What I Need to Know:
“For the sword outwears its sheath, / And the soul wears out the breast, / And the heart must pause to breathe, / And love itself have rest.
So go the words of famous English poet Lord Byron in his poem “So We'll Go No More a Roving”.
Indeed, breathing and proper lung function are critical to everyone’s health. Breathing is what sustains our bodies and allows us to use the energy of the foods we eat.
Like the rest of the human body, the lungs can be prone to certain diseases that can affect their healthy functioning.
My essential question for my capstone project is indeed related to lung function: ‘Which professions are most likely to cause IPF and COPD in healthy adults?
While shadowing at Gwinnett Pulmonary Group, my place of internship, I observed patient consultations and watched a truck driver, an airport employee, and multiple office workers come for treatment. All of the patients appeared to be healthy, but they had very dangerous lung diseases.
I was inspired to investigate the relationship between certain professions and the lung diseases they cause. I wanted to understand what would cause these diseases at workplaces despite safety equipment and precautions and if there is a way to further reduce disease occurrence. I wanted to share some insight with GPG so they can use the same in treating patients; I wanted to make a real difference to the lives of patients visiting GPG.
What I Know or Assume:
Most of what I knew about the respiratory system and its diseases prior to my research was solely based on what I had learned in AP Biology and Anatomy/Physiology courses in school. I knew little of the specifics of lung function and how certain diseases affect the lungs physically and physiologically.
I really only knew about lung cancer, mesothelioma, asthma, bronchitis, and pneumonia. I thought lung cancer was only caused by smoking and use of tobacco products and/or inhaling dangerous fumes. The only reason I knew that mesothelioma is a lung disease was from the TV commercials. I thought asthma was just something people got when they're born and that the only way to treat it is with the inhalers. I knew about bronchitis because I had gotten a viral cough when I was younger, and the doctor said that I might have bronchitis. As for pneumonia, I only knew it was something that people got if it was too cold, and it's when there's liquid in the lungs and the patient can't breathe properly. I knew a little bit about other lung diseases like cystic fibrosis from my AP Biology course.
However, as I started shadowing my mentor and other physicians at my place of internship, I learned more about other more critical lung diseases. From what I was learning, I created two hypotheses that would be answered through my research.
My first hypothesis is that IPF and COPD are the most critical lung diseases, in terms of incidence frequency and fatality. My second hypothesis is that IPF and COPD are caused primarily by certain types of professions.
The purpose of my project and this presentation is:
The Story of My Search:
Online Information Search
I referred to multiple research reports and articles on the Internet for information on lung disease, causes, statistics and correlation to professions. The following are some of the key resources I used:
In my research, I used three different articles regarding the treatment and diagnosis of COPD and IPF. (All three sources are listed in the Annotated Bibliographies tab.)
Source 1 is an article written by Dr. P. B. Terry, M.D., and it was used to understand how COPD can be diagnosed by physicians. It stated that patients can be diagnosed based on their claims about symptoms and based on testing for COPD with Pulmonary Function Tests and studies of patients' lungs via X-ray scans. I also was able to include some of the treatments for COPD that were mentioned by the article, such as medications, physical therapies, and surgeries.
Source 2 is a medical journal piece written by A. Suhaj et al and this material helped me understand the importance of pharmacists in the treatment of patients' COPD symptoms. I also utilized the piece to explain pharmacists' role in ensuring that patients are being consistent with their use of their medications and pharmacists' role in providing patients with the education they need to understand their medical conditions. It was clear to me that I could use this article to show that patient-healthcare provider relationships are very important to the treatment of the patient.
Source 3 is another medical journal, and it was written by Nesrin Mogulkoc et al and it explains the effects of IPF on pulmonary function and the various aspects of the patient's health that a physician must consider before referring the patient for a lung transplant. I didn't use a lot of information from this article, but I did learn how surgeries are suggested to patients and how a patient is affected by IPF.
Interviews
I conducted two interviews, one with a physician and another with a registered nurse at GPG to better understand the symptoms, severity, development, and treatment of the two diseases.
