307.4 📋 章末速記 Summary

307.4.1 🔑 一句話總結

職業性肺病 由 workplace 吸入暴露引起；Pneumoconioses (無機塵)：silicosis (engineered stone 2010s-2020s 新流行)、asbestosis (pleural plaque + mesothelioma + lung cancer)、CWP、berylliosis (granulomatous + HLA-DPB1)；Organic dust diseases：HP (Ch305)；Occupational asthma + RADS (Ch303)；Acute irritants：chlorine、ammonia、SO2、NO2 (silo filler)、phosgene (delayed 6-24h)；Air pollution PM2.5 是確立的 CV risk factor；Indoor：tobacco、biomass cooking、radon (lung cancer 2nd cause)、formaldehyde；EVALI (vitamin E acetate + THC vapes)；Popcorn lung (diacetyl bronchiolitis obliterans)；Mesothelioma 治療 = nivolumab + ipilimumab (CheckMate 743) first-line。

307.4.2 💊 治療精要

• all pneumoconioses：exposure cessation + supportive + lung transplant for end-stage
• silicosis：TB screening (silica-TB association)
• asbestosis：LDCT for cancer screening + smoking cessation 多重要 (multiplicative)
• berylliosis：steroids + methotrexate / infliximab for refractory
• mesothelioma：nivolumab + ipilimumab (CheckMate 743) OR cisplatin + pemetrexed；surgery for selected
• acute irritant inhalation：supportive、O2、bronchodilators、steroids、treat as ARDS if severe
• EVALI：cessation + steroids + supportive

307.4.3 🎯 盧醫師的考前提醒

1. engineered stone silicosis 2010s-2020s 新流行：Caesarstone, Silestone 等人造石英檯面切割；年輕工人、快速進展、PMF 為主；OSHA + WHO global action
2. silica-TB association：所有 silicosis 病人都要 TB screening（IGRA / TST）+ 治療 latent；alveolar macrophage 受損 → TB reactivation
3. asbestos + smoking multiplicative：smoking alone 10x lung cancer；asbestos alone 5x；合併 50-90x；asbestos + 戒菸極重要
4. mesothelioma 2024 standard：nivolumab + ipilimumab (CheckMate 743) first-line in unresectable，median OS 18.1 vs 14.1 months chemo；epithelioid prognosis 較好
5. CWP Caplan syndrome：coal worker + RA → 多發性 lung nodules + rheumatoid arthritis
6. berylliosis 鑑別 vs sarcoid：granulomas + HLA-DPB1 + BeLPT positive；exposure history 關鍵
7. silo filler’s disease：nitrogen dioxide from silage 發酵；2-4 weeks 後 bronchiolitis obliterans；avoid silos for 2 weeks after filling
8. phosgene 延遲性 pulmonary edema 6-24h：WWI chemical weapon；observation > 24h after exposure
9. PM2.5 = CV risk factor：每 10 μg/m³ ↑ → 6% ↑ CV mortality；比 DM 更大公衛影響
10. radon = lung cancer 第二大原因（僅次 smoking）；US EPA testing + mitigation < 2 pCi/L