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Other conditions

Occupational lung disease

There are a range of occupational lung diseases that have unique causes, symptoms and diagnosis.

Work-related asthma

Work-related asthma is caused by inhaling dust, fumes, gases or other potentially hazardous agents while at work, making the airways inflamed and irritable. It is likely to occur in up to 20 per cent of cases of asthma. Work-related asthma can be used to describe the development of asthma (occupational asthma) or worsening of existing asthma (work-exacerbated asthma) due to occupational factors.

There are more than 2,000 known substances which can cause work-related asthma and more are being described every year. Anyone exposed to hazardous agents at work can develop work-related asthma, although people with a family history of allergies are at greater risk.

Symptoms

Work-related asthma symptoms can vary between work-exacerbated and occupational asthma. Work-exacerbated asthma can develop quite quickly whereas occupational asthma symptoms usually develop over months or years.

You may start by experiencing nasal symptoms such as congestion or sneezing. Symptoms may occur at the time of exposure, however they can also occur several hours after exposure (up to 12 hours). Generally, work-related asthma symptoms are better when away from work, on days off and on holidays. However, symptoms can be variable and may be difficult to relate to work, especially with shift work. Common symptoms include cough and shortness of breath. Other possible accompanying symptoms may include a runny nose, nasal congestion and eye irritation and tearing.

In the later stages of the development of occupational asthma, airways may be continually inflamed and symptoms may continue even when away from work.

 

Shortness of breath

Tightness in the chest

Wheeze

Cough

Diagnosis

Work-related asthma is diagnosed in the same way as any other type of asthma, except your doctor will ask you specific questions about your workplace, symptoms and medical history. This may include:

  • Where you work and your role
  • Potential exposures (e.g. flour dust, latex, animal fur skin, chemicals, fumes, etc.)
  • Whether your symptoms change when you are away from work
  • Whether your symptoms are worse on the days you work
  • Whether you smoke – may increase sensitivity to workplace triggers.

You are also likely to undergo a series of tests, such as:

  • Physical examination
  • Lung-function (breathing) tests
  • Serial measurement of peak expiratory flow (PEF)

Your doctor may also perform tests to determine if you have a reaction to any specific substances. These may include:

  • Allergy skin tests
  • Challenge test
  • Fractional exhaled nitric oxide (FeNO) test

Management

If the substance causing your work-related asthma is identified, it is essential to limit or prevent any further exposure to it. By limiting or preventing exposure early enough, your work-related asthma may subside or even be cured. However, if exposure continues over a long period of time, you may be left with asthma even after you have limited your exposure or left the job.

Medication

You are likely to need medication to control your symptoms and prevent asthma attacks or flare-ups. Treatment is the same as for other types of asthma, with inhaled medications being prescribed. It is usual to have a regular inhaler, taken even when you feel well, and a reliever medication, to reduce symptoms when they flare up. Newer biological treatments are effective for asthma but have not been specifically studied in occupational asthma.

Occupational lung infections

Although most infections that occur in the lungs are typically acquired in the community, there are a range of viral or bacterial infections that are caused by work conditions or practices. Some common infections include:

  • Legionella pneumonia – a lung infection caused by inhaling legionella bacteria. These bacteria are found in water systems in an occupational setting and occasionally in other water systems such as evaporative conditioners. It typically affects people involved in maintaining (hot) water pipes, reservoirs, pumps or fountains and can also spread to the community.
  • Zoonotic diseases – these diseases, such as Q-fever, come from animals. They cause “flu-like” symptoms, and psittacosis, which causes pneumonia. These typically affect workers who have close contact with animals (Q-fever) or birds (psittacosis).
  • Pneumonia – a potentially fatal lung infection that can be caused by viruses (viral pneumonia), bacteria or fungi. Pneumococcal pneumonia, which is caused by the bacterium Streptococcus pneumoniae, can occur in welders as a result of metal fumes.
  • Tuberculosis – a bacterial disease that most affects the lungs. It is not common in Australia and is typically acquired overseas. In an occupational setting, the risk is primarily in healthcare workers, but may also occur in people who work in crowded environments, such as in prisons.

