Lnv|ronmenta| and Cccupanona|

Lung D|sease (art II)

ClayLon 1. Cowl, Mu, MS, lCC, lACCLM
AssoclaLe rofessor of Medlclne
ulvlslon of ulmonary & Crlucal Care Medlclne
ulvlslon of revenuve, Cccupauonal & Aerospace Medlclne
ulrecLor, Cccupauonal / 1oxlcology Cllnlc
Mayo Cllnlc
8ochesLer, MlnnesoLa uSA

Iacu|ty D|sc|osures
ur. Cowl sull has no nanclal or oLher conlcLs of
lnLeresL Lo reporL regardlng Lhe Loplcs Lo be presenLed.
Learn|ng Cb[ecnves
Aer Lhls sesslon, learners wlll be able Lo:
8ecognlze a varleLy of addluonal envlronmenLally-
relaLed condluons
8e famlllar wlLh baslc concepLs of aluLude
physlology, mounLaln lllness, and dlvlng medlclne/
hyperbarlc oxygen Lherapy
C1nLk CCCUA1ICNAL &
LNVIkCNMLN1AL kLSIkA1Ck
CCNDI1ICNS
Wh|ch of the fo||ow|ng cond|nons are character|zed
by exposure to a very ||ght meta| found |n |ndustry,
|ong |atency per|od, h|sto|og|c ev|dence for a
granu|omatous reacnon and hypersens|nv|ty to
spec|hc CD4 1-|ymphocytes?
A. Pard-meLal lung dlsease
8. Sarcoldosls
C. MeLal fume fever
u. Pydrogen sulde lnhalauon
L. 8erylllosls
8yss|nos|s
A form of reacuve alrways
dlsease wlLh an unknown
euology
Cccurs ln workers who conLacL
unprocessed, raw couon
MosLly seen ln workers wlLh
chronlc exposure
SympLoms lnclude chesL
ughLness and dyspnea LhaL ls
worse on Lhe rsL day of work
and gradually subsldes
ulagnosls based on hlsLory
and l1s LhaL show alrow
obsLrucuon
1houghL Lo be caused by
endoLoxln from Lhe couon
bracL buL noL proven
Meta| fume fever
Caused prlmarlly by exposure Lo zlnc oxlde (ZnC), usually from
weldlng, cumng, or brazlng galvanlzed meLal (also copper or
magneslum may cause)
AcuLe allerglc condluon experlenced by many welders
May cause a u-llke lllness lncludlng headache, fever, chllls,
myalglas, LhlrsL, nausea, chesL soreness, dyspepsla, faugue, &
weakness.
SympLoms sLarL several hours aer exposure and compleLe
recovery wlll oen occur wlLhouL lnLervenuon wlLhln 24 Lo 48 hrs.
More llkely Lo occur aer a perlod of ume away from Lhe [ob (e.g.
aer weekends or vacauons)
1reaLmenL ls Lo have welders keep ouL of Lhe weldlng plume, use
adequaLe venulauon, or personal resplraLory proLecuon
NOTE: Polymer Fume Fever essentially identical but from
combustion products of polymers.
nydrogen su|hde exposure (Dung
|ung)
1he gas can form naLurally from bacLerlal breakdown of
organlc mauer, or from naLural gases, volcanlc gases or hoL
sprlngs
Colorless, odorless gas LhaL ls heavler Lhan alr and smells of
rouen eggs
Low levels can cause lrrlLauon Lo Lhe eyes, nose and LhroaL
buL aL hlgh concenLrauons (>300 ppm) [usL a few breaLhs can
be leLhal (an asphyxlanL)
Several cases of deaLhs assoclaLed wlLh lnhaled manure ln a
conned space envlronmenL
Osbern LN, Crapo RO. Ann Intern Med. 1981 Sep;95(3):312-4.


