307.1 🎓 醫孞生版

307.1.0.1 📌 䞀頁重點

307.1.0.1.1 Pneumoconioses (Inorganic Dust)
307.1.0.1.1.1 Silicosis

Etiology: - Crystalline silica (quartz) - Mining, quarrying, stone cutting, sandblasting, foundries, ceramics - Resurgent epidemic: engineered stone (Caesarstone, Silestone) countertop workers (2010s-2020s)

Forms: - Acute silicosis: massive exposure over months; alveolar proteinosis pattern; rapidly fatal - Accelerated silicosis: 5-10 years exposure; progressive - Chronic silicosis (classical): 10-30+ years exposure; nodular fibrosis - Complicated (PMF): progressive massive fibrosis from coalescence

Clinical: - Asymptomatic early - Progressive dyspnea, cough - Restrictive (eventual mixed) pattern - HRCT: upper lobe nodules (1-10 mm), eggshell calcification of lymph nodes - Complications: TB (↑↑), lung cancer, autoimmune (RA, scleroderma, SLE)

Treatment: - Exposure cessation - Supportive (no specific therapy) - TB screening (silica-TB association) - Lung transplant for severe

307.1.0.1.1.2 Asbestosis

Etiology: - Asbestos fibers (chrysotile, amosite, crocidolite, anthophyllite, tremolite, actinolite) - Insulation, shipbuilding, construction, mining - Latency 20-40 years

Clinical Forms: - Pleural plaques: usually asymptomatic; CXR/CT incidental - Asbestosis (parenchymal): interstitial fibrosis, basilar - Pleural effusion (benign) - Diffuse pleural thickening - Mesothelioma (highly associated; even low exposure) - Lung cancer (multiplicative with smoking)

Diagnosis: - Occupational exposure history - HRCT: subpleural reticular fibrosis (basilar, like UIP) - Pleural plaques - BAL: ferruginous bodies (asbestos fibers coated with iron-protein)

Treatment: - Exposure cessation - Lung cancer screening (LDCT) - Smoking cessation crucial (multiplicative) - Symptomatic for fibrosis - Mesothelioma: cisplatin + pemetrexed; immunotherapy (nivolumab + ipilimumab — CheckMate 743)

307.1.0.1.1.3 Coal Workers’ Pneumoconiosis (CWP)

Etiology: - Coal dust + silica - Underground coal miners

Forms: - Simple CWP: small nodules (1-5 mm) - Complicated CWP / PMF: large opacities > 1 cm - Caplan syndrome: CWP + rheumatoid arthritis

Clinical: - Often asymptomatic until advanced - Cough, sputum (chronic bronchitis) - Progressive dyspnea

Treatment: - Exposure cessation - Supportive

307.1.0.1.1.4 Berylliosis (Chronic Beryllium Disease)

Etiology: - Beryllium (aerospace, electronics, ceramics, nuclear) - Genetic susceptibility (HLA-DPB1)

Clinical: - Granulomatous (mimics sarcoidosis) - Lung + skin + multi-organ - Progressive dyspnea

Diagnosis: - BeLPT (beryllium lymphocyte proliferation test) - Biopsy: non-caseating granulomas

Treatment: - Exposure cessation - Corticosteroids - Methotrexate, infliximab for refractory

307.1.0.1.1.5 Siderosis (Welder’s Lung)

Etiology: iron dust + welding fumes Clinical: usually asymptomatic; “benign” pneumoconiosis Imaging: nodular pattern; usually reversible with cessation

