Diagnosis Of Occupational Lung Disease Research Articles

The role of pathologists in the diagnosis of occupational lung diseases: an expert opinion of the European Society of Pathology Pulmonary Pathology Working Group.

Occupational lung/thoracic diseases are a major global public health issue. They comprise a diverse spectrum of health conditions with complex pathology, most of which arise following chronic heavy workplace exposures to various mineral dusts, metal fumes, or following inhaled organic particulate reactions. Many occupational lung diseases could become irreversible; thus accurate diagnosis is mandatory to minimize dust exposure and consequently reduce damage to the respiratory system. Lung biopsy is usually required when exposure history is inconsistent with imaging, in case of unusual or new exposures, in case of unexpected malignancy, and in cases in which there are claims for personal injury and legal compensation. In this paper, we provide an overview of the most frequent occupational lung diseases with a focus on pathological diagnosis. This is a paper that summarizes the expert opinion from a group of European pathologists, together with contributions from other specialists who are crucial for the diagnosis and management of these diseases. Indeed, tight collaboration of all specialists involved in the workup is mandatory as many occupational lung diseases are misdiagnosed or go unrecognized. This document provides a guide for pathologists in practice to facilitate the accurate diagnosis of occupational lung disease. The review article reports relevant topics discussed during an educational course held by expert pathologists, active members of the Pulmonary Pathology Working Group of the European Society of Pathology. The course was endorsed by the University of Padova as a "winter school" (selected project in the call for "Shaping a World-class University" 2022).

Pathological features and diagnostic significance of lung biopsy in occupational lung diseases

Objective: To investigate the clinicopathological characteristics of occupational lung diseases, to reduce the missed diagnoses and misdiagnoses of the diseases and to help standardize the diagnosis and treatment of these patients. Methods: A total of 4 813 lung biopsy specimens (including 1 935 consultation cases) collected at the Department of Pathology, Nanjing Drum Tower Hospital, Nanjing, China from January 1st, 2017 to December 31th, 2019 were retrospectively analyzed. Among them, 126 cases of occupational lung diseases were confirmed with clinical-radiological-pathological diagnosis. Special staining, PCR and scanning electron microscopy were also used to rule out the major differential diagnoses. Results: The 126 patients with occupational lung diseases included 102 males and 24 females. All of them had a history of exposure to occupational risk factor(s). Morphologically, 68.3% (86/126) of the cases mainly showed pulmonary fibrotic nodules, dust plaque formation or carbon end deposition in pulmonary parenchyma. 16.7% (21/126) of the cases mainly showed welding smoke particle deposition in the alveolar cavity and lung interstitium while 15.1% (19/126) of the cases showed granulomas with fibrous tissue hyperplasia, alveolar protein deposition or giant cell interstitial pneumonia. The qualitative and semi-quantitative analyses of residual dust components in the lung under scanning electron microscope were helpful for the diagnosis of welder's pneumoconiosis and hard metal lung disease. Conclusions: The morphological characteristics of lung biopsy tissue are important reference basis for the clinicopathological diagnosis and differential diagnosis of occupational lung diseases. Recognizing the characteristic morphology and proper use of auxiliary examination are the key to an accurate diagnosis of occupational lung diseases on biopsy specimens.

Computed tomography in the diagnosis of occupational lung diseases

The diagnostic efficiency of the results of clinical, x-ray methods and computed tomography data in the study of patients with chronic dust lung diseases was evaluated. The informativeness of using the method of computed tomography of lungs is shown

409 The use of an autopsy compensation database for surveillance of pulmonary tuberculosis in the South African mining industry: 1975–2011

IntroductionPulmonary tuberculosis (PTB) is a major public health problem in South Africa and gold miners have the highest incidence of tuberculosis in the world. However, there is no systematic surveillance...

Utility of CT findings on diagnosis of occupational lung disease

Introduction We experienced two occupational lung diseases on a different situation in military training. The purpose of this study was to investigate the use of CT images for inhaled pulmonary edema from the standpoint of early diagnosis and assessment of severity. Materials and methods Case 1: Two soldiers who used the rust proofing sprays and dust removal sprays for the daily maintenance of their arms suffered from severe lung edema. Case 2: Four soldiers suffered from severe dyspnea because they drilled in the field where many smoke canisters were used. We evaluated these patients by clinical symptoms, laboratory data, pulmonary function test, chest X-P and CT images. Results Case 1: Their chest CT scan showed bilateral infiltration mainly in the upper lung field. Steroid pulse treatment was used for recovery. Seven days later, their chest X-P showed almost normal. Case 2: Their chest radiographs showed mild infiltrative shadows. Their chest CT scan showed bilateral ground grass attenuation with the peripheral lung spared. They recovered gradually by steroid therapy. Seven days later, mild abnormal shadow was observed in their chest CT images. Discussion In the literature, chest CT scan showed diffused ground glass opacities mainly in the upper lung field of inhaled pulmonary edema patients. The peripheral part of the lungs was kept normal excluding the seriously injured cases. These findings are the same as those in our cases. When differential diagnosis was needed, we considered chest CT scan especially useful. The findings of CT scan are useful not only for the diagnosis of inhaled pulmonary edema but also for determining the severity of lung injury.

