Type:
Educational Exhibit
Keywords:
Pathology, Occupational / Environmental hazards, Observer performance, CT, Lung
Authors:
S. Hamid1, S. Nausheen2, N. Ahmed3, S. Kadri4, A. Ghulam Mohammad 3, N. Hussain3, T. Mahmood3; 1Karachi, Sindh/PK, 2Karachi /PK, 3Karachi/PK, 4Karachi, karachi/PK
DOI:
10.1594/ecr2018/C-2717
Background
Biomass is used as a major fuel source by more than 50% of the world’s rural population.1 It includes materials derived from animal dung,
twigs,
grass,
crop wastes,
wood,
and charcoal.
More than half of the world’s population uses biomass as a major source of energy for cooking and heating.2 This fuel source is inefficient,
requiring fires to be kept going for many hours a day,
exposing women and children exposed to years of daily smoke leading to chronic obstructive pulmonary disease.3
Patients typically present with symptoms of a pneumoconiosis without history of occupational exposure. The estimated prevalence of hut lung disease is up to 20% in at-risk women.1 It typically occurs in developing countries.
Symptoms ranges from of chronic cough and dyspnea to end-stage interstitial lung disease.
DAPLD is potentially the largest environmentally attributable disorder in the world,
with an estimated 3 billion people at risk.4 It is caused by the inhalation of particles liberated from combustion of biomass fuel.
DAPLD results in significant morbidity to the Pakistani rural population particularly the residents of cold areas where there are very lower temperatures and houses are kept close to keep warm.
A detailed environmental history is necessary in such cases for making the diagnosis.
In advanced DAPLD,
bronchoscopy with transbronchial biopsy and examination of bronchoalveolar lavage fluid help narrow down the differentials.5
Radiological imaging provides a non-invasive method to early recognize this condition as removal of the patient from the environment is the only treatment available.7 The development of well-controlled interventional trials and the commitment of sufficient resources to educate local populaces and develop alternative fuel sources,
stove designs,
and ventilation are essential toward reducing the magnitude of DAPLD.6
In a study from Turkey Kara el al8, comparison of HRCT scans of 60 nonsmoking women with at least 10 years of biomass exposure with non-exposed controls showing significantly more of the following abnormalities: reticulation,
peribronchovascular thickening,
and nodular and ground glass opacities.
The asymptomatic subjects with exposure had significantly more ground-glass opacities and less bronchiectasis than those with symptoms.
These data suggest that radiographic abnormalities are seen early in the disease,
even in asymptomatic or mildly symptomatic individuals,
and persist years after removal from exposure.7