CHAPTER 3

OCCUPATIONAL DISEASES AND

INFECTION PART II
 SUBTOPIC

• 3.1 Target Organs: Respiratory

System

• 3.2 Pandemics, Seasonal and Avian

Influenza
 Target organ:
respiratory system
 STRUCTURE
• The upper and lower respiratory tracts
are vulnerable to occupationally related
noxious agents.
• Over 80% of these agents gain access to
the body via respiratory system.
• The system is composed of:
– The mouth
- nasal sinuses
- pharynx
- larynx
– The trachea, main and segmental
bronchi;
– The alveoli
 LUNG FUNCTION

• The main function of the lungs is to

supply oxygen for uptake by the
pulmonary capillaries and to provide
means for removing carbon dioxide
diffusing in the opposite direction.

• The successful achievement of this gas

exchange require
– Ventilation (air circulation);
– Gas transfer;
– Blood-gas transport.
 RESPIRATORY HAZARD
• Respiratory hazards usually arise from exposure to
substances hazardous to health which are small enough to
be inhaled or breathed in, such as dust, fumes,
spores, or bacteria and virus. Sometimes, substances
absorbed through the skin can also be hazardous to the
respiratory system.

• Exposure can cause Occupational Respiratory Disease.

This is a term which covers a group of different respiratory
conditions which affect your lungs in different ways.
They include:

• Occupational asthma,
• Extrinsic allergic alveolitis,
• Allergic rhinitis,
• Chronic obstructive pulmonary disease,
• Lung cancer,
• Acute and chronic bronchitis,
• Paranasal sinus cancer and
• Mucous membrane irritation.
 LUNG FUNCTION TEST
• Lung function tests (also called pulmonary function
tests, or PFTs) evaluate how well your lungs work.

• The tests determine how much air your lungs can

hold, how quickly you can move air in and out of
your lungs, and how well your lungs put oxygen into
and remove carbon dioxide from your blood.

• The tests can diagnose lung diseases, measure the

severity of lung problems, and check to see how well
treatment for a lung disease is working.

• For this test, you breathe into a mouthpiece attached

to a recording device (spirometer). The information
collected by the spirometer may be printed out on a
chart called a spirogram.
 LUNG FUNCTION TEST
• Other tests such as residual volume, gas
diffusion tests, body plethysmography,
inhalation challenge tests, and exercise
stress tests may also be done to determine lung
function.

• Spirometry is the first lung function test done.

It measures how much and how quickly you
can move air out of your lungs.
 LUNG FUNCTION TEST
• The more common lung function values measured with spirometry are:

• Forced vital capacity (FVC). This measures the amount of air you can
exhale with force after you inhale as deeply as possible.

• Forced expiratory volume (FEV). This measures the amount of air you
can exhale with force in one breath. The amount of air you exhale may be
measured at 1 second (FEV1), 2 seconds (FEV2), or 3 seconds (FEV3).
FEV1 divided by FVC can also be determined.

• Forced expiratory flow 25% to 75%. This measures the air flow
halfway through an exhale (FVC).

• Peak expiratory flow (PEF). This measures how quickly you can
exhale. It is usually measured at the same time as your forced vital
capacity (FVC).
 LUNG FUNCTION TEST
• Maximum voluntary ventilation (MVV). This measures the
greatest amount of air you can breathe in and out
during one minute.
• Slow vital capacity (SVC). This measures the amount of
air you can slowly exhale after you inhale as deeply as
possible.
• Total lung capacity (TLC). This measures the amount of
air in your lungs after you inhale as deeply as possible.
• Functional residual capacity (FRC). This measures the
amount of air in your lungs at the end of a normal exhaled
breath.
• Expiratory reserve volume (ERV). This measures the
difference between the amount of air in your lungs after a
normal exhale (FRC) and the amount after you exhale
with force (RV).
 CHEST X-RAY
• The chest radiograph can show structural lung damage
from exposure to dusts, gases and fumes.

• However, there are moves to limit the use of chest X-rays

only to situations where there is a clear clinical indication.

• Although X-rays are useful for diagnosis and treatment of

individuals, they are less values in the screening of
occupational groups for surveillance and prevention.

• Efforts aimed at reduction of exposure would be more

valuable than instituting regular X-rays of exposed
workers with no clear benefit.
Harmful effects to the lung produced by
noxious agents can be grouped as:
• Acute inflammation;
• Respiratory sensitization (asthma);
• Pneumoconiosis;
• Extrinsic allergic alveolitis;
• Malignancy;
• Infections.
 Occupational Lung
Disorders – Acute
Inflammation (pneumonia)
• Primarily caused by the irritant gases and fumes.
• Their solubility determines whether their effects are most
noticeable on the upper or lower respiratory tracts.
• Soluble gases that irritate the upper respiratory tract will
cause affected individuals to move away from the source of
the gas.
• Examples of the gases are:
– Ammonia
– Chlorine
– SO2
• Some irritant gases can also caused a delayed pulmonary
oedema with respiratory distress occurring 48-72 hours after
exposure.
• Examples are Nox, phosgene, fluorine and ozone.
Occupational Lung Disorders –
Asthma
• May be caused by a variety of dusts.
• May be immediate reaction (develop within
minutes of exposure) or late (4-8 hours to
develop).

