Upper Respiratory Tract Diseases in Workplace. Characteristics of upper resp. tract NNNNares to...

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Upper Respiratory Upper Respiratory Tract Diseases Tract Diseases in in Workplace Workplace

Transcript of Upper Respiratory Tract Diseases in Workplace. Characteristics of upper resp. tract NNNNares to...

Page 1: Upper Respiratory Tract Diseases in Workplace. Characteristics of upper resp. tract NNNNares to larynx TTTTasks: AAAAir conditioning (T and.

Upper Respiratory Upper Respiratory Tract Diseases Tract Diseases inin WorkplaceWorkplace

Page 2: Upper Respiratory Tract Diseases in Workplace. Characteristics of upper resp. tract NNNNares to larynx TTTTasks: AAAAir conditioning (T and.

Characteristics of upper Characteristics of upper resp. tractresp. tract

Nares to larynxNares to larynx Tasks:Tasks:

Air conditioning (T and humidity)Air conditioning (T and humidity) Filtering (particles > 5-20Filtering (particles > 5-20μμm)m) Microbial defenseMicrobial defense

MechanicalMechanical ChemicalChemical

Specific: IgASpecific: IgA Non-specific: lysozyme and lactoferrinNon-specific: lysozyme and lactoferrin

SensationSensation Odor perception (olfactory nerve)Odor perception (olfactory nerve) Irritant perception (trigeminal nerve)Irritant perception (trigeminal nerve)

phonationphonation

Page 3: Upper Respiratory Tract Diseases in Workplace. Characteristics of upper resp. tract NNNNares to larynx TTTTasks: AAAAir conditioning (T and.

Response mechanisms in Response mechanisms in upper airwayupper airway

Allergic responseAllergic response Mast cell degranulationMast cell degranulation

RhinorrheaRhinorrhea InflammationInflammation congestioncongestion

Neurogenic reflexNeurogenic reflex Triggerd by irritantsTriggerd by irritants Parasympathetic responseParasympathetic response Axonal responseAxonal response

Page 4: Upper Respiratory Tract Diseases in Workplace. Characteristics of upper resp. tract NNNNares to larynx TTTTasks: AAAAir conditioning (T and.

Occupational diseasesOccupational diseases

Allergic rhinnitisAllergic rhinnitis Irritant rhinnitisIrritant rhinnitis Non-allrgic rhinnitisNon-allrgic rhinnitis SinusitisSinusitis Sensory alterationsSensory alterations

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Allergic rhinnitisAllergic rhinnitis

Frequency: 20% of general populationFrequency: 20% of general population TypesTypes

SeasonalSeasonal Perrenial (more common in workplace)Perrenial (more common in workplace)

Symptoms:Symptoms: RhinorrheaRhinorrhea CongestionCongestion SneezingSneezing ItchingItching ± eye and chest symptoms± eye and chest symptoms

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signs signs Pale and boggy nasal mucosaPale and boggy nasal mucosa Sticky secretionsSticky secretions

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Occupational causesOccupational causes Commonly-encountered allergensCommonly-encountered allergens

Pollens in gardenersPollens in gardeners Specific allergensSpecific allergens

HMW compoundsHMW compounds Animal antigensAnimal antigens Plant antigensPlant antigens Insect antigensInsect antigens LatexLatex

LMW compoundsLMW compounds TDITDI Acid anhydridsAcid anhydrids ColophonyColophony

Work-induced or work-aggravatedWork-induced or work-aggravated

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AttentionAttention

Causes of allergic rhinitis are the same as Causes of allergic rhinitis are the same as asthmaasthma

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ParaclinicParaclinic CBCCBC

EosinophiliaEosinophilia Increased serum IgEIncreased serum IgE

Nasal smearNasal smear EosinophiliaEosinophilia

Skin prick test (gold standard)Skin prick test (gold standard) Nasal peak flow measurement (across-shift)Nasal peak flow measurement (across-shift)

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TreatmentTreatment

Allergen avoidanceAllergen avoidance Engineering controlsEngineering controls Personal protective devicesPersonal protective devices ReassignmentReassignment

Medical therapy:Medical therapy: Systemic antihistaminesSystemic antihistamines Nasal steroidsNasal steroids Nasal Cromolyn sodiumNasal Cromolyn sodium Nasal ipratropium bromide (esp. vasomotor symptoms)Nasal ipratropium bromide (esp. vasomotor symptoms)

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Irritant rhinitisIrritant rhinitis

Most common place of irritationMost common place of irritation CausesCauses

Combustion productsCombustion products VOCsVOCs Chromic acidChromic acid

RUDSRUDS Rhinitis after a sudden high exposure to Rhinitis after a sudden high exposure to

irritantsirritants

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Irr. rhinitisIrr. rhinitis

Symptoms: nasal congestion, rhinorrheaSymptoms: nasal congestion, rhinorrhea Signs: erythema and erosion in nasal Signs: erythema and erosion in nasal

mucosamucosa Paraclinic: no paraclinic testParaclinic: no paraclinic test DDx: allergic rhinnitisDDx: allergic rhinnitis

Irritation rather than sneezing and itchingIrritation rather than sneezing and itching High prevalence among co-workersHigh prevalence among co-workers Dramatic improvement when not exposedDramatic improvement when not exposed

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Treatment:Treatment: Reduction of exposureReduction of exposure Saline nasal lavageSaline nasal lavage Topical streoid or ipratropium bromideTopical streoid or ipratropium bromide

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Non-allergic rhinitisNon-allergic rhinitis

Vasomotor rhinitisVasomotor rhinitis Augmented nasal reactivity to non-specific Augmented nasal reactivity to non-specific

physical stimuliphysical stimuli Low humidityLow humidity Rapid changes of temperatureRapid changes of temperature Excessive air motionExcessive air motion

Gustatory rhinitisGustatory rhinitis Ingestion of spicy foodsIngestion of spicy foods

Bright-light rhinitisBright-light rhinitis

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Occupational sinusitisOccupational sinusitis

Seen in:Seen in: Spice workersSpice workers Vegetable picklersVegetable picklers Grain and flour workersGrain and flour workers

Most common:Most common: Sinusitis after complication of rhinitisSinusitis after complication of rhinitis

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Occupational laryngeal Occupational laryngeal pathologypathology

Hoarseness due to:Hoarseness due to: Overuse of voiceOveruse of voice Chemical irritantsChemical irritants

Laryngeal SCC due to:Laryngeal SCC due to: AsbestosAsbestos SmokingSmoking EthanolEthanol Leather ant textile workersLeather ant textile workers Gasoline and diesel oilGasoline and diesel oil

Laryngeal stricture due to:Laryngeal stricture due to: Smoke inhalation injurySmoke inhalation injury

Vocal cord dusfunctionVocal cord dusfunction Stridor, hoarseness, shortness of breath, globusStridor, hoarseness, shortness of breath, globus Acute irritant exposuresAcute irritant exposures