Download COPD and Chronic Lung Disease in the Agriculture Environment Dr

9/20/2012
AGRICULTURE RELATED
LUNG DISEASE
Jeremy Presley, MD
Western Kansas
Respiratory Therapy Conference
Welcome to Dodge City
Objectives
Will be able to better identify agriculture
related lung illness.
Understand the need or lack of need for
treatment in relation to agriculture related
lung disease
Participants will be able to help in patient
and provider education of agriculture
related lung disease and most importantly
prevention strategies.
1
9/20/2012
Dodge City High School- 1996
Bachelor of Science-Biology, Baker
University 2000
Doctor of Medicine- KU Medical Center
Wichita 2007
Via Christi Family Medicine ResidencyWichita 2010- Chief Resident
Why Ag Lung
Diseases?
It effects us all from being
a care provider to a
community member
Ag Lung Diseases
Hypersensitivity Pneumonitis
Asthma-like Syndrome
Asthma/COPD exacerbations
Organic Dust Toxin Syndrome
(OATS)
Chemical Exposure
2
9/20/2012
Hypersensitivity
Pneumonitis
AKA: Extrinsic allergic alveolitis,
“Farmer’s Lung”
Etiology: Reaction to bacteria/fungi in
spoiled hay or grain. Also
poultry/pets.
Symptoms: Fever, chills, cough,
malaise, hypoxia, 4-6hrs after
exposure
PFT’s: Low FVC and Low DLCO
Hypersensitivity
Pneumonitis
Requires prior antigen exposure
Imaging: X-ray=may be normal, High
Resolution CT=ground glass
Treatment: Steroid therapy 2-4 wk
taper
Prevention: Respirators
High Resolution CT
3
9/20/2012
Hypersensitivity
Pneumonitis
Subacute Farmer’s Lung: longer
term/repetitive exposure with mild
symptoms
Chronic Farmer’s Lung: Irreversible
pulmonary fibrosis
Asthma-like
Syndrome
Etiology: Exposure to combination of
dust, endotoxin, & ammonia.
Exposure in confinement barns.
AKA: Reactive Airways Dysfunction
Syndrome (RADS)
Symptoms: wheezing, cough,
dyspnea
Imaging: X-ray=normal
Asthma-like Syndrome
4
9/20/2012
Asthma-like
Syndrome
Treatment: Albuterol and asthma
meds not very effective, steroids are
mainstay
Found to be protective for
allergies/asthma as it is not allergy
related
Prevention is best treatmentrespirator, limit exposure time,
ventilation
Hygiene Hypothesis
Theory that microbial and
endotoxin exposure down
regulates immune response
in children.
Hygiene Hypothesis
5
9/20/2012
Organic Dust Toxic
Syndrome
Etiology: Endotoxin or fungal spores
attached to dust. Grain bins, silo
unloaders lung, hog confinement,
36% of farmers experience
Symptoms: Flu-like, fever, malaise,
cough, myalgias, headache,
developing 4-8hrs after exposure,
NO hypoxia
Organic Dust Toxin
Syndrome
Organic Dust Toxin
Syndrome
Imaging: X-ray=normal
Labs: Elevated WBC’s
Treatment: Self-limited, no antibiotics
Prevention: Respirators, wet down
silage before breaking to settle dust
6
9/20/2012
Chemical
Exposures
Anhydrous Ammonia-Mucous
membrane irritant resulting in
pulmonary edema
Treatment: Intubation and water
Chemical Exposures
Pesticides (organophosphates)
Symptoms: Bradycardia, wheezing,
salivation, respiratory paralysis,
odor, pulmonary edema
Treatment: Atrovent, Atropine until
bronchial secretions clear, 2-PAM
Avoid succinylcholine for RSI
Chemical Exposures
Welding-fumes, Aluminum releases
NO, TIG welding releases small
amounts of tungsten
Herbicides-uncertain direct effect,
indirect increases
leukemia/lymphoma-be aware to this
as CXR may look like
lymphadenopathy in non-smokers
7
9/20/2012
Silo Filler’s Disease
Etiology: fermenting silage produces
nitrogen dioxide that induces
pulmonary edema
Symptoms: Cough, burning, fever,
nausea/vomiting
Timeline: Hours to 3 wks after filling.
