Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Bronchiectasis


Related Terms

  • Acquired Bronchiectasis
  • Bronchial Dilatation
  • Congenital Bronchiectasis
  • Dry Bronchiectasis
  • Wet Bronchiectasis

Differential Diagnosis

Specialists

  • Infectious Disease Internist
  • Pulmonologist
  • Thoracic Surgeon

Comorbid Conditions

Factors Influencing Duration

Disability is affected by any underlying medical conditions, age at onset of disease, current age, presence and type of infections, and individual compliance with treatment plans.

Medical Codes

ICD-9-CM:
494.0 - Bronchiectasis without Acute Exacerbation
494.1 - Bronchiectasis with Acute Exacerbation
748.61 - Congenital Anomalies of Respiratory System; Congenital Bronchiectasis

Overview

© Reed Group
Bronchiectasis is an obstructive lung disease characterized by irreversible enlargement (dilation) of the medium-sized bronchi (>2 mm in diameter) due to destruction of bronchial elastic tissue, smooth muscle and cartilage. It is usually caused by repeated infections and inflammation. Inflammation causes a partial obstruction of lung tissue, causing secretions to collect and setting the stage for infections to develop and persist, damaging surrounding lung tissue.

Bronchiectasis is not an independent lung disease but is a consequence of some other disease process. Infections of the lung due to viruses or bacteria (such as pneumonia or tuberculosis) can cause bronchiectasis. The condition can also occur from obstruction of the lung by a tumor or an inhaled foreign object. Bronchiectasis can follow lung injury from inhaling corrosive gases or one's own stomach contents. It can occur secondary to anatomic birth defects of the lung, as well as in diseases such as cystic fibrosis (an inherited disorder characterized by thick, viscous secretions, with recurrent sinopulmonary infections in sinuses and airways), Young's syndrome, primary ciliary dyskinesia, allergic bronchopulmonary aspergillosis (a disease characterized by colonization of the airways by a fungus, Aspergillus, in an individual with asthma or cystic fibrosis), immunodeficiency conditions, alpha-1 antitrypsin deficiency, Sjögren's syndrome, and various autoimmune diseases including rheumatoid arthritis. Cystic fibrosis is the main single cause of bronchiectasis in the US (Morrissey).

Incidence and Prevalence: It is estimated that at least 110,000 individuals in the US are currently being treated for non-cystic fibrosis bronchiectasis. The US prevalence is an estimated 4.2 per 100,000 persons aged 18 to 34 years and 272 per 100,000 persons aged 75 years and older. Outside the US, bronchiectasis is a common clinical problem, but the worldwide prevalence is unknown (O’Donnell).

Source: Medical Disability Advisor



Causation and Known Risk Factors

The cause of 50% to 80% of non-cystic fibrosis bronchiectasis is unknown. The risk of bronchiectasis is greater in individuals who have a history of pneumonia, those who do not have access to medical care, and in individuals who have immune system disorders (such as HIV infection). Individuals aged 60 to 80 years are most likely to have the disease (O'Donnell).

Source: Medical Disability Advisor



Diagnosis

History: The individual complains of a cough producing variable amounts of yellow-green and / or blood streaked mucus (sputum) (wet bronchiectasis). Cough and sputum production increase at night. Wheezing is common. The cough may worsen when the individual lies on one side. There is a history of shortness of breath (dyspnea) that worsens with exercise. With long-standing bronchiectasis, there may be loss of appetite, weight loss, fatigue, and frequent sinus infections. In the variant called "dry bronchiectasis," there is cough but only minimal sputum production. The tissue may be enlarged around the fingernails (clubbing). The individual may complain of sensations of feeling the heartbeat (palpitations) and chest pain.

Physical exam: The exam may reveal abnormal breath sounds indicating retained secretions in the lung. Wheezes or rales may be heard. The skin may be discolored and bluish (cyanotic). The individual may be pale and have foul breath odor. The ankles, feet, and legs may be swollen (edema). Heartbeat may be irregular.

Tests: Although the chest x-ray usually reveals markings in the lung indicative of bronchiectasis, chest x-ray may be normal early in the course of the disorder. A high-resolution computed tomography (CT) scan is a more accurate diagnostic method. Other tests include sputum culture and pulmonary function tests (PFT), including arterial blood gas (ABG), which helps document the severity of lung and respiratory dysfunction. An instrumental examination of the bronchial path (bronchoscopy) may be done for localized disease in which a foreign object or tumor is suspected. It is important to diagnose the underlying predisposing factors that led to the bronchiectasis. A complete blood count (CBC) may reveal anemia. An immunoglobulin test may reveal an immunodeficiency.

Source: Medical Disability Advisor



Treatment

The goal of therapy is to control infections, promote sputum clearance, improve symptoms, reduce complications, control exacerbations, and reduce morbidity and mortality. Early recognition is essential in bronchiectasis, and the success of treatment depends on management of underlying conditions. Treatment consists of antibiotic therapy. The choice of antibiotic is guided by microscopic examination of the sputum (Gram stain) and sputum culture. Physical therapy (chest percussion and postural drainage) is done to encourage drainage of secretions from the lung. Additional treatment can include bronchodilators, agents to loosen lung secretions (mucolytics), smoking cessation, supplemental oxygen, and vaccination against influenza and pneumococcal pneumonia. Anti-inflammatory medications such as steroids may be helpful, especially in bronchiectasis related to cystic fibrosis or aspergillosis.

