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Respiratory
Disorders
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/ COPD / Occupational Lung Diseases / Bronchiectasis /
/ Bronchial Asthma / Cystic Fibrosis /
Chronic Obstructive Pulmonary Disease (COPD) refers to two disorders (Chronic Bronchitis and Emphysema) that develop as a result of irritation of the respiratory organs. Cigarette smoking is a common cause of the disorder, but atmospheric irritants, occupational lung diseases, and other lung diseases can also cause these diseases.
CHRONIC BRONCHITIS
Chronic bronchitis is a constant irritation of the windpipe and bronchial tubes of the lungs. Because of the constant irritation, the body responds by producing mucous. This mucous hinders respiration and becomes a breeding ground for respiratory tract infections, and these illnesses become common in the person with bronchitis. In addition, the individual has an unsightly cough as they need to remove the heavy phlegm in the trachea. The person may experience brochospasms. As the lungs work harder, the alveoli (the sacks in the lungs in which oxygen is introduced into the bloodstream) stretch and overextend. The result is that these sacks lose their elasticity and several small sacks merge into one large sack.
EMPHYSEMA
Emphysema is the end result of chronic bronchitis. As the alveoli merge and lose elasticity, the ability of the lung to snap back into shape is lost, trapping air in the lungs and making it difficult for the person to breathe. Emphysema literally means “inability to exhale.”
Treatment: Chronic bronchitis is first treated by removing the irritating substance. Bronchodilators (such as Primatine) are often used for bronchospasms. Expectorant medications may be used to remove mucous and anti-inflammatory drugs may be used to reduce swelling in the lungs. The individual must stop smoking, get adequate fluid intake, and diet must be modified to reduce indigestion and avoid obesity, which makes breathing more difficult. Breathing exercises are taught to assist the individual in making the most of their remaining lung capacity. Once the aveoli lose their elasticity, the damage is permanent. Counseling may be necessary to help the individual adjust to reduced physical capacity and to accept that these conditions, especially emphysema, will not improve.
Rehabilitation Considerations: COPD is often found in older individuals and can be debilitating to the point that the ability and motivation to work is minimal. For those individuals that retain lung capacity necessary to perform competitive work, the individual must be placed into an environment that is free of smoke, fumes, gasses, or other irritants; for many individuals this may mean an occupational change. Occupations should also not require significant exertion, especially significant walking or stair climbing. The unsightly cough may hinder an individual’s ability to work in people oriented and persuasive occupations. Frequent respiratory infections affect punctuality and work attendance, as will attention to medical treatment, which will be regular and continuous for the rest of the individual’s life. Changes in temperature and humidity also are inadvisable in the work environment.
Occupational Lung Diseases develop as a result of exposure to pollutants present in the air in certain industrial environments. Certain industries, such as mining, are notoriously linked with occupational lung diseases. There two broad categories of occupational lung diseases are and hypersensitivity pneumonitis and pneumoconiosis, and are distinguished by the type of pollutant that causes the disorders.
HYPERSENSITIVITY PNEUMONITIS
Hypersensitivity Pneumonitis involves a reaction to an organic substance , such as a fungus, to which certain individuals are sensitive. The names of these disorders indicate the industry with which they are associated. Examples include Farmer’s Lung, Mushroom Picker’s Lung, Fish-Meal Lung, and Furrier’s Lung. Byssinosis is a particularly prevalent form of this disorder, and involves sensitivity to cotton fibers. These disorders cause irritate the lungs, cause scarring of the lung structure, and if exposure continues will develop into asthma or bronchitis.
PNEUMOCONIOSIS
Pneumoconiosis is caused by exposure to industrial dusts from metals or minerals. While hypersensitivity pneumonitis involves sensitivity of the individual to the dusts, pneumoconiosis is caused by depositing of dust in the lungs, where they scar lung tissues and eventually limit the function of the respiratory system. Examples of pneumoconiosis include Black Lung Disease (Coal Miner’s Pneumoconiosis), Silicosis (in industries dealing with silica fiber, notably the glass industry and many mining and tunneling occupations), Asbestosis (from mining or milling of asbestos), Berylliosis (exposure to beryllium dust, common in the manufacture of florescent lights prior to 1949; now largely limited to military and aerospace industries), Aluminosis, and Talcosis. The length of exposure to these substances is a major determinant of the amount of damage done to the lungs, together with cofactors such as cigarette smoking. Left unabated, the disease will develop into COPD.
