Cigarette Factory Workers
Tea Sifters and Packers
Woolen industry Workers
Chemical Plant Worker
Foundry mold makers
Furan Based Resin Binder Systems
Formalin / Formaldehyde
Polyvinyl Chloride Vapors
Stainless Steel Fumes
Western Red Cedar
Saw Mill Workers
Health Care Workers
(This list is by no means inclusive, but only partial)
When Should You Suspect an
Occupational Lung Disease Such as Asthma?
First of all, the worker in an industry which is considered a high risk such as health care workers, car painters, painters, wood workers, gardeners, pesticide/insecticide sprayers, and mechanic workers. The symptomatology of discrete and otherwise medically unexplained atypical cough, chest tightness, skin irritation, eye irritation which appears as a result of a work environment which was not there before, and have a temporal relationship to the work environment exposure.
Presentation of a Case And Analysis
J. W., 42 years, worked for Aeronautic Supplier in the paint spraying facility. He experienced an industrial orthopaedic injury, and was referred to the company doctor. He received physical therapy, was unhappy with the treatment, and elected his own primary treating physician of choice. The primary treating physician of choice was diligent enough to take a good occupational history, and was intrigued by the patient's cough and chest tightness. The diligent doctor referred the patient to my office for a consultation. After a detailed exposure history, non-industrial factors, absence of history of preexisting asthma, absence of heavy smoking, and some typical diagnostic studies which were positive, such as the Methacholine stimulation test, the diagnosis of industrial asthma was made. Essentially what happened here was, the company physician failed to take an adequate appropriate occupational history. The company failed to screen the workers on an annual basis, and specifically this worker who worked there for 10 years, in a high risk occupation known to be associated with an increased risk of occupational lung disease, specifically asthma, and the intake person in the attorneys' office concentrated on the industrial orthopaedic injuries, (since the attorney's office is not in the medical business, and is not trained to take an occupational history). It was this patient's luck to be sent to a good primary treating physician who picked up some unusual symptomatology of the chest, and quickly referred the patient to our offices. Removal of the patient from his work environment and appropriate treatment alleviated the symptoms, established a diagnosis, and required vocational rehabilitation, and a disability which included no exposure to concentration of fumes and dust particles, and in light of very abnormal oxygen saturation, and oxygen exchange on metabolic exercise test, a work restriction of no heavy work.
Take Home Message
Make sure to have the details, correct history, make sure that the primary treating physician understands occupational medicine, and will take an accurate and detailed occupational history, and will be alert to symptoms which may not be typical of asthma, but which highly supports the diagnosis of asthma. The final diagnosis should be made based on objective studies to include, when indicated, methacholine stimulation test, and for disability rating, when indicated, metabolic exercise test with oxygen exchange measurements. (See also AMA 5th Guides, American Thoracic Society)
Dr. Brautbar is a board-certified internist and nephrologist, and certified in forensic medicine. If you are interested in retaining Dr. Brautbar for forensic and expert witness testimony services, please submit the Contact Form.
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© 2013 Nachman Brautbar M.D.
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