Crgan|c dust tox|c syndrome (C1DS)
Also called Loxlc alveollus" or pulmonary mycoLoxlcosls"
non-lnfecuous febrlle lllness seen aer heavy exposure Lo
organlc dusLs, lncludlng hog connemenL faclllues
SympLoms may lnclude: producuve cough, fever, chllls,
malalse, chesL ughLness, and headache
ChesL radlographs oen normal and C
2
saLurauons normal
C8C oen shows leukocyLosls wlLh neuLrophllla
rocess ls self-llmlung buL aceLamlnophen or nSAlus oen
used (supporuve care for more serlous cases)
Von Essen et al. J Swine Health Prod 2005; 13(5):273-276.
S||o I|||er's D|sease
8esulLs from exposure Lo oxldes of nlLrogen, parucularly nC2
8eddlsh, brown gas smelllng llke bleach or clover
nC
2
gas forms rapldly aer sllo ls lled wlLh fresh organlc
maLerlal and ls heavler-Lhan-alr
MosL sympLoms are mlld and self-llmlung and lnclude cough,
dyspnea faugue, and alrway lrrlLauon, buL longer exposures
may resulL ln asphyxlauon, pulmonary edema, or bronchlollus
obllLerans leadlng Lo A8uS pauern
MosL prevalenL ln Lhe monLhs of SepLember and CcLober
uouglas WW, Pepper nC, Colby 1v. Moyo cllolc ltoc. Mar 1989,64(3):291-304.
Leavey !l, uubln 8L, Slngh n, kamlnsky uA. Aoo loteto MeJ. Sep 7 2004,141(3):410-1.
Crn|thos|s (s|uacos|s)
An lnfecuon caused by cblomyJopbllo psluocl, a Lype of
bacLerla found ln Lhe dropplngs of blrds.
8are (100-200 cases reporLed annually)
8lrd owners, peL shop employees, persons who work ln
poulLry processlng planLs, and veLerlnarlans are aL lncreased
rlsk
1yplcal blrds lnvolved are parroLs and parakeeLs, buL oLher
blrds have been reporLed
Sxs: 8lood-unged cough, fever, chllls, myalglas
ux: neumonlus radlographlcally, culLures grow Chlamydla
8x: uoxycycllne (alLernauve ls azlLhromycln)
8runham 8C. ulseases caused by chlamydlae. ln: Coldman L, Auslello u, eds. cecll MeJlcloe. 23rd
ed. hlladelphla, a: Saunders Llsevler, 2007:chap 339.
Chron|c 8ery|||um D|sease
1oxlc, dose-relaLed ln[ury syndrome LhaL Lyplcally aecLs Lhe upper
resplraLory LracL, buL wlLh hlgh-level exposures may resulL ln
chemlcal pneumonlus and alrway lnvolvemenL
rlmarlly a pulmonary granulomaLous dlsorder
MusL have (lndusLrlal) exposure Lo berylllum Lhrough dlrecL conLacL
or second-hand conLacLs
Long lnLerval or laLency beLween lnlual exposure and dlsease onseL
ulagnosls requlres demonsLrauon of granulomaLous reacuon and
berylllum sensluvlLy (vla 8AL Cu4 speclc cells or lymphocyLe
prollferauon response)
ulsuncLly resembles sarcoldosls boLh radlographlcally and ln lLs
cllnlcal manlfesLauons
8x - CorucosLerolds
nard Meta| Lung D|sease
SlnLered alloy conLalnlng mosLly LungsLen carblde
and cobalL (exLremely hard for use ln drlll blLs,
cumng Lools, eLc.)
AssoclaLed wlLh boLh alrway dlsease (occupauonal
asLhma), and lnLersuual lung dlsease
PlsLopaLhology varlable wlLh ndlngs of bronchlollus,
ul, Cl, and ul (nC1L: noL assoclaLed wlLh
granuloma formauon)
8x: Avold exposure and sysLemlc corucosLerolds
nypersens|nv|ty pneumon|ns
(Lxtr|ns|c a||erg|c a|veo||ns)
uefninon:
An lmmunologlcally-lnduced, non-lgL medlaLed
lnammaLory lung dlsease assoclaLed wlLh Lhe
sensluzauon and subsequenL recurrenL exposure Lo
any of a wlde varleLy of lnhaled organlc dusLs.
lirst described:
lnlually descrlbed ln 1932 and currenLly, Lhere are
more Lhan 400 varylng lnclung agenLs LhaL have been
ldenued
nypersens|nv|ty pneumon|ns
(Lxtr|ns|c a||erg|c a|veo||ns)
Moin ogendinq oqents:
Mlcroblal spores (Lhermophlllc acunomyceLes)
larmer's Lung
Pumldler Lung (urban) - A/C unlLs, humldlers, warm
sLagnanL waLer ls common varlable
Anlmal producLs (lgeon dropplngs)
lgeon breeder's lung
Cerbll keeper's lung
Saprophyuc fungl (Asperglllls clavaLus)
MalL worker's lung - Asperglllls


