FIBRROSING LUNG DISEASE COMPENSATION CLAIMS

What is lung fibrosis?

Fibrosing lung disease or lung fibrosis encompasses a large number of different clinical syndromes. These syndromes are all accompanied by a change in the delicate structure of the lung and disorders of gas exchange. They are diseases of the connective tissue of the lung (interstitium or parenchyma), from which the terms “interstitial lung disease” (ILD) or “diffuse parenchymal lung disease” are derived.

Some of these lung diseases start with a persistent inflammatory reaction which takes place in the air sacs (alveoli). In other forms, it is not so much the inflammatory reaction that is the prominent feature but, as we now believe, more the damage to the lining cells (epithelium) of the alveoli. Both processes subsequently result in increased formation of connective tissue and thus in fibrosis. This scar tissue forms both in the alveoli and between them, and in some forms around the airways (bronchi). Eventually there is also extensive loss of normally formed alveoli.

These processes make the lung stiffer with the result that more force needs to be used to stretch the lung and thus breathing becomes more strenuous (decrease in the elasticity or compliance of the lung). With the increase in the amount of connective tissue, the so-called diffusion distance increases. This is the distance that oxygen must cover when passing from the air side of the alveolus to the blood vessels (capillaries). As a result of this increase in the diffusion distance – as well as the loss of normally formed alveoli and thus the surface area for gas exchange overall – the uptake of oxygen into the bloodstream is made more difficult, giving rise to a decrease in exercise capacity.

How does lung fibrosis occur?

We are able to identify more than 100 different forms of lung fibrosis. In general, they can be divided into forms with a known cause and those with an unknown cause. As mentioned above, there are more than a hundred causes of the development of interstitial lung disease but those attributed to occupational reasons are as follow:

Lung fibrosis caused by inhaled dust particles

• inorganic dusts (asbestosis, silicosis [coal worker’s pneumoconiosis], talc pneumonia,)
• organic dusts (extrinsic allergic alveolitis)

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FIBRROSING LUNG DISEASE COMPENSATION CLAIMS

What symptoms occur?

The most common symptoms of lung fibrosis are breathlessness on exertion (exertional dyspnoea) and cough. The body’s exercise capacity decreases usually gradually and is thus often explained by affected individuals as normal limitations due to ageing. A reduction in the limit of performance during sporting activities is the most likely feature. In everyday life, the first problems usually occur when climbing stairs. If the disease progresses, the breathlessness may even occur at rest (dyspnoea at rest). The oxygen deficiency may also be seen as a dark blue colour (cyanosis) of the lips and fingers. Some patients may develop so-called finger clubbing (swollen ends of fingers) or watch-glass nails (swelling of the finger nails that resembles an hourglass).

A dry cough, a so-called non-productive cough, may be more marked on exercise, in the morning after getting up or during cold weather and is not easily tractable. In some patients, the cough is accompanied by clear to whitish sputum.

Patients with a Fibrosing lung disease tend to have frequent infections of the airways and lung. Infection often results in the disease being diagnosed for the first time.

A rather rare symptom of the disease is the so-called door-stop phenomenon. In this, the patient notices that inspiration stops suddenly in a specific position, which the patient is then able to overcome again after a few breaths.

Furthermore, flu-like symptoms such as fatigue, mild fever, weight loss and muscle and joint pain may occur. The symptoms develop gradually over weeks and months and this distinguishes them from the similar symptoms of a cold.

If the lung fibrosis occurs as part of a systemic connective tissue disease (e.g. collagen vascular disease), other complaints and symptoms in other parts of the body and organs can be found, such as blue discolouration of the fingers (so-called Raynaud’s syndrome), dry eyes (sicca symptoms) or difficulties swallowing.

In specific syndromes, there may be an increase in symptoms due to environmental factors, such as in extrinsic allergic alveolitis. This disease is due to sensitisation of the body to certain organic substances (allergens). In this context, antibodies to these substances are formed. Frequent triggers are feathers of pigeons and canaries, fungal spores and certain bacteria. On contact with, or inhalation of, these substances, there is then an increase in symptoms. These symptoms (including watering of the eyes, fever, and increased breathlessness) typically occur after a slight delay of about 4 to 8 hours after exposure.