Treatment of Occupational Lung Diseases involves avoidance of the environmental dusts which caused the disorder. Hypersensitivity disorders resolve themselves if the worker leaves the work environment causing the problem before serious lung damage has occurred. Pneumoconiosis is more difficult to detect, often the disease is not detected until COPD has started; treatment for COPD will then become relevant.
Rehabilitation Considerations: The individual must change occupations once these diseases have been detected. If the diseases are advanced, the rehabilitation considerations of COPD will probably also need to be considered. Vocational Rehabilitation may be very difficult in these cases. Occupational Lung Diseases will involve workers’ compensation issues, and the worker may likely be involved in litigation. These diseases are often not detected until the worker is in his or her 50’s or 60’s, and the worker’s age may limit the motivation of the worker to seek other employment. Finally, many workers in occupations prone to these types of diseases often have few skill which will transfer to light and sedentary occupations.
Bronchiectasis is a disease of the lungs in which the bronchi dilate and become infected. The disease is usually the result of an serious infection of the lungs (i.e., pneumonia or influenza) that causes a blockage of the air pathway. Shortness of breath and coughing of heavy, foul-smelling mucous streaked with pus or blood are common symptoms, and the individual becomes prone to frequent lung infection.
Treatment of bronchiectasis involves expectorants, antibiotics, posture shifting to allow draining of the lungs, and in severe cases, surgery to remove the damaged lung tissue.
Bronchial Asthma refers to attacks in which the airway is blocked and are characterized by of coughing, wheezing, shortness of breath and bronchospasms. Asthma may develop at any age, with about one in seven persons developing the disorder after the age of 40. Most children with asthma either outgrow the disease or attacks become so infrequent as to be a relatively minor concern, but for about one third of children the attacks will remain severe for the remainder of their lives. Asthma attacks may be brought on by exposure to pollutants, allergic reactions, respiratory infections, exercise, or stress. The attacks may last for minutes or hours, during which time the individual is completely debilitated. Severe prolonged attacks (status asthmaticus) sometimes occur, in which individuals may need to be hospitalized due to fatigue and inability to take care of themselves. In some cases, attacks can be so severe and frequent as to cause the individual to develop COPD.
Treatment: Prevention of attacks by avoiding allergens and irritants is an important consideration for the person with asthma. Bronchodilators often help the individual when an attack occurs.
Rehabilitation Considerations: Although the person is incapacitated during an asthma attack, function is not impaired when the attack is not occurring. Irritant free environments are imperative, and the choice of a work environment should be made with the approval of the individual’s physician. Milder cases may be able to perform medium work; more severe cases will be limited to light or sedentary employment. Absenteeism may be a concern with frequency of attacks and the necessity for medical treatment. Finally, asthma attacks may be very disturbing to those around the asthmatic, including coworkers and supervisors, and it may be advisable for the person with asthma to discuss the characteristics of his disease with his employer and those with whom he works.
Cystic Fibrosis (CF) is an hereditary disorder signified by excessive, thick mucous in the lungs, causing blockages and scarring. While usually classified as a respiratory disorder, it is the pancreas which is most affected by the disease. Pancreatic involvement causes gastrointestinal problems and stunting of growth. Other digestive organs can also be involved.
Individuals with CF typically are short in stature, have shortness of breath, reduced exercise tolerance, and are very susceptible to lung infections. The blockage of the lungs by mucous leads to COPD that tends to progress rapidly.
If lungs are primary area of involvement, death usually occurs by early adulthood (i.e., the late teens or early 20’s); death in infancy is common. Causes of death are related to malnutrition, intestinal blockages, pneumonia, and respiratory failure. Primary involvement in the pancreas and digestive tract usually indicates somewhat longer survival. With improved treatment, CF patients are surviving longer than in the past.
Treatment involves antibiotics, postural drainage, bronchodilators, and exercises to drain and break up mucous. Patients may be “homebound” and restricted to humidity tent. Hot temperatures must be avoided due to loss of body salts from sweating. Dietary control is difficult due to involvement of pancreas. Hospitalization is usually very frequent. Because of the intensive treatment with frequent hospitalization, this disorder is very costly in terms of medical bills, and parents of children with CF often have problems adjusting to the financial burden incurred.
Rehabilitation Considerations: As more individuals survive into adulthood it is possible they could become involved with vocational rehabilitation. Because of the frequent hospitalizations and, for many patients, restriction to the home, job placement is quite difficult. Home-based employment of some type may be the best alternative for CF patients. Because of the financial issues involved with the disease, assistance of the parents in maintaining vocational stability and family and financial integrity may be a more pressing issue.