Copyright © 2006 by Mosby, Inc. Slide 1 PART VII Environmental Lung Diseases.

Copyright © 2006 by Mosby, Inc.Slide 1

PART VIIPART VII

Environmental Lung DiseasesEnvironmental Lung Diseases


Chapter 25Chapter 25Pneumoconiosis Pneumoconiosis

Figure 25-1. Pneumoconiosis, illustrated here in a case of asbestosis (close-up of one alveolar Figure 25-1. Pneumoconiosis, illustrated here in a case of asbestosis (close-up of one alveolar unit). unit). AF,AF, Asbestos fiber; Asbestos fiber; FIB,FIB, fibrosis; fibrosis; MM, macrophage. , macrophage. Inset,Inset, Cross-section showing fibrotic Cross-section showing fibrotic

thickening of the alveolus, a common secondary anatomic alteration of the lungs. thickening of the alveolus, a common secondary anatomic alteration of the lungs.


Anatomic Alterations of the LungsAnatomic Alterations of the Lungs

Destruction of the alveoli and adjacent pulmonary Destruction of the alveoli and adjacent pulmonary capillariescapillaries

Fibrotic thickening of the respiratory bronchioles, Fibrotic thickening of the respiratory bronchioles, alveolar ducts, and alveolialveolar ducts, and alveoli

Cystlike structures (honeycomb appearance)Cystlike structures (honeycomb appearance) Fibrocalcific pleural plaques (e.g., asbestosis)Fibrocalcific pleural plaques (e.g., asbestosis) Airway obstruction caused by inflammation and Airway obstruction caused by inflammation and

excessive bronchial secretionsexcessive bronchial secretions BronchospasmBronchospasm Bronchogenic carcinomaBronchogenic carcinoma Mesothelioma (in asbestosis)Mesothelioma (in asbestosis)


EtiologyEtiology

Etiologic DeterminantsEtiologic Determinants

Size of inhaled particleSize of inhaled particle 0.3 and 0.5 0.3 and 0.5 μμm reach the alveolim reach the alveoli

Chemical nature of the particleChemical nature of the particle

Concentration of the particleConcentration of the particle

Length of exposureLength of exposure

The individual’s susceptibilityThe individual’s susceptibility


EtiologyEtiologyAsbestosisAsbestosis

Acoustic productsAcoustic products

Automobile Automobile undercoatingundercoating

Brake liningBrake lining

CementsCements

Clutch casingsClutch casings

Floor tilesFloor tiles

Fire-fighting suitsFire-fighting suits

Fireproof paintsFireproof paints

InsulationInsulation

Roofing materialsRoofing materials

Ropes Ropes

Steam pipe materialSteam pipe material


EtiologyEtiologyCoal Worker’s PneumoconiosisCoal Worker’s Pneumoconiosis

The deposition and accumulation of large The deposition and accumulation of large amounts of coal dust cause what is know as amounts of coal dust cause what is know as coal worker’s pneumoconiosis (CWP)coal worker’s pneumoconiosis (CWP)

Also called:Also called: Coal miner’s lungCoal miner’s lung

Black lungBlack lung

Black phthisisBlack phthisis

Miner’s phthisisMiner’s phthisis


EtiologyEtiologySilicosisSilicosis

Tunneling Tunneling

Hard-rock miningHard-rock mining

SandblastingSandblasting

Quarrying Quarrying

StonecuttingStonecutting

Foundry workFoundry work

Ceramics workCeramics work

Abrasive workAbrasive work

Brick makingBrick making

Paint makingPaint making

PolishingPolishing

Stone drillingStone drilling

Well drillingWell drilling


EtiologyEtiologyBerylliosisBerylliosis

Beryllium is a steel-gray, lightweight Beryllium is a steel-gray, lightweight metal found in: metal found in: Certain plastics and ceramicsCertain plastics and ceramics

Rocket fuelsRocket fuels

X-rayX-ray


EtiologyEtiologyOther Forms of PneumoconiosisOther Forms of Pneumoconiosis

AluminumAluminum Ammunition workersAmmunition workers

Baritosis (barium)Baritosis (barium) Barite millers and minersBarite millers and miners Ceramics workersCeramics workers

Kaolinosis (clay)Kaolinosis (clay) Brick makers and pottersBrick makers and potters Ceramics workersCeramics workers

Siderosis (iron)Siderosis (iron) Welders Welders

Talcosis (certain talcs)Talcosis (certain talcs) Ceramics workersCeramics workers Plastic and rubber workersPlastic and rubber workers


Overview of the Cardiopulmonary Overview of the Cardiopulmonary Clinical Manifestations Associated Clinical Manifestations Associated

with PNEUMOCONIOSISwith PNEUMOCONIOSIS

The following clinical manifestations result from The following clinical manifestations result from the pathophysiologic mechanisms caused (or the pathophysiologic mechanisms caused (or activated) by activated) by Increased Alveolar-CapillaryIncreased Alveolar-Capillary membrane (see Figure 9-9), membrane (see Figure 9-9), BronchospasmBronchospasm (see Figure 9-10), and (see Figure 9-10), and Excessive Bronchial Excessive Bronchial SecretionsSecretions (see Figure 9-11)—the major (see Figure 9-11)—the major anatomic alterations of the lungs associated anatomic alterations of the lungs associated with chronic bronchitis (see Figure 25-1).with chronic bronchitis (see Figure 25-1).