I also had the opportunity to interview Dr. Andrew Mazzoli, Director of Respiratory Therapy at Augusta University during a field trip to the institution. I learned from this interview about the specific effects of the two diseases (COPD & IPF) on lung function.
I was able to support both of my hypotheses with the data I’d collected, to a large extent; although, I would have preferred to collect even more statistical data to support my research.
The research project was a great learning opportunity for me:
Key inputs I received from my interview with Physician at GPG:
Key inputs I received from my interview with a Registered Nurse at GPG:
What I Discovered in the End
According to the US National Institute of Health (NIH), Chronic Obstructive Pulmonary Disease (COPD) is the most common respiratory disease and is one of the leading causes of death in the United States.
The Center for Disease Control stated that as of May 2017, the mortality rate in the US from COPD is 39.1 cases per 100,000. COPD is the 3rd most common cause of death in the United States.
The American Thoracic Society reported that mortality rate for Idiopathic Pulmonary Fibrosis (IPF) is quite low as compared to that of COPD, only 50.8 cases per 1 million people.
The NIH also stated that approximately 15% of all COPD cases are occupation-related.
Mayo Clinic describes COPD as the chronic inflammation of the lungs, which leads to a blockage of airflow to and from the lungs.
Dr. Andrew Mazzoli explained that COPD primarily affects the airways of the lungs like the main bronchus stem, the bronchi, and bronchioles.
It is characterized primarily by dyspnea (difficulty in breathing), excessive mucus, sputum production, cyanosis of the lips or nailbeds, frequent pulmonary infection, lack of energy, and swelling in the feet or ankles, just to name a few symptoms.
COPD is almost always caused by smoking and tobacco, but it can also be caused by exposures to air pollution in the environment, genetic irregularities, and improper lung development. With regards to occupation-based COPD, exposure to harmful gases, dusts, and chemicals in the workplace can lead to irritation and inflammation of the lungs. This inflammation can lead to COPD if the exposure is prolonged and no measures are taken to prevent inhalation of these dangerous particles.
IPF, or Idiopathic Pulmonary Fibrosis, is a type of Pulmonary Fibrosis, which can be caused by drugs, radiation therapy, environmental factors, autoimmune disorders, occupation, or even genetic predisposition. However, IPF also falls under a larger category of diseases called interstitial lung diseases, that include any diseases associated with inflammation and scarring of lung tissue.
IPF is the scarring of lung tissue, which is caused by multiple factors, but in regards to occupation, it is primarily caused by smoking and exposure to harmful fumes and dusts. IPF affects the alveoli and inner portions of the lungs rather than airways. When the dusts and chemicals damage the lungs, the body reacts to the particles and scars form where the lung tissue was affected. The lungs experience what is called honeycombing, by which surface area of usable alveolar tissue is decreased, so gas exchange is less effective.
Because the lung tissue is scarred, it does not function properly and oxygen taken from the air by the lungs cannot be sent to the bloodstream.
Symptoms of IPF include shortness of breath; rapid, shallow breaths; fatigue; aching muscles and joints; clubbing; and dry, hacking cough.
IPF can likely lead to other health issues such as collapsed or infected lungs, pulmonary blood clots, and lung cancer.
Profession-Disease Correlation
The NIH wrote that COPD is primarily caused by sulfur dioxide, mineral dusts, vanadium and endotoxin, which are all different kinds of chemicals and dusts that are found in construction jobs, mining, and industrial work. The exposure to these dusts and chemicals leads to irritation in the lungs, just like how getting dust in your eyes can lead to itchiness and redness.
Exposure to chemicals like silica and hard metal dusts and organic dusts like bacteria and animal proteins can lead to IPF. Exposure to these dusts is most likely to occur in agriculture-based professions like farming, livestock-handling, and stonework.
Current State of Disease Prevention in the Industry
There are regulations in place to ensure the health and safety of workers in all industries by organizations like OSHA. However, some of these regulations may be enforced in a very lax manner, leading to new cases of COPD and IPF. Another possibility is that the regulations in place are not strict or safe enough for the workers because the nature of the industry is so dangerous (an example may be industrial work with wood or steel).