nypersens|nv|ty pneumon|ns
(Lxtr|ns|c a||erg|c a|veo||ns)
Moin ogendinq oqents {cont.):
CLher agenLs
PoL-Lub lung (MAC)
MeLal worklng ulds
1ul, Pul, Lrlmellluc anhydrlde

nypersens|nv|ty pneumon|ns
(Lxtr|ns|c a||erg|c a|veo||ns)
1ype Speclc anugen Lxposure
8lrd fancler's lung Avlan proLelns leaLhers and blrd
dropplngs
larmer's lung
1hermophlllc acunomyceLes
Asperglllls
Saccharopolyspora
Mlcropolyspora
Moldy hay, molsL
solls or manure
Crack lung Crack cocalne llllclL cocalne
smoklng
8agassosls 1hermophlllc
acunomyceLes
Moldy bagasse
(pressed sugarcane)
nypersens|nv|ty pneumon|ns
(Lxtr|ns|c a||erg|c a|veo||ns)
1ype Speclc anugen Lxposure
Maple bark
sLrlpper's
dlsease
CrypLosLroma
corucale
Moldy maple bark
Suberosls
enlcllllum
frequenLans
Moldy cork dusL
Wlne grower's
lung
8oLryus clnerea Moldy grapes
Cheese washer's
lung
enlcllllum sp. Cheese caslngs
Mohr LC. Curr Opin Pulm Med 2004; 10(5):401-11.
nypersens|nv|ty pneumon|ns
(Lxtr|ns|c a||erg|c a|veo||ns)
MosL lndlvlduals who are exposed do noL develop
dlsease
uevelops much more commonly ln non-smokers
(93)
ALopy ls noL a pre-exlsung facLor (do noL see lncrease
ln lgL or eoslnophllla)
vlral lnfecuon occurrlng concurrenLly or serlally wlLh
exposure may play a role
nypersens|nv|ty pneumon|ns
(Lxtr|ns|c a||erg|c a|veo||ns)
Acute n
8rlef buL lnLermluenL lnLense exposure
Aer 4-8 hrs, u-llke sxs ensue and lasL 12-24 hrs
AsympLomauc beLween auacks" LhaL recur wlLh each
exposure Lo lnclung anugen
Subacute n
lnsldlous onseL of sympLoms resembllng progresslve chronlc
bronchlus
AssoclaLed wlLh less lnLense buL more prolonged exposure
and each exposure causes worse sxs
lf noL recognlzed, may progress Lo chronlc P
nypersens|nv|ty pneumon|ns
(Lxtr|ns|c a||erg|c a|veo||ns)
Chron|c n
8esulL of unrecognlzed or lnadequaLely LreaLed acuLe
or subacuLe P (occurs ln 3 of cases)
Slgns and sxs very slmllar Lo end-sLage ll
1here ls some debaLe as Lo Lhe prevalence of ll LhaL may
be assoclaLed wlLh chronlc P (esumaLes of up Lo 10)
nypersens|nv|ty pneumon|ns
(Lxtr|ns|c a||erg|c a|veo||ns)
athogenes|s
8equlres correcL slze and Lype of anugen (reslsLs
degradauon)
auenL musL be sensluzed Lo anugen (varlable perlod of
ume - monLhs Lo years)
8emember - noL all who are exposed become sensluzed and
noL all who are sensluzed develop dlsease
May lnvolve boLh lmmune complex and cell-medlaLed
mechanlsms
8elleved Lo be conslsLenL wlLh 1ype lll and 1ype lv
hypersensluvlLy reacuons
nypersens|nv|ty pneumon|ns
(Lxtr|ns|c a||erg|c a|veo||ns)
D|agnosncs
no slngle LesL or cllnlcal feaLure ls dlagnosuc, buL from a
comblnauon of ndlngs
nelLher sensluve nor speclc: mlld leukocyLosls,
eoslnophllla, lncrease ln globullns, LS8 lncreased,
posluve AnA or 8l
Cx8 plcLure ls varlable (and may even be normal)
May see a ne reuculonodular pauern LhaL reLurns Lo normal
over days Lo weeks (alveolar moullng")
Cllnlcal sxs seem Lo be worse Lhan Lhe radlographlc ndlngs
Luslons and adenopaLhy rare
nypersens|nv|ty pneumon|ns
(Lxtr|ns|c a||erg|c a|veo||ns)
D|agnosncs
Cn C1 lmaglng, see poorly dened cenLrllobular
mlcronodules and wldespread ground glass opaclues wlLh
mosalc auenuauon ln Lhe upper and mlddle lung zones
l1s show resLrlcuve venulaLory lmpalrmenL and uLCC
may be reduced
Skln Lesung rarely helpful and noL recommended
Serum preclplLaung anubodles may be useful ln
esLabllshlng prlor exposure (buL do dlsappear over ume)
8AL shows lymphocyLosls (63 versus 6 ln normals), and
a reducuon ln Cu4/Cu8 rauo, plasma cells ls suggesuve of
P
nypersens|nv|ty pneumon|ns
(Lxtr|ns|c a||erg|c a|veo||ns)
D|agnosncs
May see arLerlal hypoxemla
Lung blopsy may be consldered:
Cellular bronchlollus
8ronchlolcenLrlc lymphocyuc lnLersuual pneumonlus
oorly-formed non-caseaung granulomas
Management
Avoldlng exposure ls Lop prlorlLy
SympLomauc rellef wlLh supplemenLal C2, anupyreucs
CorucosLerolds may be consldered buL may noL beneL
long-Lerm

