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Prevention, Clinic and Diagnosis of Respiratory Diseases of Occupational Origin.

Occupational lung diseases appear after repeated and prolonged exposure to a substance, although a single exposure to a harmful agent can lead to lung injury. the r

 

Prevention

In the second half of the XNUMXth century, preventive measures and their practical application have constituted an important advance in modern medicine. But prevention is not always possible in the face of this type of pathology due to the existence of a long latency period between occupational exposure and the appearance of symptoms, the appearance of non-specific pulmonary reactions, individual susceptibility factors, the existence of previous respiratory problems , constant appearance of new substances and political and/or economic reasons.

 

The basic principles for the control and prevention of occupational lung diseases are:

 

AVOID inhaling the substances that produce them:

Reduction of the concentrations of the inhaled agent in the work area with humidification, ventilation or laminar flow systems.

 

Use of respiratory protection equipment:

Masks that supply clean external air or totally filter particles.

Replacement of the inhaled toxic agent with a less or non-toxic agent.

Efficient and safe transport and storage of toxic substances.

In high-risk areas automation of work.

Staff turnover. If there is a person sensitized to a substance, it is necessary to change their job or even their job.

Carry out educational programs on smoking cessation and occupational risk prevention.

Identify workers at risk of suffering from COPD or asthma to control them periodically.

Monitor the most exposed workers: Frequent chest X-rays, for example:

 

6 months: sandblasters due to their high exposure to silica dust.

2 to 5 years: Workers exposed to silica dust who do not sandblast.

4 to 5 years: coal mine workers.

Frequent spirometry.

 

The clinic

The clinic of these pathologies is non-specific and may even be asymptomatic in some people. In many cases, symptoms appear long after exposure has ceased.

Symptoms such as cough, wheezing and shortness of breath (dyspnea) usually appear during working days and improve, or even disappear, on rest days. When this happens, it is a warning sign that this type of pathology may be present.

 

Discovery

Although the physical examination is not very useful for diagnosis, it is necessary to look for signs of this type:

Inflammatory in the eyes, oropharynx, nose and/or eyes.

Severe respiratory insufficiency:

Tachypnea: increase in breaths per minute, that is, increase in respiratory rate above normal values.

Tachycardia: increased beats per minute, that is, increased heart rate or pulse.

Use of accessory muscles of respiration: when breathing, neck muscles are used, among others, to facilitate the entry of air.

 

Chronic respiratory failure:

Cyanosis: bluish color in nails, lips...

Clubbing: fingers shaped like drumsticks.

Findings in the auscultation of abnormal noises and their location and extension.

 

To make the diagnosis, it is essential to identify the causal agent and demonstrate the relationship between it and the respiratory disease. But this is difficult since most occupational respiratory pathologies are not occupationally specific, the cause is not usually present in all cases and is not usually unique, and the disease may not develop in all exposed people.

 

Due to the medicolegal implications that this type of diagnosis entails (change of job, economic compensation, elimination of the cause...) it is essential that it be carried out objectively and precisely, trying to avoid a presumptive diagnosis as much as possible. .

 

The diagnosis is desirable to be made early because the persistence in exposure will influence its subsequent evolution.

 

An adequate assessment must be made up of medical history including work history, imaging studies, pulmonary function tests and others (immunological tests in cases of allergy, blood and urine tests...). It is also very interesting and important to measure the impact of the disease on the individual with questionnaires such as the Medical Research Council (MRC) and Borg dyspnea questionnaires, quality of life questionnaires such as St George's…among others.