransplantation

Pulmonary MalignancyPulmonary Malignancy

Primary Parenchymal CancerPrimary Parenchymal Cancer MesotheliomaMesothelioma

Primary Lung CancerPrimary Lung Cancer

Coal ExposureCoal Exposure Asbestos ExposureAsbestos Exposure

- Tobacco Influence- Tobacco Influence

MesotheliomaMesothelioma

Special Type of Pleural DiseaseSpecial Type of Pleural Disease Without Parenchymal DiseaseWithout Parenchymal Disease Tobacco ExposureTobacco Exposure

Cardiac DiseaseCardiac Disease

Role in Pulmonary DysfunctionRole in Pulmonary Dysfunction Cor PulmonaleCor Pulmonale

Coronary AtherosclerosisCoronary Atherosclerosis

Primary Disease of the HeartPrimary Disease of the Heart Myocardial InfarctionMyocardial Infarction

Cor PulmonaleCor Pulmonale

Right Ventricular SizeRight Ventricular Size Emphysema or PneumoconiosisEmphysema or Pneumoconiosis

Cardiac TransplantationCardiac Transplantation

Rare EventRare Event Multiple FactorsMultiple Factors

Type of TransplantType of Transplant

Single OrganSingle Organ Double OrganDouble Organ

Examples of ClaimantsExamples of Claimants

42 year old Coal Miner42 year old Coal Miner 12 years surface mine12 years surface mine

- Blaster / Drill- Blaster / Drill Non SmokerNon Smoker PFTsPFTs

- FVC - FVC 62%62%- FEV- FEV11 67%67%

- FEV- FEV11/FVC /FVC NormalNormal

Examples of ClaimantsExamples of Claimants

78 year old Plant Worker78 year old Plant Worker 40 years Pipe Fitter40 years Pipe Fitter 45 years – 1 ppd smoker45 years – 1 ppd smoker PFTsPFTs

- FVC- FVC 70%70%- FEV- FEV11 50%50%

- FEV- FEV11/FVC/FVC 45%45%

- Diffusion- Diffusion 50%50%

Examples of ClaimantsExamples of Claimants

70 year old Coal Miner70 year old Coal Miner 35 years underground roof bolter35 years underground roof bolter 40 years – 1 ppd smoker40 years – 1 ppd smoker PFTsPFTs

- FVC- FVC 60%60%- FEV- FEV11 30%30%

- FEV- FEV11/FVC/FVC Total ImpairmentTotal Impairment

Right Lung MassRight Lung Mass