Asbestosis in an asbestos composite mill at Mumbai: a prevalence study.

BackgroundOf an estimated 100000 workers exposed to asbestos in India, less than 30 have been compensated. The reasons for such a small number are: refusal by management sponsored studies to grant medical certifications to workers suffering from occupational diseases, lack of training for doctors in diagnosis of occupational lung diseases, deliberate misdiagnosis by doctors of asbestosis as either chronic bronchitis or tuberculosis and the inherent class bias of middle class doctors against workers. The aim of the study was to identify workers suffering from Asbestosis (parenchymal and pleural non-malignant disease) among the permanent workers of the Hindustan Composites Factory and assess their disability and medically certify them, whereupon they could avail of their basic rights to obtain compensation and proper treatment.MethodsThe study was conducted by the Occupational Health and Safety Centre and the Workers' Union. Asbestosis was diagnosed if they had an occupational history of asbestos exposure for at least 15 years and showed typical radiographic findings.ResultsOf 232 workers in the factory, 181 participated in the survey. 22% of them had asbestosis. All the asbestos affected workers had at least 20 years of exposure. 7% had rhonchi, 34% had late basal inspiratory rates, 82% had more than 80% of Forced Expiratory Volume in the first second (FEV1)/Forced Vital capacity (FVC) ratio and 66% had FVC less than 80% of the predicted value. On radiology 7% had only pleural disease, 10% had both pleural and parenchymal disease and 82% had only parenchymal disease. The association of pleural disease with chest pain was statistically significant.ConclusionWe found the prevalence of asbestosis among exposed workers to be less than that anticipated for the number of years of exposure due to "Healthy Worker Effect". We suggest that all affected asbestos workers (including those who have been forced to leave) in India be medically certified and compensated. We also recommend better control of asbestos use in India. We also implore the management to provide all information about the work process and its hazards, conduct medical checkups as mandated by law and give the medical records to the workers.

PULMONARY FUNCTION TESTS AT WORK

Occupational exposures remain an important cause of lung disease. A number of PFTs are used in the occupational setting, including spirometry, PEF recordings, methacholine challenge testing, lung volume, and DL(CO). These tests are used in a number of situations, including the clinical evaluation and management of patients with possible occupational lung disorders, preplacement and fitness-for-duty examinations, medical screening of exposed workers, impairment and disability evaluations, and research. The diagnosis of occupational lung disease has serious consequences for a worker and, in addition to a careful occupational history, usually requires objective assessment using PFTs. Serial PFTs are useful in following such patients and screening exposed populations of workers for respiratory conditions.

Vaginal itching as a manifestation of seasonal allergic disease

J A LLERGY C LIN I MMUNOL 1995;95:781-2.

CLINICAL OVERVIEW OF OCCUPATIONAL LUNG DISEASE

The workplace has been a source of lung injury for centuries, yet awareness of the types of injuries has varied over time. Because of distinctive differences among the occupational lung disorders, a continual update of the clinical findings, dose response data, physiologic characteristics, and radiographic findings is needed. The radiologist plays a key role for the evaluation of miners, foundry or factory workers exposed to mineral dusts, and of workers exposed to the "biologic" dusts, infectious agents, cancer causing agents, and chemicals causing interstitial lung diseases. This overview includes a discussion of classification systems, criteria for diagnosis of occupational lung diseases, the pulmonary clinician's evaluation, and important aspects of specific disorders and concludes with a discussion of pulmonary disability determination.

A TOXICOLOGIC APPROACH TO THE DIAGNOSIS OF OCCUPATIONAL LUNG DISEASE

A large number of chemical and biologic agents have been associated with occupational lung disease. The diagnosis of occupational lung diseases in many cases is complex because symptoms often mimic other lung disorders and specific confirmatory tests are limited. The diagnosis depends on a careful and detailed history with specific attention to evaluation of the work site, in combination with selected testing to ascertain the toxin as well as the pulmonary disease process. In evaluating potential exposures, a familiarity with industrial processes, safety measures, testing methods, and disease processes associated with inhaled toxins is essential. Early recognition of toxin-induced lung disease and prevention of further exposure is the key to preventing disease progression.