Treatment is also needed for the underlying cause of bronchiectasis, such as cystic fibrosis, immotile cilia syndrome, foreign body aspiration, allergic bronchopulmonary aspergillosis, or congenital absence or low levels of gamma globulin (hypogammaglobulinemia).

Surgical removal of the diseased part of the lung (segmentectomy/lobectomy) is considered if the individual is unresponsive to medical therapy and if the disease is well localized and limited to one lung. On occasion, individuals with end-stage bronchiectasis may be considered for lung transplantation. Single and double lung transplantation has been used as treatment for severe bronchiectasis, predominantly when related to cystic fibrosis. In general, individuals with cystic fibrosis and bronchiectasis should be considered for lung transplant when forced expiratory volume in 1 second (FEV1) falls below 30% of predicted levels. Lung transplantation in females and younger individuals may need to be considered even sooner.

Source: Medical Disability Advisor



Prognosis

Overall the prognosis is good, but it varies with the underlying disease or predisposing condition, as well as with the amount of lung tissue destroyed. The expected outcome worsens with multiple successive pulmonary infections. Individuals who have had bronchiectasis from childhood usually have a shortened life expectancy. In general, individuals do well if they comply with all treatment regimens and practice routine preventive medical strategies. Lung transplantations have a reasonable chance of success, provided the individual makes healthy lifestyle changes.

Source: Medical Disability Advisor



Complications

The most common complication is pulmonary infection. If severe, pulmonary infection can lead to respiratory failure. Chronic infections can create a strain on the right side of the heart, causing enlargement of the right ventricle of the heart (cor pulmonale). Other complications are lung abscess, pus in the pleural cavity (pleural empyema), bronchopleural fistula, and pneumothorax, all of which are more common in individuals with onset of bronchiectasis early in life.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

In localized, early stage bronchiectasis, there may be no need for restriction of workload. If more severe lung damage has occurred, significant restriction of physical workload may be needed. In both instances, it is wise to wear proper respiratory protection and to avoid irritating dusts and gases.

Risk: Jobs that require exposure to heavy fumes, dusts, and respiratory irritants are best avoided if possible, although a paper mask may be sufficient protection in most cases. More advanced mask systems as per OSHA guidelines should also be followed in certain industries.

Capacity: This is measurable with PFT, often with metabolic stress echocardiogram (ECHO) testing to confirm oxygenation.

Tolerance: Tolerance may be enhanced by ensuring medication compliance if prescribed, excluding concurrent conditions such as anemia, and possibly offering rapid testing and physician evaluation should the individual have a recurrence of symptoms.

Source: Medical Disability Advisor



Maximum Medical Improvement

90 days (for a steady state and no flare ups).

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Has individual had a history of repeated bronchial or lung infections or inflammation?
  • Did individual experience symptoms of a productive cough, purulent sputum, blood-stained sputum, dyspnea, or wheezing?
  • Did physical exam reveal abnormal breath sounds, tachypnea, pale skin, cyanosis, or leg edema?
  • Were diagnostic x-rays (chest x-ray or high-resolution CT scan) done to confirm the diagnosis?
  • Was the severity of the disease determined with additional tests such as PFT and / or arterial blood gases?
  • Were other lung conditions (atelectasis, asthma, pneumonia, cystic fibrosis) ruled out?

Regarding treatment:

  • Was individual responsive to standard medical interventions such as oxygen, respiratory therapy, and administration of bronchodilators or anti-inflammatories?
  • Was individual instructed to avoid bronchial irritants such as tobacco smoke?
  • Did individual receive prophylactic vaccination for influenza and pneumococcal pneumonia?
  • Has individual been compliant with the treatment regimen?
  • Would individual benefit from a smoking cessation program?
  • Was surgical intervention indicated?

Regarding prognosis:

  • Were appropriate work accommodations (reduced physical workload, protection from respiratory irritants) made to allow individual to return to work safely?
  • Based on individual's clinical condition and treatment required, what was the expected outcome?
  • Does individual have a history of recurrent pulmonary infections or other underlying pulmonary disease that may affect recovery and prognosis?
  • Did individual suffer any associated complications such as cor pulmonale, lung abscesses, fistula or pneumothorax that could impact recovery and prognosis?

Source: Medical Disability Advisor



References

Cited

"Bronchiectasis." MedlinePlus. 26 Feb. 2014. National Library of Medicine. 5 May 2014 <http://www.nlm.nih.gov/medlineplus/ency/article/000144.htm>.

Emmons, Ethan E. "Bronchiectasis." eMedicine. Eds. Zab Mosenifar, et al. 31 Mar. 2014. Medscape. 5 May 2014 <http://emedicine.medscape.com/article/296961-overview>.

Morrissey, B. M. "Pathogenesis of Bronchiectasis." Clinics in Chest Medicine 28 (2007): 289-296.

O'Donnell, A. E. "Bronchiectasis." Chest 134 (2008): 815-823.

Source: Medical Disability Advisor






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