Occupational Lung Diseases

Management Team

Occupational Lung Diseases

Overview

Occupational lung diseases are a group of lung conditions that have been caused or made worse by long-term exposure to certain irritants in the workplace.

Dust particles, chemicals, fungal spores, and certain animal droppings are examples of exposures that may increase your risk of developing occupational lung disease.

Asbestosis results from inhaling asbestos fibres.

  • Symptoms: Shortness of breath, persistent dry cough, chest tightness, and in advanced cases, finger clubbing.
  • Diagnosis: It is diagnosed based on exposure history, chest X-rays, high-resolution CT scans, and pulmonary function tests (PFTs).
  • Treatment: Supportive care, including oxygen therapy, pulmonary rehabilitation and avoiding further exposure.

Silicosis is caused by inhaling silica dust.

  • Symptoms: Shortness of breath, cough, and sometimes, chest pain.
  • Diagnosis: History taking, chest X-rays, CT scans, and PFTs.
  • Treatment: Symptom management, using corticosteroids for inflammation, and preventing further exposure.

Coal Workers' Pneumoconiosis (Black Lung Disease) results from coal dust inhalation.

  • Symptoms: Chronic cough, shortness of breath and black sputum.
  • Diagnosis: History taking, chest X-rays, CT scans, and PFTs.
  • Treatment: Supportive care, managing complications like chronic bronchitis and avoiding further exposure.

Berylliosis results from beryllium dust or fumes.

  • Symptoms: Shortness of breath, cough, fatigue, and chest pain.
  • Diagnosis: Blood tests, chest X-rays, CT scans, PFTs, and sometimes, bronchoscopy.
  • Treatment: Corticosteroids to reduce inflammation, immunosuppressive drugs in severe cases, and avoiding further exposure.

Byssinosis (Brown Lung Disease) is caused by inhalation of cotton dust.

  • Symptoms: Chest tightness, cough and wheezing, especially at the beginning of the workweek. Diagnosis: Exposure history and PFTs.
  • Treatment: Bronchodilators, corticosteroids, reducing dust exposure and using protective equipment.

Chemical Pneumonitis results from inhaling chemicals, such as chlorine or ammonia.

  • Symptoms: Cough, shortness of breath, chest pain, and sometimes, fever.
  • Diagnosis: Exposure history, chest X-rays, CT scans, and blood gas analysis.
  • Treatment: Supportive care with oxygen therapy, corticosteroids, and removing exposure to the chemical.

Providing education on preventive measures and coordinating care with other healthcare providers plays a vital role not only in treatment but also in diagnosis and long-term support as required. Tailored programmes are made considering all the above factors as per the patients’ clinical condition.

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Lung Cancer

Management Team

Lung Cancer

Overview

Lung cancer occurs when normal cells in the lungs turn abnormal and grow out of control. There are different types of lung cancers. Some types grow much faster than others and spread faster in the body. It is important to note that lung cancer is the leading cause of cancer deaths worldwide.

People who smoke are at the greatest risk of developing lung cancer. The risk of lung cancer increases with the time and number of cigarettes smoked. Quitting smoking, even after smoking for many years, significantly lowers the chances of developing lung cancer. Lung cancer can also occur in people who have never smoked, and can be caused due to genetic predisposition, exposure to biomass fuel, air pollution or heavy metals.

Common symptoms of lung cancer include:

  • New onset or worsening cough
  • Breathlessness, or wheezing
  • Spitting or coughing up blood (haemoptysis)
  • Chest pain
  • Hoarseness of voice
  • Loss of weight
  • Loss of appetite
  • Headache and swelling of the face, arms or neck
  • Pain in the arm, shoulder or neck
  • Droopy eyelids or blurred vision
  • Weakness of the hand muscles

If a doctor suspects lung cancer they can ask for the following tests:

  • Blood tests
  • CT scan of the chest and neck
  • PET CT to look for lesions outside the lungs and to understand the activity level of the lesions in the lungs
  • Biopsy of the suspected lesion either through bronchoscopy, EBUS (ultrasound or CT guided) depending on the location of the lesion

