2023-05-22 15:02:42
Black lung disease is not a thing of the past: occupational diseases of the respiratory tract are more relevant than ever. The most common clinical pictures and triggers at a glance.
Occupational physicians attribute an estimated ten to 30 percent of all acquired respiratory and lung diseases to occupational risk factors. To the most important occupational diseases According to the central association of the German statutory accident insurance, infectious diseases (153,821 suspected reports), Asbestosis (3.132), Silicosis (924) and allergic respiratory diseases (1,060). The numbers are from 2021.
Allergisches Asthma
Numerous substances in the workplace can cause allergies Bronchial asthma cause or aggravate existing diseases. This includes food or its raw materials, such as flour dust. Many chemicals, be they cleaning agents, chemicals from the pharmaceutical and plastics processing industries, dyes or chlorine, show similar properties. Scientists know more than 400 allergens that are found in different industries.
In order to identify triggers, a detailed search for clues is often required. For example, if patients work in different areas of the company, exposure and thus complaints only occur at irregular intervals. The symptoms also subside again during longer breaks caused by changes in production. If there are initial suspicions, the results of peak flow measurements after 14 days of exposure and after 14 days of non-operational time can be compared. The further diagnostic repertoire includes unspecific bronchial provocations and biomarkers.
The gold standard in the diagnosis of occupational asthma is the specific exposure, as occupational physician Prof. Dennis Nowak together with colleagues in one review article writes. This is “due to the effort involved but primarily reserved for expert questions”.
Chronic Obstructive Pulmonary Disease (COPD)
Researchers also bring COPD related to occupational risk factors – not just a smoker’s affliction. “The history of exposure in COPD patients does not end with the determination of the smoking status, but a smoker can also have COPD as an occupational disease,” Nowak and his co-authors explain. The most well-known triggers of COPD include inorganic or organic vapors, gases, dust and fumes, such as coal, silicon dioxide, dust in agriculture or in cotton processing companies. It can also be the result of silicosis, asbestosis or other occupational lung diseases.
The detection of work-related COPD does not differ from the known diagnosis of other forms of COPD. In addition to lung function analysis, pulmonologists rely on physical examinations, lung function diagnostics, imaging and blood tests.
infectious diseases
Numerous pathogenthat people come into contact with at work are also risk factors for diseases of the lungs and respiratory tract. Doctors, nurses and laboratory workers are particularly at risk.
In recent years was SARS-CoV-2 the most important pathogen. Healthcare workers can also become infected with numerous other pathogens. Beyond Corona has Tuberculosis the greatest importance. Workers in agriculture, on the other hand, become infected with the bacterium through dusty animal excretions Coxiella burnetiitrigger of Q fever. Here, too, the routine diagnostics correspond to the methods for infections from non-occupational causes.
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Interstitial lung diseases
Numerous inorganic or organic dusts sometimes lead to interstitial lung diseases. The challenge remains to identify noxae – and not just assume idiopathic causes. “The high proportion of work-attributable causes in the ostensibly idiopathic pulmonary fibrosis is a warning to more consistent work-related anamnestic surveys,” write Nowak and colleagues.
In addition to the exposure history itself, clinical and imaging examinations also help to track down causes. Inorganic ones are particularly common In pneumoconiosis such as silicosis or asbestosis. Occupational physicians also know Siderosen (caused by iron dust during welding), talcosis (caused by talc dust), Beryllium, Aluminosen (triggered by metal dust) and many more. Organic substances are also gaining in importance here. An example: In plants that produce popcorn, various flavorings have caused workers to “popcorn lungs” (Bronchiolitis obliterans) guided.
Malignancies of the lungs
“In the case of cancer of the lungs, it is important to collect a qualified work history in addition to the factor smoking, which is easily and quickly recorded and routinely quantified,” write the occupational physicians around Nowak. There are no differences to the diagnosis of malignant diseases acquired in other ways. Asbestos and quartz are among the most common triggers.
The bottom line is that the diagnosis of work-related lung diseases usually requires a comprehensive, time-consuming assessment of the situation. Although doctors have a wide range of diagnostic methods at their disposal, there is an almost unmanageable number of noxae. Doctors only have to find out – ideally together with the company – which substances are the cause.
Image source: Stefano Zocca, unsplash
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