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Upper Respiratory Upper Respiratory Tract Diseases Tract Diseases inin WorkplaceWorkplace
Characteristics of upper Characteristics of upper resp. tractresp. tract
Nares to larynxNares to larynx Tasks:Tasks:
Air conditioning (T and humidity)Air conditioning (T and humidity) Filtering (particles > 5-20Filtering (particles > 5-20μμm)m) Microbial defenseMicrobial defense
MechanicalMechanical ChemicalChemical
Specific: IgASpecific: IgA Non-specific: lysozyme and lactoferrinNon-specific: lysozyme and lactoferrin
SensationSensation Odor perception (olfactory nerve)Odor perception (olfactory nerve) Irritant perception (trigeminal nerve)Irritant perception (trigeminal nerve)
phonationphonation
Response mechanisms in Response mechanisms in upper airwayupper airway
Allergic responseAllergic response Mast cell degranulationMast cell degranulation
RhinorrheaRhinorrhea InflammationInflammation congestioncongestion
Neurogenic reflexNeurogenic reflex Triggerd by irritantsTriggerd by irritants Parasympathetic responseParasympathetic response Axonal responseAxonal response
Occupational diseasesOccupational diseases
Allergic rhinnitisAllergic rhinnitis Irritant rhinnitisIrritant rhinnitis Non-allrgic rhinnitisNon-allrgic rhinnitis SinusitisSinusitis Sensory alterationsSensory alterations
Allergic rhinnitisAllergic rhinnitis
Frequency: 20% of general populationFrequency: 20% of general population TypesTypes
SeasonalSeasonal Perrenial (more common in workplace)Perrenial (more common in workplace)
Symptoms:Symptoms: RhinorrheaRhinorrhea CongestionCongestion SneezingSneezing ItchingItching ± eye and chest symptoms± eye and chest symptoms
signs signs Pale and boggy nasal mucosaPale and boggy nasal mucosa Sticky secretionsSticky secretions
Occupational causesOccupational causes Commonly-encountered allergensCommonly-encountered allergens
Pollens in gardenersPollens in gardeners Specific allergensSpecific allergens
HMW compoundsHMW compounds Animal antigensAnimal antigens Plant antigensPlant antigens Insect antigensInsect antigens LatexLatex
LMW compoundsLMW compounds TDITDI Acid anhydridsAcid anhydrids ColophonyColophony
Work-induced or work-aggravatedWork-induced or work-aggravated
AttentionAttention
Causes of allergic rhinitis are the same as Causes of allergic rhinitis are the same as asthmaasthma
ParaclinicParaclinic CBCCBC
EosinophiliaEosinophilia Increased serum IgEIncreased serum IgE
Nasal smearNasal smear EosinophiliaEosinophilia
Skin prick test (gold standard)Skin prick test (gold standard) Nasal peak flow measurement (across-shift)Nasal peak flow measurement (across-shift)
TreatmentTreatment
Allergen avoidanceAllergen avoidance Engineering controlsEngineering controls Personal protective devicesPersonal protective devices ReassignmentReassignment
Medical therapy:Medical therapy: Systemic antihistaminesSystemic antihistamines Nasal steroidsNasal steroids Nasal Cromolyn sodiumNasal Cromolyn sodium Nasal ipratropium bromide (esp. vasomotor symptoms)Nasal ipratropium bromide (esp. vasomotor symptoms)
Irritant rhinitisIrritant rhinitis
Most common place of irritationMost common place of irritation CausesCauses
Combustion productsCombustion products VOCsVOCs Chromic acidChromic acid
RUDSRUDS Rhinitis after a sudden high exposure to Rhinitis after a sudden high exposure to
irritantsirritants
Irr. rhinitisIrr. rhinitis
Symptoms: nasal congestion, rhinorrheaSymptoms: nasal congestion, rhinorrhea Signs: erythema and erosion in nasal Signs: erythema and erosion in nasal
mucosamucosa Paraclinic: no paraclinic testParaclinic: no paraclinic test DDx: allergic rhinnitisDDx: allergic rhinnitis
Irritation rather than sneezing and itchingIrritation rather than sneezing and itching High prevalence among co-workersHigh prevalence among co-workers Dramatic improvement when not exposedDramatic improvement when not exposed
Treatment:Treatment: Reduction of exposureReduction of exposure Saline nasal lavageSaline nasal lavage Topical streoid or ipratropium bromideTopical streoid or ipratropium bromide
Non-allergic rhinitisNon-allergic rhinitis
Vasomotor rhinitisVasomotor rhinitis Augmented nasal reactivity to non-specific Augmented nasal reactivity to non-specific
physical stimuliphysical stimuli Low humidityLow humidity Rapid changes of temperatureRapid changes of temperature Excessive air motionExcessive air motion
Gustatory rhinitisGustatory rhinitis Ingestion of spicy foodsIngestion of spicy foods
Bright-light rhinitisBright-light rhinitis
Occupational sinusitisOccupational sinusitis
Seen in:Seen in: Spice workersSpice workers Vegetable picklersVegetable picklers Grain and flour workersGrain and flour workers
Most common:Most common: Sinusitis after complication of rhinitisSinusitis after complication of rhinitis
Occupational laryngeal Occupational laryngeal pathologypathology
Hoarseness due to:Hoarseness due to: Overuse of voiceOveruse of voice Chemical irritantsChemical irritants
Laryngeal SCC due to:Laryngeal SCC due to: AsbestosAsbestos SmokingSmoking EthanolEthanol Leather ant textile workersLeather ant textile workers Gasoline and diesel oilGasoline and diesel oil
Laryngeal stricture due to:Laryngeal stricture due to: Smoke inhalation injurySmoke inhalation injury
Vocal cord dusfunctionVocal cord dusfunction Stridor, hoarseness, shortness of breath, globusStridor, hoarseness, shortness of breath, globus Acute irritant exposuresAcute irritant exposures