Ny|on I|ock Worker's Lung
ShorL bers (ock) are sllced from cables of synLheuc
monolamenLs and applled Lo fabrlcs wlLh adheslve
coaungs Lo glve a velveLy" surface
8oLary cuuers used ln ouLbreak facLorles produced
resplrable-slzed nylon parucles
AecLed workers were dlagnosed wlLh lnLersuual
lung dlsease
1reaLmenL ls ber avoldance
Kern DG, Crausman RS, Durand KT et. al. Ann Int Med 1998;129:261.
8u||d|ng-ke|ated I||ness
ulvlded lnLo speclc (23 of cases) and non-speclc
dlsorders (73) referred Lo as slck bulldlng syndrome"
Speclc dlsorders lnclude: 1) anugens and organlc dusLs,
2) lnfecuous agenLs, 3) Loxlns and lrrlLanLs
SympLoms oen reporLed lnclude: leLhargy, mucous
membrane lrrlLauon, headache, eye sympLoms, and dry
skln
nlCSP found LhaL 39 had ldenuable conLamlnanLs and
30 were assoclaLed wlLh lnadequaLe alr reclrculauon
(11 had no ldenuable cause)
urlll blLs, meLal hardenlng = cobalL wlLh Cl or hard-
meLal lung dlsease
nasal sepLal perforauon or leslons on ngers (chrome
holes) = chromlum exposure
CaLalyuc converLers or [ewelry manufacLure wlLh asLhma
= plaunum (1ype l sensluzer)
Carllc odor on breaLh or sweaL = selenlum
Creen Longue = vanadlum
lrreverslble blue-grey skln dlscolorauon (argyrla) = sllver
lnLoxlcauon
Carllc or shy odor LhaL ls non-lrrlLaung and masslve
hemolysls = arslne gas
"C|ay's C|ues"
hoLo courLesy of nlCSP
"C|ay's C|ues" (cont.)
MeLhampheLamlne producuon = ammonla or
phosgene
8one necrosls (hossy !aw") and deep burns on
conLacL = phosphorus
8enlng nlckel wlLh dluse lnLersuual lung dlsease =
nlckel carbonyl
Pypocalcemla and severe burns = hydrouorlc acld
Cll lndusLry and rouen eggs smell = hydrogen sulde
(P
2
S)
AL1I1UDL AND DIVING
nSICLCG
kev|ew of the atmosphere

Composition
(dry air)
nlLrogen
Cxygen
Argon
Carbondloxlde

N
2

78.09%
O
2
20.95%
Stratosphere: 11 80km
Troposphere: 0 11km
Operational Levels
A
l
t
i
t
u
d
e