Current Treatment Options
Most of the treatments for these patients are medicines like Prednisone that help stop the spread of scarring. Some treatments aim to help the patient increase their oxygen intake with oxygen therapy. For some cases of IPF, surgery is the only other option that can be used to help the patient retain the ability to breathe.
Potential Alternative Approaches for Reduction of Disease Incidence and for Treatment
One possible treatment approach is to bring scaled-down versions of certain treatment equipment to patients’ homes. For example, non-pill medications like albuterol, which are be administered in hospitals, can be made more available to people who would like to use the treatment at home. Other treatments like oxygen therapy can be made cheaper and more available to patients that require it and may not be able to afford it.
Making machines for oxygen therapy and other treatments available and affordable to patients will help patients to manage or reduce their symptoms.
In industries like steel-making and stonework, companies can provide very safe and well-designed specialized masks (similar to ones used in nuclear plants) to prevent inhalation of harmful fumes or dusts so that workers are less prone to COPD and IPF.
In service-based workplaces like offices, employers can offer incentives to employees to stop smoking and adopting a healthy lifestyle.
Educating employees about the importance of workplace safety and the effects of these diseases can significantly help in disease prevention.
“For the sword outwears its sheath, / And the soul wears out the breast, / And the heart must pause to breathe, / And love itself have rest.
So go the words of famous English poet Lord Byron in his poem “So We'll Go No More a Roving”.
Indeed, breathing and proper lung function are critical to everyone’s health. Breathing is what sustains our bodies and allows us to use the energy of the foods we eat.
Like the rest of the human body, the lungs can be prone to certain diseases that can affect their healthy functioning.
My essential question for my capstone project is indeed related to lung function: ‘Which professions are most likely to cause IPF and COPD in healthy adults?
While shadowing at Gwinnett Pulmonary Group, my place of internship, I observed patient consultations and watched a truck driver, an airport employee, and multiple office workers come for treatment. All of the patients appeared to be healthy, but they had very dangerous lung diseases.
I was inspired to investigate the relationship between certain professions and the lung diseases they cause. I wanted to understand what would cause these diseases at workplaces despite safety equipment and precautions and if there is a way to further reduce disease occurrence. I wanted to share some insight with GPG so they can use the same in treating patients; I wanted to make a real difference to the lives of patients visiting GPG.
What I Know or Assume:
Most of what I knew about the respiratory system and its diseases prior to my research was solely based on what I had learned in AP Biology and Anatomy/Physiology courses in school. I knew little of the specifics of lung function and how certain diseases affect the lungs physically and physiologically.
I really only knew about lung cancer, mesothelioma, asthma, bronchitis, and pneumonia. I thought lung cancer was only caused by smoking and use of tobacco products and/or inhaling dangerous fumes. The only reason I knew that mesothelioma is a lung disease was from the TV commercials. I thought asthma was just something people got when they're born and that the only way to treat it is with the inhalers. I knew about bronchitis because I had gotten a viral cough when I was younger, and the doctor said that I might have bronchitis. As for pneumonia, I only knew it was something that people got if it was too cold, and it's when there's liquid in the lungs and the patient can't breathe properly. I knew a little bit about other lung diseases like cystic fibrosis from my AP Biology course.
However, as I started shadowing my mentor and other physicians at my place of internship, I learned more about other more critical lung diseases. From what I was learning, I created two hypotheses that would be answered through my research.
My first hypothesis is that IPF and COPD are the most critical lung diseases, in terms of incidence frequency and fatality. My second hypothesis is that IPF and COPD are caused primarily by certain types of professions.
The purpose of my project and this presentation is:
- To analyze data and confirm my assumption that IPF and COPD are indeed the most critical lung diseases
- To confirm the correlation between certain professions and IPF and COPD
- To look at current preventive measures being taken by industries and to explore any other possible actions that can be taken to further reduce the occurrence of these diseases.