Figure 9-9. Increased alveolar-capillary membrane thickness clinical scenario.Figure 9-9. Increased alveolar-capillary membrane thickness clinical scenario.


Figure 9-10. Bronchospasm clinical scenario (e.g., asthma). Figure 9-10. Bronchospasm clinical scenario (e.g., asthma).


Figure 9-11. Excessive bronchial secretions clinical scenario. Figure 9-11. Excessive bronchial secretions clinical scenario.


Clinical Data Obtained at the Clinical Data Obtained at the Patient’s BedsidePatient’s Bedside

Vital signsVital signs

Increased respiratory rateIncreased respiratory rate

Increased heart rate, cardiac output, Increased heart rate, cardiac output, blood pressureblood pressure



CyanosisCyanosis

Digital clubbingDigital clubbing

Peripheral edema and venous distentionPeripheral edema and venous distention Distended neck veinsDistended neck veins

Pitting edemaPitting edema

Enlarged and tender liverEnlarged and tender liver

Cough and sputum productionCough and sputum production


Digital Clubbing

Figure 2-46. Digital clubbing.Figure 2-46. Digital clubbing.


DistendedDistendedNeck VeinsNeck Veins

Figure 2-48. Distended neck veins (Figure 2-48. Distended neck veins (arrowsarrows).).


Figure 2-47. Pitting edema. From Bloom A, Ireland J: Figure 2-47. Pitting edema. From Bloom A, Ireland J: Color atlas of diabetesColor atlas of diabetes, ed 2,, ed 2,London, 1992, Mosby-Wolfe.London, 1992, Mosby-Wolfe.



Chest assessment findingsChest assessment findings Increased tactile and vocal fremitusIncreased tactile and vocal fremitus

Dull percussion noteDull percussion note

Bronchial breath soundsBronchial breath sounds

Crackles, rhonchi, and wheezingCrackles, rhonchi, and wheezing

Pleural friction rubPleural friction rub

Whispered pectoriloquyWhispered pectoriloquy


Figure 2-11. Figure 2-11. A short, dull, or flat percussion note is typically produced over areas A short, dull, or flat percussion note is typically produced over areas of alveolar consolidation.of alveolar consolidation.


Figure 2-16. Figure 2-16. Auscultation of bronchial breath sounds over a consolidated lung Auscultation of bronchial breath sounds over a consolidated lung unit.unit.


Figure 2-19. Figure 2-19. Whispered voice sounds auscultated over a normal lungWhispered voice sounds auscultated over a normal lungare usually faint and unintelligible.are usually faint and unintelligible.


Clinical Data Obtained from Clinical Data Obtained from Laboratory Tests and Special Laboratory Tests and Special

ProceduresProcedures


Pulmonary Function Study: Pulmonary Function Study: Expiratory Maneuver FindingsExpiratory Maneuver Findings

FVC FEVT FEF25%-75% FEF200-1200

PEFR MVV FEF50% FEV1%

N

FVC FEVT FEF25%-75% FEF200-1200

PEFR MVV FEF50% FEV1%

N


Pulmonary Function Study: Pulmonary Function Study: Lung Volume and Capacity Findings Lung Volume and Capacity Findings

VT RV FRC TLC

VC IC ERV RV/TLC%

N or

VT RV FRC TLC

VC IC ERV RV/TLC%

N or


Decreased Diffusion Capacity Decreased Diffusion Capacity (DL(DLCOCO))


Arterial Blood GasesArterial Blood Gases

Mild to Moderate PneumoconiosisMild to Moderate Pneumoconiosis

Acute alveolar hyperventilation with Acute alveolar hyperventilation with hypoxemiahypoxemia

pH PaCO2 HCO3- PaO2

(Slightly)

pH PaCO2 HCO3- PaO2

(Slightly)


Time and Progression of Disease Time and Progression of Disease

100100

5050

3030

8080

00

PaCO2

1010

2020

4040

Alveolar HyperventilationAlveolar Hyperventilation

6060

7070

9090 Point at which PaO2 declines enough to stimulate peripheral oxygen receptors

Point at which PaO2 declines enough to stimulate peripheral oxygen receptors

PaO2

Disease OnsetDisease OnsetP

aO2

or

PaC

O2

PaO

2 o

r P

aCO

2

Figure 4-2. PaO2 and PaCO2 trends during acute alveolar hyperventilation.