Guidelines for the preparation and characterization of high molecular weight allergens used for the diagnosis of occupational lung disease: Report of the Subcommittee on Preparation and Characterization of High Molecular Weight Allergens

75. Lutsky I, Teichtahl H, Bar-Sela S. Occupational asthma due to poultry mites. J ALLERGY CLIN IMMUNOL 1984;73:56. 76. Baur X, Fruhmann G. Allergic reactions, including asthma, to the pineapple protease bromelain following occupational exposure. Clin Allergy 1979;9:443. 77. doPico GA. Asthma due to dust from redwood. Chest 1987;73:3. 78. Davies RJ, Pepys J. Asthma due to inhaled chemical agents. The macrolide antibiotic spiramycin. Clin Allergy 1975;1:99. 79. Gleich GJ, Welsh PW, Yunginger JW, Hyatt RE, Catlett JB. Allergy to tobacco: an occupational hazard. N Engl J Med 1980;302:617. 80. Butcher BT, Salvaggio JE, O’Neil CE, Weill H, Garg 0. Toluene diisocyanate pulmonary disease: immunopharmacologic and mecholyl challenge studies. J ALLERGY CLIN IMMUNOL 1977;59:223. 81. Butcher BT, O’Neil CE, Reed MA, Salvaggio JE. Radioallergosorbent testing of toluene diisocyanate-reactive individuals usingp-tolyl isocyanate antigen. J ALLERGY CLIN IMMUNOL 1980;66:213. 82. Butcher BT, Karr RIM, O’Neil CE, et al. Inhalation challenge and pharmacologic studies of TDI sensitive workers. J ALLERGY CLIN IMMUNOL 1979;64:146. 83. Butcher BT, Jones RN, O’Neil CE, et al. Longitudinal study of workers employed in the manufacture of toluene diisocyanate. Am Rev Respir Dis 1977;116:411_ 84. Chan-Yeung M, Barton GM, MacLean L, Grzybowski S. Occupational asthma and rhinitis due to Western red cedar (Thuja plicutu). Am Rev Respir Dis 1973;108:1094. 85. Sutton R, Skerritt JH, Baldo BA, Wrigley CW. The diversity of allergens involved in baker’s asthma. Clin Allergy 1984;14:93. 86. Block G, Tse KS, Kijek K, Chan H, Chan-Yeung M. Baker’s asthma. Clinical and immunological studies. Clin Allergy 1983;13:359. 87. Baldo BA, Wrigley CW. IgE antibodies to wheat flour components. Clin Allergy 1978;8:109.

Immunologic Techniques Utilized in the Diagnosis of Occupational Lung Disease

Humoral and/or cell-mediated immune responses may contribute to the tissue injury in patients with certain types of occupational asthma, hypersensitivity pneumonitis, silicosis, and asbestosis. Numerous diagnostic modalities are available to the clinician investigating the etiology of these disorders. Among the current immunologic techniques discussed in this article are immunoassays for specific anti-IgE antibody, gel diffusion reactions, immunoelectrophoresis, ANA assays, complement studies, and immune complex assays.

Immunologic Techniques Utilized in the Diagnosis of Occupational Lung Disease

Numerous immunologic diagnostic modalities are available to the clinician investigating the etiology of occupational lung disorders. Certain tests--immunoassays for specific anti-IgE antibody, gel diffusion reactions, and immunoelectrophoretic techniques--may aid in the identification of specific antigens or analysis of antigens involved in the pathogenesis of environmental lung diseases. Other techniques--ANA assays, complement studies, and immune complex assays--should be regarded as complementary. For example, a specific non-histone nucleoprotein "marker," ANA has not been identified in any of the environmental fibrotic lung diseases, and ANA positivity does not always correlate with severity or progression of disease. Additionally complement assays and detection of circulating immune complexes do not identify specific antigens. Clearly, there are other assays useful in determining immunologic mechanisms that may be important in occupational lung diseases but were not discussed in this article. Bronchoalveolar lavage with cellular identification and therapeutically important when considering the activity of various lung disorders. Also, lymphokine and leukotriene identification, lymphocyte transformation studies, and assessment of macrophage function are contributing greatly to our understanding of the possible immunologic mechanisms involved in different environmental pulmonary diseases. Thus, the investigation of immunologic mechanisms offers an exciting and rewarding future in the evaluation of the pathologic mechanisms of occupational and environmental pulmonary disease.