200
100
80
60
20
7
4
Subcritical hypoxia
Critical hypoxia
Ebullism (Armstrong line)
aerodynamic navigation
(von Karman line)
Demarkation
Atmosphere - Space
Border of mechanically
effective atmosphere
nypobar|c nypox|a
760 mmPg - Sea level"
AmblenL oxygen 160 mmPg (21)
a0
2
93
363 mmPg - Cabln AluLude
8,000
AmblenL oxygen 119 mmPg (21)
a0
2
68
179 mmPg - Crulslng AluLude
33,000
AmblenL oxygen 38 mmPg (21)
a0
2
slngle dlglLs"
http://www.accpstorage.org/newOrganization/patients/TravelingwithOxygen.pdf
Acute Mounta|n S|ckness (AMS)
lrom Lhe comblnauon of low
aLmospherlc pressure and lower
oxygen concenLrauon LhaL occur aL
hlgh aluLudes
Sxs range from mlld Lo llfe-
LhreaLenlng, and can aecL Lhe
nervous sysLem, lungs, muscles, and
hearL.
ln severe cases pulmonary edema, or
cerebral edema leadlng Lo confuslon,
coma, or even deaLh
1he chance of gemng acuLe mounLaln
slckness lncreases Lhe fasLer a person
cllmbs Lo a hlgh aluLude, how much
exeruon ls Laklng place
Acute Mounta|n S|ckness (AMS)
eople who normally llve aL or near
sea level are more prone Lo acuLe
mounLaln slckness.
ApproxlmaLely 20 of people wlll
develop mlld sympLoms aL aluLudes
beLween 6,300 Lo 9,700 feeL, buL
pulmonary and cerebral edema are
exLremely rare aL Lhese helghLs.
Powever, above 14,000 feeL, a
ma[orlLy of people wlll experlence aL
leasL mlld sympLoms. Some people
who sLay aL Lhls helghL can develop
pulmonary or cerebral edema.
Acute Mounta|n S|ckness (AMS)
1he maln form of LreaLmenL for all forms of mounLaln slckness ls Lo
descend to a |ower a|ntude as rap|d|y and safe|y as poss|b|e. LxLra
oxygen should be glven, lf avallable.
AceLazolamlde (ulamox) ls a dlureuc used Lo sumulaLe breaLhlng and
reduce mlld sympLoms of mounLaln slckness. When Laklng Lhls
medlcauon, uld lnLake should be hlgh and alcohol should noL be used
ulmonary edema, ls LreaLed wlLh supplemenLal oxygen, nlfedlplne or
phosphodlesLerase lnhlblLors (e.g. slldenal), and, ln severe cases,
mechanlcal venulauon ls requlred.
uexameLhasone (uecadron) may help reduce swelllng ln Lhe braln
(cerebral edema).
orLable hyperbarlc chambers have been developed Lo allow hlkers Lo
slmulaLe condluons aL lower aluLudes wlLhouL movlng from Lhelr locauon
on Lhe mounLaln. 1hese new devlces are very lmporLanL lf bad weaLher or
oLher facLors make cllmblng down Lhe mounLaln lmposslble.
Acute Mounta|n S|ckness (AMS):
revennon
Lducauon of mounLaln Lravelers before ascenL ls Lhe key Lo prevenuon. 8aslc
prlnclples lnclude: gradual ascenL, sLopplng for a day or Lwo of resL for each
2,000 feeL (600 meLers) above 8,000 feeL (2,400 meLers), sleeplng aL a lower
aluLude when posslble, and learnlng how Lo recognlze early sympLoms
AceLazolamlde (ulamox) helps speed Lhe process of gemng used Lo hlgher
aluLudes, and reduces mlnor sympLoms. 1hls drug should be Laken sLarung
one day before Lhe ascenL and conunue one Lo Lwo days lnLo Lhe excurslon.
1hls ls recommended for Lhose maklng a rapld ascenL Lo hlgh aluLudes.
1hose who may be prone Lo anemla (parucularly women) should conslder an
lron supplemenL Lo correcL Lhe condluon before Lravellng aL hlgh aluLudes.
urlnk enough ulds, avold alcohol, and eaL regularly. loods should be
relauvely hlgh ln carbohydraLes.
eople wlLh underlylng hearL or lung dlseases should avold hlgh aluLudes.
What do av|ators, d|vers and soh dr|nks
have |n common?
Llquld sysLems saLuraLed
wlLh a dlssolved gas"
nenry's Law
AmounL of dlssolved gas ln soluuon varles
dlrecLly wlLh pressure of LhaL gas over Lhe
soluuon

1
/
2
=A
1
/A
2
Decompress|on S|ckness (DCS)
uisso/ved nitroqen equo/ites with the
surroundinq environment os pressure
chonqes
lf the pressure chonqe is too ropid it comes
out of so/unon ropid/y forminq bubb/es in the
b/ood ond nssues

Decompress|on |||ness (the "bends")