The Story of My Search:
Online Information Search
I referred to multiple research reports and articles on the Internet for information on lung disease, causes, statistics and correlation to professions. The following are some of the key resources I used:
- https://www.cdc.gov/nchs/fastats/copd.htm
- https://www.atsjournals.org/doi/full/10.1164/rccm.200701-044OC
- https://www.atsjournals.org/doi/abs/10.1164/ajrccm.150.3.8087336?journalCode=ajrccm
- https://www.cdc.gov/copd/data.html
In my research, I used three different articles regarding the treatment and diagnosis of COPD and IPF. (All three sources are listed in the Annotated Bibliographies tab.)
Source 1 is an article written by Dr. P. B. Terry, M.D., and it was used to understand how COPD can be diagnosed by physicians. It stated that patients can be diagnosed based on their claims about symptoms and based on testing for COPD with Pulmonary Function Tests and studies of patients' lungs via X-ray scans. I also was able to include some of the treatments for COPD that were mentioned by the article, such as medications, physical therapies, and surgeries.
Source 2 is a medical journal piece written by A. Suhaj et al and this material helped me understand the importance of pharmacists in the treatment of patients' COPD symptoms. I also utilized the piece to explain pharmacists' role in ensuring that patients are being consistent with their use of their medications and pharmacists' role in providing patients with the education they need to understand their medical conditions. It was clear to me that I could use this article to show that patient-healthcare provider relationships are very important to the treatment of the patient.
Source 3 is another medical journal, and it was written by Nesrin Mogulkoc et al and it explains the effects of IPF on pulmonary function and the various aspects of the patient's health that a physician must consider before referring the patient for a lung transplant. I didn't use a lot of information from this article, but I did learn how surgeries are suggested to patients and how a patient is affected by IPF.
Interviews
I conducted two interviews, one with a physician and another with a registered nurse at GPG to better understand the symptoms, severity, development, and treatment of the two diseases.
I also had the opportunity to interview Dr. Andrew Mazzoli, Director of Respiratory Therapy at Augusta University during a field trip to the institution. I learned from this interview about the specific effects of the two diseases (COPD & IPF) on lung function.
I was able to support both of my hypotheses with the data I’d collected, to a large extent; although, I would have preferred to collect even more statistical data to support my research.
The research project was a great learning opportunity for me:
- To understand the field of pulmonology, the lung function, the critical diseases of COPD & IPF, causes and treatment.
- To understand the correlation between certain professions and the critical lung diseases of COPD & IPF.
- To think about possible alternative approaches to reduce the incidence of diseases and for treatment.
Key inputs I received from my interview with Physician at GPG:
- COPD is the most common pulmonary disease.
- COPD is more common in the obese, the elderly, and those exposed to harmful fumes and chemicals.
- It causes a tightening of the airways similar to asthma, except COPD is chronic, which means it occurs over a longer period of time and asthma tightens airways during attacks.
- COPD can be treated and its symptoms handled with medication like bronchodilators and inhalers.
Key inputs I received from my interview with a Registered Nurse at GPG:
- IPF affects lung function more than other respiratory diseases.
- Diseases like asthma and COPD can greatly influence the effects of IPF on the lungs by magnifying the symptoms.
- The only way to eradicate IPF in a patient is to replace the diseased lung.
- Preventing IPF early on can make treatment easier because medications can be prescribed earlier. IPF can be fatal if not detected.
What I Discovered in the End
According to the US National Institute of Health (NIH), Chronic Obstructive Pulmonary Disease (COPD) is the most common respiratory disease and is one of the leading causes of death in the United States.
The Center for Disease Control stated that as of May 2017, the mortality rate in the US from COPD is 39.1 cases per 100,000. COPD is the 3rd most common cause of death in the United States.
The American Thoracic Society reported that mortality rate for Idiopathic Pulmonary Fibrosis (IPF) is quite low as compared to that of COPD, only 50.8 cases per 1 million people.
The NIH also stated that approximately 15% of all COPD cases are occupation-related.
Mayo Clinic describes COPD as the chronic inflammation of the lungs, which leads to a blockage of airflow to and from the lungs.