Can relapse in 2-6 wks after original
episode
Silo Filler’s Disease
•
Treatment: oxygen, mechanical
ventilation, high dose steroids
•
Prevention: Avoid exposure
Asthma/COPD
Exacerbations
AsthmaSymptoms: wheezing, cough, if
related to exposures may only
occur at work
Treatment: inhaled beta agonists,
steroids
Prevention: avoid exposures (once
asthma developed)
8
9/20/2012
Asthma/COPD
Exacerbations
COPD
Symptoms: cough, hypoxia,
mucous secretions, dyspnea
Treatment: inhaled beta agonists,
inhaled anticholinergics,
inhaled/oral steroids, PD4 inhibitor
Prevention: Exposure reduction
Zoonotic Infections
Tuberculosis-Bovine derived
Q fever: exposure to
cattle/sheep/goats. Treat with
tetracycline
Chlamydia pneumonia- exposure to
chickens/turkeys/parrots/parakeets.
Treat with tetracyclines
Hantavirus-transmitted from mice
Swine influenza
Other...
Distiller’s Grain: fermented grains
used for feed mixture-new to feed
market
Diesel Exhaust- irritant effect that
exacerbates asthma/COPD,
carcinogen exposure, uncertain
effect of new exhaust reduction
efforts i.e. DEF, Regen
9
9/20/2012
Other...
Byssinosis “Brown Lung”: Cotton
fiber inhalation causing asthma like
symptoms. Treat with asthma
medications and limit exposure
Breath through your nose-particles
>20microns-100% filtered, 5 microns
only 50% filtered
Prevention
Respirators
10
9/20/2012
Respirator
• DISPOSABLE DOUBLE STRAP
• Uses: Most any agriculture use but caution
with anhydrous ammonia, $1
• Limitations: No face protection, hot,
requires negative pressure breathing and
significant effort
Respirator
• REUSABLE CARTRIDGE MASK
• Uses: Most any agriculture application,
better fit and seal, different cartridges
for different exposures, $30-50
• Limitations: No face protection, hot,
requires negative pressure breathing
but easier than disposables typically
Respirator
• SELF CONTAINED BREATHING
APPARATUS
• Uses: Any agriculture environment, face
protection, cool air, easy breathing
• Limitations: Cost, bulk as you have to
wear the pump, $1000-1500
11
9/20/2012
Best Medicine
References
Treatment and Prognosis of Hypersensitivity Pneumonitis. Talmadge,
E. www.UTDOL.com. July 2012
What Farming Can Do to Your Lungs: How it can make you sick & how
it can protect. Von Essen, S. www.unmc.edu/publichealth. 2011
Exposure assessment and lung function in pig and poultry farmers.
Radon, K., Weber, C., Iversen, M. Occupational Environmental
Medicine 2001,Vol 58 pg405-410
Environmental Exposure to Endotoxin and Its Relation to Asthma in
School-Age Children. Braun-Fahrlander., C. Riedler, J., Herz, U. New
England Journal of Medicine 2002 Vol 347 pg 869-877
Exposure to Environmental Microorganisms and Childhood Asthma.
Ege, M., Mayer, M., Normand, A. New England Journal of Medicine
2011 Vol 364 pg 701-709
References
Agricultural Lung Diseases. Kirkhorn, S., Garry, V. Environmental
Health Perspectives 2000. Vol 108 pg 705-712
University of Wisconsin Agricultural Safety & Health Website. Silo Gas
and Silo Filler’s Disease. 7/27/12
3M Manufacturing,
http://solutions.3m.com/wps/portal/3M/en_US/PPESafetySolutions/PPE
Safety/
http://respiratorytherapycave.blogspot.com/p/rt-humor.html
12
9/20/2012
Questions/
Comments
13