OCCUPATIONAL LUNG DISEASES

INTRODUCTION:
Lung diseases are among the most common occupational health problems. Diseases of the
lungs occur in numerous occupations as a result of exposure to organic and inorganic
(mineral) dusts and noxious gases (fumes and aerosols). Clients who are smokers or who
have underlying lung disease are at greater risk.

PNEUMOCONIOSIS
Pneumoconiosis is derived from the Greek word “Pneumokonios” in which “pneumo” means
‘lung’ and “Konios” mean ‘dust’. Accumulation depends upon particle size and velocity of
air, anatomy and physiology of lung, breathing pattern of the patient.

Pneumoconiosis refers to a chronic fibrotic lung disease s caused by inhalation of mineral or

inorganic dust. (e.g. “dusty lung”) and particulate matter. Pneumoconiosis is caused by
inhalation and deposition of mineral dusts in the lungs, resulting in pulmonary fibrosis and
parenchymal changes. The most common pneumoconioses are silicosis, asbestosis, and coal
workers’ pneumoconiosis.

SILICOSIS
Silicosis caused if inhaled silica dust, most common form seen in miners, foundry workers,
and others who inhaled relatively low concentration of dust for 10-20 yrs.

ETIOLOGY:

Exposure to silica and silicates occurs in almost all mining, quarrying, and tunnelling
operations. Glass manufacturing, stone-cutting, the manufacture of abrasives and pottery, and
foundry work are other occupations with exposure hazards. Finely ground silica, such as that
found in soaps, polishes and filters, is extremely dangerous.

PATHOPHYSIOLOGY:
Inhaled silica dust produces nodular lesions in the lungs.

Nodules enlarge and coalesce.

Dense masses form on upper portion of the lungs, resulting in loss of pulmonary volume.

Fibrotic destruction of pulmonary tissue can lead to restrictive lung disease, emphysema,

Pulmonary hypertension and cor pulmonale.

CLINICAL MANIFESTATIONS:
 Acute silicosis: Dyspnoea, fever, cough, weight loss.
  Chronic silicosis: Progressive symptoms indicative of hypoxemia, severe airflow
obstruction and right-sided heart failure.

MEDICAL MANAGEMENT:

There is no specific treatment for silicosis, because the fibrotic process in the lung is
irreversible. Supportive therapy is directed at managing complications and preventing
infection. Testing is performed to rule out other lung diseases, such as TB, lung cancer, and
sarcoidosis. If TB is present, it is aggressively treated. Additional therapy might include
oxygen, diuretics, inhaled beta-adrenergic agonists, anticholinergics, and bronchodilator
therapy.
ASBESTOSIS

Asbestosis is a disease characterized by diffuse pulmonary fibrosis from the inhalation of

asbestos dust.

PATHOPHYSIOLOGY:

Inhaled asbestos fibres alveoli and are surrounded by fibrous tissue.

Fibrous changes can also affect the pleura, which thicken and develop plaque.

These changes lead to restrictive lung disease, with a decrease in lung volume, diminished
exchange of oxygen and carbon dioxide, hypoxemia, cor pulmonale, and respiratory failure.

CLINICAL MANIFESTATIONS:
Progressive dyspnoea, persistent dry cough, mild to moderate chest pain, anorexia, weight
loss, malaise, clubbing of the fingers.

MEDICAL MANAGEMENT:
There is no effective treatment for asbestosis as the lung damage is permanent and often
progressive. Management is directed at controlling infection and treating the lung disease.
When oxygen– carbon dioxide exchange becomes severely impaired, continuous oxygen
therapy may help improve activity tolerance. The patient must be instructed to avoid
additional exposure to asbestos and to stop smoking.

COAL WORKER’S PNEUMOCONIOSIS

Coal workers’ pneumoconiosis (“black lung disease”) includes a variety of respiratory

diseases found in coal workers who have inhaled coal dust over the years. Coal miners are
exposed to dusts that are mixtures of coal, kaolin, mica, and silica.
 PATHOPHYSIOLOGY:

Inhaled dusts that are mixtures of coal, kaolin, mica and silica are deposited in the alveoli and
respiratory bronchioles.

When macrophages that engulf the dusts can no longer be cleared, they aggregate and
fibroblasts appear.

The bronchioles and alveoli become clogged with dusts, dying macrophages and fibroblasts
leading to formation of coal macules.

Fibrotic lesions develop and subsequently localized emphysema develops with cor pulmonale
and respiratory failure.

CLINICAL MANIFESTATIONS:
Chronic cough, dyspnoea and expectoration of black or grey sputum, especially in miners
who are smokers with cavitation in the lungs.

MEDICAL MANAGEMENT:
Preventing this disease is key because there is no effective treatment. Instead, treatment
focuses on early diagnosis and management of complications.

HYPERSENSITIVITY PNEUMONITIS

Hypersensitivity pneumonitis is an allergic pulmonary diseases caused by exposure to inhaled

organic dusts.
Bysssinosis, resulting from cotton dust exposure; bagassosis, due to exposure to moldy
sugarcane fibre are examples of hypersensitivity pneumonitis.

PATHOPHYSIOLOGY:

Inhaled dusts are deposited in the alveoli and alveoli gets inflamed

Fibrous scar tissue forms in the lungs

Fibrosis occurs

Abnormal breathing and respiratory failure

CLINICAL MANIFESTATIONS:
Either acute or subacute illness can occur.
Acute illness occurs 4-8 hrs after exposure and is characterized by sudden onset of malaise,
chills and fever, dyspnoea, cough and nausea.
The subacute syndrome is characterized by an insidious onset of chronic cough, progressive
dyspnoea, and anorexia and weight loss.