Arterial Blood GasesArterial Blood Gases

Severe Pneumoconiosis with ExtensiveSevere Pneumoconiosis with ExtensiveFibrosisFibrosis

Chronic ventilatory failure with hypoxemiaChronic ventilatory failure with hypoxemia

pH PaCO2 HCO3- PaO2

Normal (Significantly)

pH PaCO2 HCO3- PaO2

Normal (Significantly)


Time and Progression of DiseaseTime and Progression of Disease

100100

5050

3030

80

0

PaO2

1010

2020

4040

Alveolar HyperventilationAlveolar Hyperventilation

6060

7070

9090Point at which PaO2 declines enough to stimulate peripheral oxygen receptors

Point at which PaO2 declines enough to stimulate peripheral oxygen receptors

PaCO 2

Chronic Ventilatory Failure Chronic Ventilatory FailureDisease OnsetDisease Onset

Point at which disease becomes severe and patient begins to become fatigued

Point at which disease becomes severe and patient begins to become fatigued

Pa0

2 o

r P

aC0 2

Pa0

2 o

r P

aC0 2

Figure 4-7. PaO2 and PaCO2 trends during acute or chronic ventilatory failure.


Acute Ventilatory Changes Superimposed Acute Ventilatory Changes Superimposed on Chronic Ventilatory Failureon Chronic Ventilatory Failure

Acute alveolar hyperventilation on chronic Acute alveolar hyperventilation on chronic ventilatory failureventilatory failure

Acute ventilatory failure on chronic Acute ventilatory failure on chronic ventilatory failure ventilatory failure


Oxygenation IndicesOxygenation Indices

QS/QT DO2 VO2 C(a-v)O2

Normal Normal

O2ER SvO2

QS/QT DO2 VO2 C(a-v)O2

Normal Normal

O2ER SvO2


Hemodynamic Indices Hemodynamic Indices (Severe Pneumoconiosis) (Severe Pneumoconiosis)

CVP CVP RAPRAP PAPA PCWPPCWP

NormalNormal

COCO SVSV SVISVI CICI

NormalNormal NormalNormal NormalNormal Normal Normal

RVSWIRVSWI LVSWILVSWI PVRPVR SVRSVR

NormalNormal NormalNormal


Laboratory FindingsLaboratory Findings

Complete blood count (CBC)Complete blood count (CBC) Elevated hemoglobin concentration and Elevated hemoglobin concentration and

hematocrit if the patient is chronically hypoxemichematocrit if the patient is chronically hypoxemic


Radiologic FindingsRadiologic Findings

Chest radiographChest radiograph

Small rounded opacities scattered throughout Small rounded opacities scattered throughout the lungthe lung

Irregularly shaped opacitiesIrregularly shaped opacities

Irregular cardiac and diaphragmatic bordersIrregular cardiac and diaphragmatic borders

Pleural plaquesPleural plaques

Honeycomb appearanceHoneycomb appearance


Figure 25-2. Figure 25-2. Chest X-ray of a patient with asbestosisChest X-ray of a patient with asbestosis..


Figure 25-3, Figure 25-3, Calcified pleural plaques on the superior border of the Calcified pleural plaques on the superior border of the diaphragm (arrows) in a patient with asbestosis. Thickening of the diaphragm (arrows) in a patient with asbestosis. Thickening of the pleural margins also is seen along the lower lateral borders of the pleural margins also is seen along the lower lateral borders of the

chest. A, Anteroposterior view. B, Lateral viewchest. A, Anteroposterior view. B, Lateral view..


General Management of General Management of PneumoconiosisPneumoconiosis

Control of occupational diseases is the Control of occupational diseases is the responsibility of the:responsibility of the: Worker Worker

Management Management

Community health departmentCommunity health department

State and federal governmentsState and federal governments

Prevention is the keyPrevention is the key

After the disease is established, it has no After the disease is established, it has no effective cureeffective cure


General Management of General Management of PneumoconiosisPneumoconiosis

Respiratory care treatment protocolsRespiratory care treatment protocols Oxygen therapy protocolOxygen therapy protocol

Bronchopulmonary hygiene therapy protocolBronchopulmonary hygiene therapy protocol

Aerosolized medication protocolAerosolized medication protocol

Hyperinflation therapy protocolHyperinflation therapy protocol


Classroom DiscussionClassroom DiscussionCase Study: PneumoconiosisCase Study: Pneumoconiosis

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Copyright © 2006 by Mosby, Inc. Slide 1 PART VII Environmental Lung Diseases.

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