Occupational pneumopathies, acute respiratory failure, and their impact in driving

Occupational pneumopathies, acute respiratory failure, and their impact in driving Occupational pneumopathies, acute respiratory failure, and their impact in driving

Occupational pneumopathies are pulmonary diseases related directly to the inhalation of various substances in the professional environment.

  • Asbestosis: The main effects of asbestos on health are diffuse pulmonary interstitial fibrosis and malignant tumors of the respiratory tract, pleura and peritoneum. 
  • The patient notices an insidious onset of dyspnea on effort with a reduced tolerance to exercise, over time resulting in a restrictive pattern progressing to respiratory failure, and developing faster in smokers.
  • Silicosis:In this disease, fibrosis can be simple nodular, generally with no symptoms or respiratory dysfunction, or conglomerated with marked dyspnea, cough and expectoration. As the conglomerates invade and obliterate the vascular bed, pulmonary restriction and obstruction occur with air entry, and pulmonary hypertension with right ventricular hypertrophy occurs. If the pulmonary silicotic conglomerates are very large, the patient suffers severe physical disability. Intense, short-term exposure can cause rapidly fatal pulmonary fibrosis.
  • Cotton powder: The exposure to cotton powder causes dyspnea, that can eventually obstruct the airways. In addition to avoiding exposure, the treatment is based on bronchodilators and antihistamines.
  • Grain powder: The symptoms are as those of the smoker with cough, mucus expectoration, wheezing and airway obstruction.
  • Farmer lung: People exposed to hay parasitized by actinomycetes can show hypersensitivity pneumonitis. The acute form causes fever, shivering, malaise, dyspnea, and cough at 4-8 hours of exposure. Prolonged contact, even if not intense, causes interstitial fibrosis.
  • Toxic chemical products: They affect the lung as vapors or gases. Serious cases of smoke inhalation can lead to pulmonary edema, and poisoning by CO can be fatal. Repeated exposure to thiocyanates, aromatic amines, and aldehydes leads to productive cough, asthma, malaise, or fever, and is frequent in synthetic matter workers. Fluoridated hydrocarbons contaminate the hands and then the cigarettes and can volatilize and be inhaled, causing fever, shivering, malaise and sometimes wheezing.

Advice on Occupational pneumopathies

  • These diseases can be prevented with an adequate airway protection and quitting smoking.
  • Workers in the early stage of the disease can drive.
  • Episodes of respiratory failure with cough and dyspnea, that occur in most occupational pneumopathies, are disabling for driving.
  • Although the patient has no symptoms in the morning when he goes to work, he is sleepy and tired for the lack of night rest, and is at a higher risk of falling asleep while driving.
  • In this situation, even if he does not fall asleep, the lack of concentration and attention for driving increases the possibility of causing an accident.
  • The frequent self-medication with antihistamines causing drowsiness is compounded to this situation.
  • Physicians should warn the patients of the side effects of the drugs and their interference with driving, since, although the patient is respiratorily well to drive, the pharmacological symptoms will disable him for driving safely.
  • Some treated drivers consider that their improvement is slow and often increase on its own the dose or the number of administrations, suffering somnolence that, added to the lack of night rest for coughing, increases the risk of accident while driving.
  • We should warn our patients to comply with the treatment guidelines indicated, and that, if they do not improve, they must visit us again to establish any necessary changes.
  • Coughing fits while driving prevent from controlling the car and the environment, and can lead to an accident of serious consequences.
  • In these circumstances, the patients must be advised against driving until the clinical condition subsides, for their safety and that of others.
  • If cough is productive, when he feels the coughing fit is starting, the driver is often distracted to look for a paper or handkerchief where to expectorate, taking off one or both hands of the steering wheel and losing the control of the car during that time.
  • Furthermore, during the process of expectoration, the driver uses the hands losing partially or completely the control of the car commands during that time.
  • We should recommend these patients to perform short travels when they drive, doing all stops in a safe place, to be able to expectorate without running risks.
  • The worker who knows the risk of inhaling vapors or hazardous substances at work will be more motivated to protect himself and not to suffer the disease, reducing the risks while driving.
  • The evolution of each patient will allow the physician to individualize driving advice.

Acute respiratory failure

Acute respiratory failure can be triggered by infections, aggravation of bronchospasm, pneumothorax, pulmonary thromboembolism, and administration of sedatives.

Hypoxemia and/or hypercapnia occur, associated with cyanosis, dyspnea, progressive tachypnea, abnormal ventilation movements, neurological symptoms, etc.

It is an emergency that requires hospital treatment with life support measures.

Advice on Acute respiratory failure

  • The patient cannot drive and indeed he cannot go to the hospital driving.
  • The disease causing paroxysmal dyspnea prevents from driving, since the driver loses suddenly the control of the car, with the attendant risk of accident.
  • There are unexpected urgent situations originating dyspnea such as pneumothorax, and, since the patient is not warned, all he can do is park the car immediately in a safe area and ask for help.
  • Physicians should warn patients about the risk of some drugs to depress the respiratory center, particularly if they suffer an underlying pulmonary disease with breathlessness.
  • All pulmonary conditions associated with dyspnea prevent from driving, and the physician should inform patients about this, given the possibility of clinical recurrence.
  • The patient whose treatment can balance the ventilation function without dyspnea can drive provided the physician considers it appropriate and reports favorably for it.
  • If the patient learns to know his situation, knows how to control it in the start, and the treatment stabilizes the clinical progression, he can drive if his physician indicates it.
  • The driver starting with dyspnea should park the car as soon as possible without forcing driving, and follow the recommendations given to him by the physician for cases of dyspnea in his specific disease.
  • If he does not improve, he cannot go driving to the emergency room, but he will ask for help and will wait calm and resting, following the indications given by his physician in case of onset of dyspnea.
  • It is advisable that drivers who can suffer ventilatory function disorders due to their disease take inside the car, in a visible place, the physician’s report specifying the treatment and the recommendations, that facilitate care by emergency services.