TREATMENT:
No specific treatment. Avoidance of exposure to the dust and corticosteroids can be given.

BYSSINOSIS
Byssinosis is a disease of the lungs brought on by breathing in cotton dust or dusts from other
vegetable fibres such as flax, hemp, or sisal while at work.

PATHOPHYSIOLOGY:
In this chronic bronchitis and emphysema develop in time. Constriction of bronchioles in
response to something in crude cotton.

CLINICAL MANIFESTATIONS:
Tightness in chest on returning to work after a weekend away (Monday fever),
Cough, wheezing and chronic bronchitis and emphysema.

MEDICAL MANAGEMENT:

There is no specific treatment and treatment is directed towards symptomatic relief. The best
treatment is to decrease or stop exposure to the harmful agents. The most important treatment
is to stop being exposed to the dust. Reducing dust levels in the factory (by improving
machinery or ventilation) will help prevent byssinosis. Medications used for asthma, such as
bronchodilators, will usually improve symptoms. Corticosteroids may be prescribed in more
severe cases.

Stopping smoking is very important for people with this condition. Breathing treatments,
including nebulizers, may be prescribed if the condition becomes long-term. Home oxygen
therapy may be needed if blood oxygen levels are low.

BAGASSOSIS
Bagassosis is a hypersensitivity pneumonitis due to inhalation of dust from bagasse (the
residue of cane after extraction of sugar).

CLINICAL MANIFESTATIONS:

 Impaired lung function

 Shortness of breath
 Fatigue
 Weight loss
 Cough
 Fever
 Chills
 Body aches
 Coughing
MEDICAL MANAGEMENT:

There is no specific treatment and treatment is directed towards symptomatic relief. The best
treatment is to decrease or stop exposure to the harmful agents. The most important treatment
is to stop being exposed to the dust.
DIAGNOSTIC EVALUATION:

 History
 Chest x-ray (characteristic patterns are seen for each disorder on x-ray)
 Pulmonary function studies (restrictive impairment of lung ventilation, with reduced
vital capacity and reduced total lung capacity)
 Bronchoscopy (performed to obtain tissue for biopsy), and
 Lung biopsy
 ABG (reveals hypoxemia)

NURSING MANAGEMENT:
1. Nursing Diagnosis: Ineffective breathing pattern related to fibrotic lung tissue
causing restriction.
Goal: Improve breathing pattern
Interventions:
 Assess the breathing pattern of the patient
 Provide fowler’s or semi-fowler’s position and make the patient comfortable
 Administer oxygen therapy as required
 Administer or teach self administration of bronchodilators as ordered
 Encourage smoking cessation
 Ask the patient to take rest.
Evaluation: Breathing pattern is improved

2. Nursing Diagnosis: Impaired gas exchange related to fibrotic lung tissue and
secretions.
Goal: to promote gas exchange
Interventions:
 Asses the condition of the patient
 Encourage mobilization of secretions through hydration
 Ask the patient to do breathing and coughing exercises
 Advise pt. On pacing activities to prevent fatigue
 Take the ABG
Evaluation: Effectively mobilizes secretions

3. Nursing diagnosis- Activity intolerance related to tissue hypoxia associated with

impaired gas exchange.
Goal: The client will demonstrate an increased tolerance for activity as evidenced by:
verbalization of feeling less fatigued and weak.
 Intervention:
 Asses for sign and symptoms of activity tolerance.
 Perform action to promote rest
 Maintain activity restriction as ordered
 Minimize environmental activity and noise
 Keep supplies and personal articles within easy reach
 Implement measure to promote sleep.
 If oxygen therapy is necessary during activity, keep portable oxygen equipment.
 Increase client activity gradually as allowed and tolerated.
 Stop any activity that causes increase chest pain, increase shortness of breath and
dizziness.

4. Nursing Diagnosis: Anticipatory grieving related to potential loss of employment and

income.
Goal: Facilitate healthy grieving process.
Interventions:
 Assess for signs and symptoms of grieving (change in eating habits, insomnia,
etc.)
 Provide an atmosphere of care and concern (provide privacy, be available and
non-judgemental, etc)
 Implement measures to promote trust (e.g., answer questions honestly, provide
requested information)
 Encourage client to express his/her feelings in whatever ways are comfortable
(e.g. writing, drawing, conversation)
 When appropriate assist client to meet spiritual needs.
 Encourage participation in daily self care-activities
 Consult physician if signs of dysfunctional grieving (e.g. excessive anger or
sadness, emotional labiality) occur.
Evaluation: Facilitated healthy grieving process.

Nursing diagnosis – Knowledge deficit related to ineffective management of therapeutic

regimen or altered health maintenance.
Goal - Provide knowledge regarding disease.
Intervention
 Instruct client in ways to maintain respiratory health.
 Consume well balanced diet.
 Maintain balance program of rest and exercise.
 Avoid contact with patients who have respiratory infection.
 Continue coughing and deep breathing exercise.
 Avoid exposure of respiratory irritants
 Instruct the client to report the following sign and symptoms.
 Recurrent temperature elevation
 Chills
 Difficulty breathing
 Cough
 Explain the rationale for side effects of and importance of taking medication
prescribed.

Evaluation: Knowledge level of the patient have been improved.

 CONCLUSION:
Occupational lung diseases are a diverse group of disorders directly related to inhalation
of noxious substances in the environment. These lung diseases damage the interstitial or
connective tissue of the lung. These disorders may be acute or severe.

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