HUT LUNG: One of the Effects of Household Air Pollution (HAP) Thomas V. Colby MD Professor of Pathology (Emeritus) Mayo Clinic Arizona

Transcription

1 HUT LUNG: One of the Effects of Household Air Pollution (HAP) Thomas V. Colby MD Professor of Pathology (Emeritus) Mayo Clinic Arizona

2 Conflicts of Interest NONE

3 Lung Disease = 40%

4 Respiratory risks from household air pollution in low and middle income countries (Gordon et al. Lancet Respir Med 2014)

5 Deaths worldwide in 2010 Respiratory risks from household air pollution in low and middle income countries (Gordon et al. Lancet Respir Med 2014)

6 HAP has been around for millennia: Massive anthracosis grossly Anthracosis with scarring 56F: Chile ~290 AD 22F: Chile ~2000 BC 25F: Peru 11 th century (Images courtesy Prof G Fornaciari, University of Pisa, Da Aufderheide (1998), and Prof. E. Gerstzen, University of Virginia)

7 HAP has been around for millennia: Lung showing anthracosis from a 60F in Papua New Guinea in 1960 at the time of her first contact with the 20 th century. Morphologically identical to Coal Workers Pneumoconiosis Image courtesy Robin Cooke MD

8 Women and children are especially at risk* (from Google images) (*Respiratory risks from household air pollution in low and middle income countries; Gordon et al. Lancet Respir Med 2014)

9 The Energy Ladder Respiratory risks from household air pollution in low and middle income countries (Gordon et al. Lancet Respir Med 2014); Images from Google

10 HAP-Associated Chronic Lung Disease COPD with some differences from tobacco associated COPD Asthma-COPD overlap syndrome Interstitial lung disease (UIP)?? Hut Lung Bronchial anthracofibrosis (BAF) Assad et al. Curr Opin Pulm Med 2016; 22:150

11 HAP-Associated Chronic Lung Disease COPD Asthma-COPD overlap syndrome Interstitial lung disease (UIP) Hut Lung Bronchial anthracofibrosis (BAF) Cofactors Malnutrition Poverty Overcrowding Respiratory infections Inadequate immunizations Continued exposures Respiratory risks from household air pollution in low and middle income countries (Gordon et al. Lancet Respir Med 2014)

12 Whom does Hut Lung affect? Image courtesy A. Griffiths

13 HAP-Associated Chronic Lung Disease COPD Asthma-COPD overlap syndrome Interstitial lung disease (UIP) Hut Lung Bronchial anthracofibrosis (BAF) Pathologic Studies? Mostly population based epidemiologic studies Predominantly case reports and small series Pathology of domestic dust exposure has centered on Fibrotic lung disease: Hut Lung and BAF

14 OCCUPATIONAL/ENVIRONMENTAL LUNG FIBROSIS Pneumoconioses ( Dust particle exposure) Silicosis/silicatosis, asbestosis, et al. Immunologically Mediated Hypersensitivity pneumonitis (Many causes) Berylliosis

15 OCCUPATIONAL/ENVIRONMENTAL LUNG FIBROSIS Pneumoconioses ( Dust exposure) Silicosis/silicatosis, asbestosis, et al. Dust-filled histiocytes Birefringent silica and silicates Asbestos bodies

16 CAUSES OF PNEUMOCONIOSES: THE USUAL SUSPECTS Mining Refining/smelting Transport Stone cutting Foundry work Sandblasting/grinding Ceramic industry Insulators Other asbestos exposures Plumbers Construction work Et.al. These all revolve around Occupation

17 ANTHRACOSILICOSIS From Google images Airway-centered dust Dust in lymphatics Dust in bronchi Peural lymphatic dust Anthracotic nodes

18 ANTHRACOSILICOSIS Courtesy A. Churg M.D. Dust along lymphatics Early silicotic nodule Coalescent silicotic nodules

19 KEY POINT: One need not have a classic occupation to develop a pneumoconiosis

20 THERE ARE DOMESTIC EXPOSURES: The few case reports do not reflect the magnitude of the problem

21 HUT LUNG: OVERVIEW Exposures: Woodsmoke, cow dung smoke, grinding maize, dust in ambient air, biomass Radiology: Nodules, reticulation, GGO, peribronchovascular thickening, massive fibrosis, hilar/mediastinal adenopathy Histopathology: Anthracosis, dust macules, mixed dust fibrosis including silicotic type nodules and interstitial fibrosis Radiology and pathology similar to classic occupational exposures

22 HUT LUNG Anthracosis along lymphatic routes in a 38F Haitian with presumed domestic exposure

23 HUT LUNG Case Courtesy Sanjay Mukhopadhyay MD Dust deposition seen on TBBx Fibrosis on trichrome stain

24 HUT LUNG MIXED DUST FIBROSIS Anthracosilicotic changes Case Courtesy Kelly Butnor MD

25 Anthracotic fibrotic infiltrative mass Antracosilicotic fibrotic pseudotumorbronchus adjacent to a large airway Lumen = Bronchial anthracofibrosis (BAF) Case Courtesy Kelly Butnor MD

26 HUT LUNG Domestically acquired particulate lung disease and similar terms have been suggested We should call it what it is: a pneumoconiosis!! (Pneumoconiosis: lung disease caused by the inhalation of dust particles)

27 Is there a solution? Cookstove types* *Respiratory risks from household air pollution in low and middle income countries (Gordon et al. Lancet Respir Med 2014)

28 Interventions Technologies Fuels Ventilation Behavior Respiratory risks from household air pollution in low and middle income countries (Gordon et al. Lancet Respir Med 2014)

29 Ongoing Research in HAP Recent article in the Blue Journal from this group Respiratory risks from household air pollution in low and middle income countries (Gordon et al. Lancet Respir Med 2014)

30 And from Google...keep this in mind I am indebted to Annie Griffiths, National Geographic Photographer, who sparked my interest in this problem. And for those interested: