Upper Respiratory Tract Diseases in Workplace Characteristics of

Upper Respiratory Tract Diseases in Workplace

Characteristics of upper resp. tract § Nares to larynx § Tasks: § § § Air conditioning (T and humidity) Filtering (particles > 5 -20μm) Microbial defense § Mechanical § Chemical § Specific: Ig. A § Non-specific: lysozyme and lactoferrin § Sensation § Odor perception (olfactory nerve) § Irritant perception (trigeminal nerve) § phonation

Response mechanisms in upper airway § Allergic response § Mast cell degranulation § Rhinorrhea § Inflammation § congestion § Neurogenic reflex § Triggerd by irritants § Parasympathetic response § Axonal response

Occupational diseases § § § Allergic rhinnitis Irritant rhinnitis Non-allrgic rhinnitis Sinusitis Sensory alterations

Allergic rhinnitis § Frequency: 20% of general population § Types § Seasonal § Perrenial (more common in workplace) § Symptoms: § Rhinorrhea § Congestion § Sneezing § Itching § ± eye and chest symptoms

§ § § signs Pale and boggy nasal mucosa Sticky secretions

Occupational causes § Commonly-encountered allergens § Pollens in gardeners § Specific allergens § HMW compounds § § Animal antigens Plant antigens Insect antigens Latex § LMW compounds § TDI § Acid anhydrids § Colophony § Work-induced or work-aggravated

Attention Causes of allergic rhinitis are the same as asthma

§ Paraclinic § CBC § Eosinophilia § Increased serum Ig. E § Nasal smear § Eosinophilia § Skin prick test (gold standard) § Nasal peak flow measurement (acrossshift)

Treatment § Allergen avoidance § Engineering controls § Personal protective devices § Reassignment § Medical therapy: § Systemic antihistamines § Nasal steroids § Nasal Cromolyn sodium § Nasal ipratropium bromide (esp. vasomotor

Irritant rhinitis § Most common place of irritation § Causes § Combustion products § VOCs § Chromic acid § RUDS § Rhinitis after a sudden high exposure to irritants

Irr. rhinitis § Symptoms: nasal congestion, rhinorrhea § Signs: erythema and erosion in nasal mucosa § Paraclinic: no paraclinic test § DDx: allergic rhinnitis § Irritation rather than sneezing and itching § High prevalence among co-workers § Dramatic improvement when not exposed

§ Treatment: § Reduction of exposure § Saline nasal lavage § Topical streoid or ipratropium bromide

Non-allergic rhinitis § Vasomotor rhinitis § Augmented nasal reactivity to non-specific physical stimuli § Low humidity § Rapid changes of temperature § Excessive air motion § Gustatory rhinitis § Ingestion of spicy foods § Bright-light rhinitis

Occupational sinusitis § Seen in: § Spice workers § Vegetable picklers § Grain and flour workers § Most common: § Sinusitis after complication of rhinitis

Occupational laryngeal pathology § Hoarseness due to: § Overuse of voice § Chemical irritants § Laryngeal SCC due to: § § § Asbestos Smoking Ethanol Leather ant textile workers Gasoline and diesel oil § Laryngeal stricture due to: § Smoke inhalation injury § Vocal cord dusfunction § § Stridor, hoarseness, shortness of breath, globus Acute irritant exposures