  • Surgery: Lung cancer can sometimes be treated with surgery to remove the tumour. However, it can be performed only when detected early and is limited to one lobe or segment of the lung.
  • Chemotherapy: Chemotherapy is the treatment that is given in later stages and also sometimes before the surgery to reduce the size of the lesion to make it more feasible to remove.
  • Targeted therapy: Some medicines work only for cancers that have certain characteristics. Your doctor might test your tumour to verify if your lung cancer would respond to these medicines.
  • Immunotherapy: This is the term doctors use for medicines that work with the body's infection-fighting system (the "immune system") to stop cancer growth. These are newer therapies that target the particular gene or mutation that stops the growth of cancerous cells.
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Type 1 Diabetes

Management Team

Type 1 Diabetes

Overview

Type 1 diabetes refers to an autoimmune disorder in which the immune system of the body mistakenly targets and destroys insulin-producing cells in the pancreas, causing little or no insulin production.

  • Frequent urination
  • Weight loss
  • Excessive thirst
  • Fatigue

Blood tests to measure blood sugar levels and check for antibodies.

  • Lifelong insulin therapy through injections or via an insulin pump, along with regular blood sugar monitoring. Managing type 1 diabetes involves a balanced diet, regular exercise, and education on managing blood sugar levels.
  • Early diagnosis and appropriate disease management are critical to prevent complications and lead to a good quality of life.
  • Please talk to a paediatric endocrinologist if you notice any of the above-mentioned symptoms in your child.
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Interstitial Lung Disease

Management Team

Interstitial Lung Disease

Overview

Interstitial lung diseases (ILDs), also known as Diffuse Parenchymal Lung Diseases (DPLDs) or Pulmonary Fibrosis, are a diverse group of disorders characterised by inflammation and scarring of the interstitium, which is the tissue surrounding the air sacs (alveoli) in the lungs. This leads to thickening of the interstitium and affects the ability of the lung to transfer oxygen to the bloodstream. ILDs can be acute or chronic and may have various causes and clinical presentations. Most ILDs cause irreversible damage to the lung, and the most serious ILDs are progressive, where the patient’s condition continues to worsen with time.

ILDs can be triggered by a multitude of factors:

  • Autoimmune Diseases: Autoimmune diseases, such as rheumatoid arthritis, systemic sclerosis (scleroderma) and systemic lupus erythematosus can cause ILDs.
  • Exposure to Environmental Factors: Long-term exposure to factors, such as asbestos fibres, silica dust, environmental toxins, grain dust, bird and animal droppings and indoor hot tubs has been reported to cause ILD.
  • Medication: Many drugs, such as chemotherapy drugs (Otrexup, Trexall), some heart medications used to treat irregular heartbeats (Nexterone, Pacerone, Inderal, Innopran), some antibiotics (Macrobid, Macrodantin, Myambutol), and certain anti-inflammatory drugs (Rituxan, Azulfidine), can cause lung damage.
  • Infections: Some viral, bacterial, and fungal infections can lead to ILDs.

However, in many cases, the cause remains unknown (idiopathic interstitial pneumonias).

The clinical presentation of ILDs can vary widely depending on the specific type and stage of the disease. Common symptoms include shortness of breath, dry cough, weight loss and fatigue.

Diagnosing ILDs typically involves a combination of:

  • Clinical evaluation, including a detailed medical history and physical examination.
  • Imaging-based Techniques, such as HRCT Chest, which can reveal characteristic patterns of lung involvement.
  • PFTs to assess lung function, including measures of lung volumes and diffusion capacity.
  • Biopsy is needed sometimes to confirm the specific type of ILD and guide treatment.