Dr. Andrew Mazzoli explained that COPD primarily affects the airways of the lungs like the main bronchus stem, the bronchi, and bronchioles.
It is characterized primarily by dyspnea (difficulty in breathing), excessive mucus, sputum production, cyanosis of the lips or nailbeds, frequent pulmonary infection, lack of energy, and swelling in the feet or ankles, just to name a few symptoms.
COPD is almost always caused by smoking and tobacco, but it can also be caused by exposures to air pollution in the environment, genetic irregularities, and improper lung development. With regards to occupation-based COPD, exposure to harmful gases, dusts, and chemicals in the workplace can lead to irritation and inflammation of the lungs. This inflammation can lead to COPD if the exposure is prolonged and no measures are taken to prevent inhalation of these dangerous particles.
IPF, or Idiopathic Pulmonary Fibrosis, is a type of Pulmonary Fibrosis, which can be caused by drugs, radiation therapy, environmental factors, autoimmune disorders, occupation, or even genetic predisposition. However, IPF also falls under a larger category of diseases called interstitial lung diseases, that include any diseases associated with inflammation and scarring of lung tissue.
IPF is the scarring of lung tissue, which is caused by multiple factors, but in regards to occupation, it is primarily caused by smoking and exposure to harmful fumes and dusts. IPF affects the alveoli and inner portions of the lungs rather than airways. When the dusts and chemicals damage the lungs, the body reacts to the particles and scars form where the lung tissue was affected. The lungs experience what is called honeycombing, by which surface area of usable alveolar tissue is decreased, so gas exchange is less effective.
Because the lung tissue is scarred, it does not function properly and oxygen taken from the air by the lungs cannot be sent to the bloodstream.
Symptoms of IPF include shortness of breath; rapid, shallow breaths; fatigue; aching muscles and joints; clubbing; and dry, hacking cough.
IPF can likely lead to other health issues such as collapsed or infected lungs, pulmonary blood clots, and lung cancer.
Profession-Disease Correlation
The NIH wrote that COPD is primarily caused by sulfur dioxide, mineral dusts, vanadium and endotoxin, which are all different kinds of chemicals and dusts that are found in construction jobs, mining, and industrial work. The exposure to these dusts and chemicals leads to irritation in the lungs, just like how getting dust in your eyes can lead to itchiness and redness.
Exposure to chemicals like silica and hard metal dusts and organic dusts like bacteria and animal proteins can lead to IPF. Exposure to these dusts is most likely to occur in agriculture-based professions like farming, livestock-handling, and stonework.
Current State of Disease Prevention in the Industry
There are regulations in place to ensure the health and safety of workers in all industries by organizations like OSHA. However, some of these regulations may be enforced in a very lax manner, leading to new cases of COPD and IPF. Another possibility is that the regulations in place are not strict or safe enough for the workers because the nature of the industry is so dangerous (an example may be industrial work with wood or steel).
Current Treatment Options
Most of the treatments for these patients are medicines like Prednisone that help stop the spread of scarring. Some treatments aim to help the patient increase their oxygen intake with oxygen therapy. For some cases of IPF, surgery is the only other option that can be used to help the patient retain the ability to breathe.
Potential Alternative Approaches for Reduction of Disease Incidence and for Treatment
One possible treatment approach is to bring scaled-down versions of certain treatment equipment to patients’ homes. For example, non-pill medications like albuterol, which are be administered in hospitals, can be made more available to people who would like to use the treatment at home. Other treatments like oxygen therapy can be made cheaper and more available to patients that require it and may not be able to afford it.
Making machines for oxygen therapy and other treatments available and affordable to patients will help patients to manage or reduce their symptoms.
In industries like steel-making and stonework, companies can provide very safe and well-designed specialized masks (similar to ones used in nuclear plants) to prevent inhalation of harmful fumes or dusts so that workers are less prone to COPD and IPF.
In service-based workplaces like offices, employers can offer incentives to employees to stop smoking and adopting a healthy lifestyle.
Educating employees about the importance of workplace safety and the effects of these diseases can significantly help in disease prevention.