• Occupational asthma has been variously

estimated causing as causing 2-15% of all
asthma, but it is important to realize that
atopy
is not predisposing state, except for a very
few of the known allergenic dusts.
 Occupational Lung
Disorders – Asthma
Prevention involves several factors:
– Efficient and rigorous hygiene control in the
workplace;
– Substitution with less allergenic materials;
– Effective personal respiratory protection for
the workers for specific unavoidable
tasks where exposure is anticipated;
– Identification of workers at risk – not an easy
task;
– Health surveillance, with pre- and post-shift
ventilator capacity measurement (secondary
prevention).
 Occupational Lung Disorders
– Byssinosis
There is some debate over whether byssinosis should be classified
as occupational asthma.

• The conditions is however, more broader and complex than other

forms of asthma.
• In susceptible individuals, exposure to dusts of cotton, sisal,
hemp or flax can produce acute dyspnoea, with cough and
reversible obstruction of the airways.
• It is noticed initially on the first day of the working week, and
subsides on subsequent days. Later, with continuous exposure,
symptoms also occur on the subsequent days of the week until
weekends or holidays.
• The effects are greatest where the dust concentrations are
highest, and are noticeable with coarser cotton.
• Byssinosis is probably a mixture of a true asthma to chronic
bronchitis.
 Occupational Lung Disorders
– Pneumoconiosis
• The term means ‘dusty lungs’. It is the accumulation of dust in
the lungs and the tissue reaction to
its presence.
• For practical purposes, pneumoconiosis is usually restricted to
those conditions that cause permanent alteration in lung
architecture following the inhalation of mineral dusts which
include:
– Silica (or quartz);
– Coal;
– Asbestos.
• The clinical and radiographic features of silicosis, ‘coal workers’
pneumoconiosis is summarized in the handouts.
• Silicosis occurs following the inhalation of ‘free’ silica, and is
most common among workers involved in quarrying, mining
and tunnelling through quarts-bearing rock i.e. gold mining.
Occupational Lung Disorders –
Pneumoconiosis
May present as one of four clinical types:
– Nodular, with hyaline and collagenous lesions in
the lungs,
– Mixed dust fibrosis, with irregular, stellate, fibrotic
lesions,
– Diatomite – a picture similar to fibrosing alveolitis
and usually attributed to diatomaceous earth;
– Acute – a rapidly developing alveolar
lipoproteinosis (mucuous) with fibrosing alveolitis.
 Occupational Lung Disorders –
Extrinsic Allergic Alveolitis
As noted, the inhalation of organic materials
can give rise to asthma.

• However, organic dusts produce alveolitis,

resulting in lower gas transfer across the
blood-gas barrier.
• Most of the agents capable of producing
this effect are fungal spores, and the most
common clinical condition in Britain is
farmer’s lung.
• These diseases frequently have acute,
influenza-like episodes, which if exposure is
continued, lead to subacute and chronic
pulmonary
fibrotic diseases.
 Pandemics Influenza
• An influenza (flu) pandemic is a widespread outbreak
of disease that occurs when a new influenza virus
appears that people have not been exposed to
before.
• Pandemics are different from seasonal outbreaks of
influenza. Pandemic influenza can cause serious
illness because people do not have immunity to
the new virus.
• Effective vaccines would not be immediately available
and impacts on society would be significant.
 Seasonal influenza
• Seasonal Influenza is a respiratory illness, caused by
the influenza virus that affects many Canadians each
year.
• Influenza viruses are easily passed from person- to-
person.
• Although most people will recover completely, 2000–
8000 Canadians die every year from influenza and its
complications.
• Seasonal influenza outbreaks are caused by viruses
that people have already been exposed to; flu
shots are available to prevent widespread illness and
impacts on society are less severe
 Avian influenza
• Avian Influenza is a group of influenza viruses
that cause sickness and death in birds.
Sometimes, these bird viruses infect other
species, such as pigs and humans.
• Avian influenza is mainly spread by direct
contact between infected birds and healthy
birds.
• It can also be transmitted when birds come in
contact with equipment or materials
(including water and feed) that have been
contaminated with faeces or secretions from
the nose or mouth of infected birds.
• People can also spread the disease indirectly
from farm to farm by their carrying the virus on
their clothing, boots or vehicle wheels.
 Tutorial
• Based on previous slides,
construct a table of
characteristics of COVID19 in
Malaysia as below:
-occurrences
-Infection rates
-Fatality
-Recovery
-Group at risk
-Prevention
-Treatment