Treatment of ILDs depends on the underlying cause and severity of the disease. It may include:

  • Medications: Corticosteroids, immunosuppressants or antifibrotic agents.
  • Oxygen Therapy: To improve oxygenation in advanced cases.
  • Pulmonary Rehabilitation: Includes exercise programmes and education to manage symptoms.
  • Lung Transplant: This is the treatment of choice in severe cases, when other treatments are ineffective.

Overall, ILDs are a complex group of disorders that require careful evaluation and management by pulmonologists and other specialists to optimise outcomes and improve quality of life of the affected individuals.

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I

Hypersensitivity Pneumonitis

Management Team

Hypersensitivity Pneumonitis

Overview

Hypersensitivity pneumonitis (HP), also known as extrinsic allergic alveolitis, is an inflammatory lung disease that is caused by repeated inhalation of organic dusts or other antigens to which an individual is sensitised. These antigens can include mould spores, bacteria, animal proteins, or chemicals found in workplaces or home environments.

HP develops when the immune system exhibits an exaggerated response to these inhaled antigens. Initially, exposure leads to an immune reaction in the small airways and air sacs (alveoli) of the lungs, causing inflammation. With repeated exposure over time, chronic inflammation can lead to scarring of the lung tissue.

Symptoms of HP can vary depending on the frequency and intensity of antigen exposure. Common symptoms include dry cough, shortness of breath, fatigue and weight loss and flu-like symptoms, particularly after exposure to the antigen.

Diagnosis involves a combination of clinical evaluation, imaging-based techniques (e.g., chest X-ray or high-resolution CT scan), pulmonary function tests (PFTs), and sometimes bronchoscopy with bronchoalveolar lavage (BAL) and lung biopsy to confirm the presence of inflammation and rule out other lung diseases.

Treatment includes avoiding further exposure to the offending antigen, which is crucial in managing symptoms and preventing disease progression. In some cases, corticosteroids may be prescribed to reduce inflammation. Severe cases may require immunosuppressive therapy, and in rare instances, lung transplantation.

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H

Pre-diabetes

Management Team

Pre-diabetes

Overview

Prediabetes is a condition where blood sugar levels are elevated but not yet enough to get a diagnosis of diabetes. It significantly raises the likelihood of developing type 2 diabetes, heart disease, and stroke.

Often do not show up easily

This condition can be detected through blood tests like fasting glucose or HbA1c testing.

  • Effective management of Prediabetes entails lifestyle changes involving maintaining a healthy and balanced diet, adequate and regular physical activity, and reducing body weight to decrease the risk of progression to diabetes.
  • Regular monitoring and early intervention can prevent or prolong the onset of type 2 diabetes and its related complications, improving long-term health outcomes.
  • If you have any worries about diabetes or observe signs or symptoms of type 2 diabetes, it is advisable to get an endocrine consultation. Inquire about blood sugar screening if you think you have any diabetes-related risk factors to stay proactive about your health and well-being.
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Granulomatosis with Polyangiitis

Management Team

Granulomatosis with Polyangiitis

Overview

Granulomatosis with polyangiitis (GPA), formerly known as Wegener's granulomatosis, is a rare disorder characterised by inflammation of the blood vessels, which can restrict blood flow to various organs. It primarily affects the respiratory tract (upper as well as lower) and kidneys; however, it can affect other organs as well.

The exact cause of GPA is unknown, but it is considered as an autoimmune disorder, where the body's immune system mistakenly attacks its own blood vessels. Genetic and environmental factors may contribute to its development.

  • Respiratory: Persistent nasal congestion, sinusitis, nosebleeds, cough, and shortness of breath.
  • Renal: Blood in the urine, decreased kidney function, and in severe cases, kidney failure.
  • General: Fatigue, fever, weight loss, and joint pain.

Diagnosing GPA involves a combination of clinical evaluation, laboratory tests (including blood tests for specific antibodies like ANCA), imaging-based techniques (e.g., chest X-rays or CT scans), and sometimes biopsy of the affected tissues.

GPA is typically treated with immunosuppressive medications to reduce inflammation and suppress the immune system. Commonly used drugs include corticosteroids and other immunosuppressants like cyclophosphamide, methotrexate, or rituximab. Early diagnosis and treatment are crucial to prevent organ damage.

