Occupational asthma, acute bronchitis, hypersensitivity pneumonitis, and its impact on driving

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Occupational asthma

It is caused by the inhalation of particles or industrial vapors, with irritant and allergenic properties.

The symptoms usually occur during working hours on contact with the substance, and include dyspnea, chest tightening, wheezing, and cough, associated with upper airway symptoms such as sneezing, rhinorrhea, and tearing.

However, in other cases, the symptoms start several hours later, hindering night rest.

These workers will suffer somnolence, lack of attention, and concentration on driving, both when traveling to work, as in the use of cars and machines at works or the industry.

Advice on Occupational asthma

  • Patients with serious occupational asthma cannot drive.
  • These diseases can be largely prevented with an appropriate airway protection and giving up smoking.
  • Respiratory failure episodes with cough and dyspnea are disabling for driving.
  • Although the patient in the morning when going to work does not have pulmonary symptoms, he feels sleepy and tired for the lack of night rest, and shows a higher risk of falling asleep while driving.
  • In this situation, though he does not fall asleep, the lack of concentration and attention when driving increases the possibility of causing an accident.
  • The frequent self-medication with antihistamines causing drowsiness is added to this situation.
  • Physicians should warn about the side effects of antiasthmatic drugs and their interference with driving, since though respiratorily the patient feel well to drive, the pharmacological symptoms will disable him for driving safely.
  • The worker who knows the risk of inhaling steams or hazardous substances at work will be more motivated to protect himself and not suffer the disease, reducing the risks when driving.
  • The evolution of each patient will allow the physician for individualizing the recommendations for driving.

Acute bronchitis

It is the acute inflammation of the tracheobronchial tree, in general of self-limited clinical progression, with cure and complete return to normal pulmonary function.

Although it frequently is a mild condition, it can be serious in weakened patients, those with heart disease or with chronic pneumopathy.

The origin of acute bronchitis can be infectious, irritative by powders or gases, and asthmatic.

  • Symptoms: It is often preceded by a viral rhinosinusal infection with runny nose, rhinitis, malaise, shivering, low-grade fever, myalgia, backache, and sore throat. The appearance of dry cough establishes the beginning of bronchitis, subsequently becoming productive and with fever, with possible secondary dyspnea from airway obstruction. After some days, the symptoms subside, though cough can last weeks. If fever continues, it suggests the presence of pneumonia as a complication of bronchitis.
  • Treatment: It requires rest until fever subsides, hydration, and use of antipyretic and antitussive agents. In the necessary cases antibiotics will be administered.

Advice on Acute bronchitis

  • The patient cannot drive until the condition subsides completely, without symptoms.

Pneumonitis from hypersensitivity or extrinsic allergic alveolitis

It is an interstitial, granulomatous, diffuse pulmonary disease of immune mechanism, that affects the alveolar wall and the most distal airway, as a result of the repeated inhalation of organic powders by a patient susceptible to them.

  • Clinical manifestations:
    • In the acute form, cough, fever, shivering, and dyspnea occur 6-8 hours after exposure to the antigen, and can include nausea and vomiting.
    • The subacute form begins insidiously with cough and dyspnea for several days or weeks, until it worsens and requires urgent hospital admission.
    • In the chronic form, the patient shows for months or years, progressive dyspnea on effort, with productive cough, tiredness, and weight loss, that can progress to respiratory failure.
  • In the treatment it is essential to avoid contact with the causal antigen.

The chronic forms are treated with corticoids.

Advice on Pneumonitis from hypersensitivity or extrinsic allergic alveolitis

  • These diseases are largely preventable with an adequate airway protection to avoid contact with the causal agent.
  • The respiratory failure episodes with cough and dyspnea are disabling for driving, until the symptoms disappear.
  • The chronic forms not responding to treatment prevent from driving.
  • The physician will indicate the patient, with his individual characteristics, the appropriate recommendations given the current outcome of the disease.