1he cllnlcal feaLures of uCS lnclude 1ype l (musculoskeleLal) or 1ype
ll (cardlopulmonary & neurologlc) and are seen durlng or aer
ascenL.
ln Lhe ma[orlLy of cases, sxs evldenL wlLhln 6 hrs, and 30 wlLhln
Lhe rsL hour of Lhe dlve. Less commonly, a delay ln onseL of 24
hours or greaLer has been descrlbed.
ulvers oen deny Lhe reallLy of Lhelr sxs, or wlll rauonallze Lhem.
1he ume of onseL of sympLoms depends on Lhe Lype of dlve. ueep
dlves (>30 m), are llkely Lo presenL early.
Larller Lhe sympLoms, Lhe more poLenually serlous Lhe uCS.
Sxs may be lnluaLed or aggravaLed by exposure Lo aluLude (drlvlng
over mounLalns, alr Lravel), exerclse or breaLhlng cerLaln gases.
uelay alr Lravel aL leasL 24 hours aer lasL dlve.
Cxygen tox|c|ty

Cxygen (C
2
) ls Loxlc when breaLhed aL a parual pressure ln excess of
0.4 A1A (40 C2 aL aLmospherlc pressure) for sumclenL ume.
1he greaLer Lhe concenLrauon and pressure, Lhe
shorLer Lhe ume.
1he Lwo common forms of C
2
LoxlclLy aecL Lhe lungs and Lhe
braln, resulung ln aLyplcal chesL paln and cough (pulmonary) or
selzure acuvlLy wlLhouL warnlng
lor Lhls reason lL ls noL recommended LhaL recreauonal dlvers use
oxygen-enrlched dlvlng equlpmenL
www.dlvlngmedlclne.lnfo
N|trogen narcos|s
aka "Compressed a|r |ntox|canon" or "kapture of the
deep"
When breaLhed under pressure, nlLrogen has an lnLoxlcaung eecL
whlch, llke alcohol, ls varlable and may lead Lo pleasure or dlsasLer
LxacL cause remalns lndeLermlnaLe
1he narcouc eecL usually becomes eecuve wlLhln a few mlnuLes of
reachlng a parucular depLh and does noL worsen as exposure
conunues aL Lhls depLh. 8apld descenLs may lncrease Lhe eecL, buL
wlLh ascenL lL ls dlsslpaLed.
ueaLh may supervene due Lo errors provoked by lmpalred [udgmenL or
percepuon, and by overcondence. Loss of consclousness may happen
wlLhouL warnlng and be unnouced by Lhe dlver's buddy.
lacLors LhaL lncrease Lhe eecLs of narcosls lnclude: low lnLelllgence,
faugue or heavy work, anxleLy, lnexperlence or apprehenslon, cold
(hypoLhermla), recenL alcohol lnLake or use of sedauve drugs (lncludes
seaslckness medlcauons), or poor vlslblllLy
Can avold by llmlung dlves Lo less Lhan 30-40 m (100-130 )
Why do our ears "pop" |n |ght or
when d|v|ng?
8oyles Law
volume of a gas ls lnversely proporuonal
Lo Lhe pressure

1
v
1
=
2
v
2
Middle Ear Barotrauma or Squeeze
nyperbar|c Cxygen 1herapy (n8C1)
Dehn|non
Breathing 100% FiO
2
at pressure of greater than one
atmosphere absolute (1 ATA)
Systemic delivery of oxygen under pressure greater than sea
level
Usually 2 and 3 times normal pressure
Intermittent, 90-120 minutes daily.
Delivered within a pressure vessel" - (chamber)
1|ssue Cxygen Leve|s |n kad|ated 1|ssue w|th n8C1
Monop|ace Chambers
Mu|np|ace Chambers
Cxygen Dose & ressure
3x

3 A1A
100

2 A1A
100

1 A1A
21

ressure Ls" more
oxygen molecules
lnLo each breaLh.

1 A1A
100

160mmPg
760mmPg 1320mmPg 2280mmPg
1x
10x 13x
Summary
Cccupauonal lllness assessmenL requlres a deLalled
hlsLory
Work-relaLed asLhma may be classled varlous ways
8ecall key concepLs of Lhe varleLy of
envlronmenLally-relaLed lllnesses
8ecognlze hypersensluvlLy pneumonlus
1oxlc lnhalauons
MounLaln lllness and dlvlng
1hanks for your auennon and best
of |uck on the 8oards!