Prognosis: With prompt and appropriate treatment, the prognosis for GPA has improved significantly. However, the condition can be life-threatening if not treated early, and long-term follow-up is necessary as relapses can occur.

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G

Fungal Diseases of the Lung

Management Team

Fungal Diseases of the Lung

Overview

Fungal diseases of the lung are caused by various types of fungi and can range from mild to severe.

  • Histoplasmosis: Caused by Histoplasma capsulatum, typically found in soil contaminated with bird or bat droppings. Symptoms can range from mild flu-like symptoms to severe lung infections.
  • Coccidioidomycosis (Valley Fever): Caused by Coccidioides species, common in the southwestern United States. Symptoms include cough, fever, and chest pain.
  • Blastomycosis: Caused by Blastomyces dermatitidis, often found in moist soil and decomposing organic matter. It can cause symptoms such as fever, cough, and weight loss.
  • Aspergillosis: Caused by Aspergillus species, found in soil, decaying vegetation and dust. It can cause a range of conditions from allergic reactions to severe infections in individuals with weakened immune systems (immunocompromised).
  • Cryptococcosis: Caused by Cryptococcus neoformans, commonly found in soil and bird droppings. It primarily affects immunocompromised individuals and can lead to severe lung and central nervous system infections.
  • Pneumocystis pneumonia (PCP): Caused by Pneumocystis jirovecii, it mainly affects individuals with weakened immune systems, such as in those with HIV/AIDS.
  • Mucormycosis: Caused by fungi belonging to the order Mucorales. It is a very rare but serious infection that often affects immunocompromised individuals and can cause severe lung damage. 

Diagnosis typically involves imaging-based techniques like chest X-rays or CT scans, as well as laboratory tests such as fungal cultures, serology and molecular methods.

Treatment often includes antifungal medications and addressing any underlying conditions that predispose the patient to infection.

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F

Diabetes Mellitus

Management Team

Diabetes Mellitus

Overview

Diabetes mellitus refers to a long-term condition characterised by elevated levels of blood sugar due to the inability of the body to properly produce or utilise insulin. Insulin plays a critical role in controlling blood sugar by transporting glucose from the bloodstream into cells for energy use. There are two main types: type 1 and type 2 diabetes.

  • Excessive thirst
  • Increased frequency of urination
  • Unexplained weight loss

Early detection is crucial, as starting treatment promptly can improve outcomes. Diagnostic methods include blood tests to assess blood sugar levels.

  • Effective diabetes treatment involves lifestyle changes like balanced diet, regular physical activity, and medications to control blood sugar levels. However, in some cases, insulin therapy is necessary.
  • Regular monitoring and management are essential to prevent complications like heart disease, kidney damage, and nerve problems. Education and support empower individuals to manage their condition and lead a healthier life.
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D

Glasgow Coma Scale

Management Team

Glasgow Coma Scale

Overview

The Glasgow Coma Scale is a neurological assessment tool to measure the severity of brain injury based on a patient's response to stimuli, including eye opening, motor response, and verbal response. It assigns a score ranging from 3 to 15, with higher scores indicating better neurological function.

  • Spontaneous: 4 points
  • To verbal stimuli, command, speech: 3 points
  • To pain only: 2 points
  • No response: 1 point

  • Oriented: 5 points
  • Confused conversation, but able to answer questions: 4 points
  • Inappropriate words: 3 points
  • Incomprehensible speech: 2 points
  • No response: 1 point

  • Obeys commands: 6 points
  • Purposeful movement to painful stimulus: 5 points
  • Withdraws in response to pain: 4 points
  • Flexion in response to pain (decorticate posturing): 3 points
  • Extension response in response to pain (decerebrate posturing): 2 points
  • No response: 1 point

  • Evaluate brain function
  • Communicate a patient’s condition
  • Group patients into severity categories
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