Symptoms

The symptoms vary depending on which type of infection you have. Each infection is different, although most people will start to experience symptoms several days to 2 to 3 weeks after they have been exposed to the virus or bacteria. In general, symptoms of lung infections typically include:

Cough with sputum that may be yellowish or green

Coughing up rusty or blood-stained sputum

Shortness of breath

Fever or chills

Muscle aches and pains

Diagnosis

You should discuss your symptoms, job and other activities where you could have been exposed with your doctor. If your doctor thinks an infection could be the cause of your symptoms, they will examine your lungs, and test if you have a fever. Other tests will depend on what infection they suspect but are likely to include sputum samples and blood tests. Nasal and throat swabs may also be needed.

Management

Most occupational lung infections can be effectively treated with antibiotics, although the specific antibiotic selected depends on which infection you have.

Hypersensitivity pneumonitis

Hypersensitivity pneumonitis, or extrinsic allergic alveolitis, occurs when the tissue in your lungs has an allergic reaction to an inhaled substance and becomes inflamed (swollen and irritable). The disease is known to develop across many occupations and industries, and it is likely that some people are more susceptible to developing the disease than others. Generally, you have to be exposed to the substance over some months or years to develop the condition.

There are hundreds of substances known to cause hypersensitivity pneumonitis. A number of specific disease names have been given as a result of the substance that causes it. These include:

  • Bird fancier’s lung – bird feathers and droppings
  • Bagassosis – mouldy sugar cane
  • Farmer’s lung – mould that grows on hay, straw or grain
  • Humidifier lung – fungus growing in humidifiers, air conditioners and heating systems
  • Hot tub lung – bacteria in the water vapour (mist) from hot tubs, particularly indoor hot tubs
  • Miller’s lung – mouldy grain, flour or dust

Note: This is not an exhaustive list of all types of hypersensitivity pneumonitis.

Symptoms

The symptoms of hypersensitivity pneumonitis include:

Shortness of breath

Cough

Fever or chills

Headache

Fatigue

Aching muscles and joints

Types

There are three types of hypersensitivity pneumonitis: acute, sub-acute and chronic. They differ based on the length of time people experience symptoms, as well as the types of symptoms experienced.

  • Acute hypersensitivity pneumonitis: often referred to as an “acute attack” – usually occurs for 4-6 hours after heavy exposure to the substance. Symptoms may last for 12 hours to a few days, and generally resolve if further exposure is avoided
  • Sub-acute hypersensitivity pneumonitis: symptoms last for weeks to months
  • Chronic hypersensitivity pneumonitis: symptoms last for years. In rare cases, chronic hypersensitivity pneumonitis can lead to irreversible, permanent scarring of the lung tissue – a condition known as Pulmonary Fibrosis.

Chronic hypersensitivity pneumonitis is more likely to cause shortness of breath, cough, fatigue and weight loss than acute hypersensitivity pneumonitis, which generally presents with fever, fatigue and muscle aches as well as the respiratory symptoms.

If severe Pulmonary Fibrosis develops, then finger or toe clubbing may occur (rounding and widening of the ends of the digits and the nails).

Management

If you and your doctor can identify the substance you are allergic to, the single most important thing to do is to avoid further exposure. If your disease is diagnosed early, avoiding the substance you are allergic to may help reverse the damage to your lungs, or even cure it. If avoidance strategies don’t work, your doctor may prescribe medications to help manage your disease.

Medication

There are several types of medications that may help you manage your symptoms. These include:

  • Corticosteroids, which reduce inflammation
  • Immunosuppressive medications, which also reduce inflammation and prevent your immune system from reacting to the substances you are inhaling.
  • Your doctor may also suggest reliever medication which helps to open up your airways and make breathing easier.

Oxygen therapy

Oxygen therapy may be prescribed by your doctor if you have low blood oxygen levels. Read more here.

Lung transplantation

Surgery is rarely used as a treatment for hypersensitivity pneumonitis, but in very severe disease, lung transplantation may be considered. If you are suitable for lung transplantation, your doctor will discuss the risks and benefits of the surgery.

Resources for you

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