307.1.0.1.1.6 Other Pneumoconioses
  • Talcosis: talc (sometimes contaminated with silica or asbestos)
  • Stannosis: tin
  • Baritosis: barium
  • Hard-metal disease: cobalt + tungsten carbide (machinists); giant cell interstitial pneumonia
307.1.0.1.2 Organic Dust Diseases
307.1.0.1.2.1 Hypersensitivity Pneumonitis (HP)
  • See Ch305
  • Organic antigens (farmer’s lung, bird fancier’s, etc.)
307.1.0.1.2.2 Organic Dust Toxic Syndrome (ODTS)
  • Acute febrile illness 4-12h after heavy organic dust exposure
  • No prior sensitization (unlike HP)
  • Self-limited (1-7 days)
  • Similar to HP acute but no immune sensitization
307.1.0.1.2.3 Byssinosis (“Monday Fever”)
  • Cotton, flax, hemp dust
  • Bronchospasm worse on Mondays (after weekend off)
  • Treatment: dust control, bronchodilators
307.1.0.1.2.4 Asthma (Occupational)
  • See Ch303
307.1.0.1.3 Toxic Inhalation
307.1.0.1.3.1 Acute Irritant Exposure
  • Chlorine: pool, industrial; tracheobronchitis, pulmonary edema
  • Ammonia: refrigerants, fertilizer; mucosal damage, ARDS
  • Sulfur dioxide: industrial, volcanic
  • Nitrogen dioxide: silo filler’s disease (silage off-gas)
  • Ozone: photochemical smog, industrial
  • Phosgene: WWI chemical, industrial; delayed pulmonary edema 6-24h
  • Smoke inhalation: thermal injury + chemical (CO, cyanide)
307.1.0.1.3.2 RADS (Reactive Airways Dysfunction Syndrome)
  • See Ch303
  • Single massive irritant exposure → asthma-like syndrome
307.1.0.1.4 Air Pollution (Outdoor)
307.1.0.1.4.1 Components
  • Particulate matter (PM10, PM2.5): combustion, dust
  • Ozone (O3): photochemical
  • Nitrogen oxides (NOx): vehicle, industrial
  • Sulfur dioxide (SO2): coal burning
  • Carbon monoxide (CO): combustion
  • Lead (declining)
307.1.0.1.4.2 Health Effects
  • Respiratory: ↑ Asthma exacerbations, ↑ COPD admissions, ↑ lung cancer
  • Cardiovascular: ↑ MI, stroke, HF, arrhythmia, atherosclerosis
  • Other: dementia, low birth weight, premature death
307.1.0.1.4.3 PM2.5 + Cardiovascular
  • 2024 AHA/ESC: established CV risk factor
  • Each 10 ÎŒg/m³ ↑ PM2.5 → 6% ↑ CV mortality
  • Worse than diabetes for population CV risk
307.1.0.1.5 Indoor Air Pollution
307.1.0.1.5.1 Tobacco Smoke
  • First-hand, second-hand, third-hand
  • Major cause of COPD, lung cancer, CV disease
307.1.0.1.5.2 Biomass Cooking
  • Wood, dung, coal, agricultural waste
  • Developing countries
  • Major cause of COPD + lung cancer in non-smokers
  • Improving stoves reduces risk
307.1.0.1.5.3 Radon
  • Naturally occurring radioactive gas (uranium decay)
  • Basements, ground contact
  • Second leading cause of lung cancer (after smoking)
  • Testing + mitigation
307.1.0.1.5.4 Other Indoor
  • Formaldehyde (carpets, particleboard)
  • VOCs (paints, cleaners)
  • Mold (especially water damage)
  • Pet dander
307.1.0.1.6 E-Cigarettes + Vaping
307.1.0.1.6.1 EVALI (E-Cigarette / Vaping Product Use-Associated Lung Injury)
  • Outbreak 2019, ongoing
  • Lipoid pneumonia pattern
  • Vitamin E acetate in THC products implicated
  • Acute respiratory failure
  • Steroids + cessation
  • Long-term complications
307.1.0.1.6.2 Vaping Health Effects
  • “Popcorn lung” (bronchiolitis obliterans from diacetyl)
  • ↑ Asthma + COPD risk (probably)
  • Nicotine addiction
  • Adolescent use concern
  • Not “harm reduction” definitive
307.1.0.1.7 Specific Occupational Syndromes
307.1.0.1.7.1 Popcorn Worker’s Lung
  • Diacetyl (butter flavoring)
  • Bronchiolitis obliterans
  • Lung transplant for end-stage
  • OSHA regulations now
307.1.0.1.7.2 Flock Worker’s Lung
  • Synthetic fiber (nylon, polyester)
  • Lymphoid hyperplasia + ILD
  • Often reversible with cessation
307.1.0.1.7.3 Hard-Metal Disease
  • Cobalt + tungsten carbide
  • Tool sharpeners, drill bits
  • Giant cell interstitial pneumonia
  • Steroids + exposure cessation
307.1.0.1.7.4 Indium Lung
  • Indium tin oxide (LCD manufacturing)
  • ILD + pulmonary alveolar proteinosis

307.1.0.2 🩺 床邊速查

  • Silicosis: silica; upper lobes, eggshell calcification of LN, TB risk
  • Asbestosis: pleural plaques + basilar fibrosis + mesothelioma + multiplicative lung cancer with smoking
  • CWP: coal dust; simple → complicated/PMF; Caplan + RA
  • Berylliosis: granulomatous, mimics sarcoid; BeLPT
  • Engineered stone silicosis: 2010s-2020s resurgent epidemic
  • Mesothelioma: nivolumab + ipilimumab (CheckMate 743)
  • Radon: 2nd cause of lung cancer
  • EVALI: vitamin E acetate + lipoid pneumonia