Occupational lung disease
Occupational lung diseases are occupational, or work-related, lung conditions that have been caused or made worse by the materials a person is exposed to within the workplace. It includes a broad group of diseases, including occupational asthma, chronic obstructive pulmonary disease (COPD), bronchiolitis obliterans, inhalation injury, interstitial lung diseases (such as pneumoconiosis, hypersensitivity pneumonitis, lung fibrosis), infections, lung cancer and mesothelioma. These diseases can be caused directly or due to immunological response to a exposure to a variety of dusts, chemicals, proteins or organisms.
Occupational cases of interstitial lung disease may be misdiagnosed as COPD, idiopathic pulmonary fibrosis, or a myriad of other diseases; leading to a delay in identification of the causative agent.
- 1 Types of occupational lung diseases
- 2 Occupational environmental exposure
- 3 Infectious exposure
- 4 Others
- 5 Examples
- 6 References
Types of occupational lung diseases
Asthma is a respiratory disease that can begin or worsen due to exposure at work and is characterized by episodic narrowing of the respiratory tract. Occupational asthma has a variety of causes, including sensitization to a specific substance, causing an allergic response; or a reaction to an irritant that is inhaled in the workplace. Exposure to various substances can also worsen pre-existing asthma. People who work in isocyanate manufacturing, who use latex gloves, or who work in an indoor office environment are at higher risk for occupational asthma than the average US worker. Approximately 2 million people in the US have occupational asthma.
Bronchiolitis obliterans, also known as constrictive bronchiolitis or obliterative bronchiolitis is a respiratory disease caused by injury to the smallest airways, called bronchioles. It has been reported to occur from exposure to inhaled toxins and gases including sulfur mustard gas, nitrogen oxides, diacetyl (used as popcorn flavoring), fly ash and fiberglass.
Chronic obstructive pulmonary disease is a respiratory disease that can encompass chronic bronchitis and/or emphysema. 15% of the cases of COPD in the United States can be attributed to occupational exposure, including exposure to silica and coal dust. People who work in mining, construction, manufacturing (specifically textiles, rubber, plastic, and leather), building, and utilities are at higher risk for COPD than the average US worker.
Hypersensitivity pneumonitis (HP; also called allergic alveolitis, bagpipe lung, or extrinsic allergic alveolitis, EAA) is an inflammation of the alveoli within the lung caused by hypersensitivity to inhaled organic dusts.
Numerous categories of ionizing radiation, chemicals and mixtures, occupational exposures, metals, dust and fibers have been linked to occurrence of lung cancer.
Pneumoconiosis are occupational lung diseases that are caused due to accumulation of dust in the lungs and body's reaction to its presence. Most common pneumoconiosis are silicosis, coal workers’ pneumoconiosis (CWP), and asbestosis. Other examples include minerals (such kaolin, talc, mica), beryllium lung disease, hard metal disease and silicon carbide pneumoconiosis.
Occupational environmental exposure
Asbestos is a mineral which was extensively used in the United States to fireproof buildings and textiles, among other items, in the 1950s-1980s. Workers are frequently exposed to asbestos during demolition and renovation work, which can cause asbestosis and/or mesothelioma. Asbestos exposure can also cause pleural effusion, diffuse pleural fibrosis, pleural plaques, and non-mesothelioma lung cancer. Smoking greatly increases the lung cancer risk of asbestos exposure.
Beryllium is classified as an IARC Group 1 carcinogen and can also cause interstitial lung disease. Manufacturing workers, dental technicians, machinists, jewelers, plumbers, electricians, precious metal reclamation workers, and welders are at risk for beryllium exposure.
Cadmium is classified as an IARC Group 1 carcinogen and it is a cause of several cancers, including lung cancer. Workers can be exposed to cadmium through welding, zinc smelting, copper smelting, lead smelting, electroplating, battery manufacture, plastics manufacture, and in alloying.
Chromium is classified as an IARC Group 1 carcinogen and is linked to lung cancer. Workers can be exposed to chromium via welding, steel manufacturing, pigment/dye manufacturing, and electroplating.
Exposure to coal dust is the cause of coalworker's pneumoconiosis, also called "black lung disease", is an interstitial lung disease caused by long-term exposure (over 10 years) to coal dust. Symptoms include shortness of breath and lowered pulmonary function. It can be fatal when advanced. Between 1970-1974, prevalence of CWP among US coal miners who had worked over 25 years was 32%; the same group saw a prevalence of 9% in 2005-2006.It can also exacerbate or cause COPD.
The high surface area to volume ratio of nanoparticles may make them an inhalation hazard for workers exposed to them. This is a topic of ongoing research as of 2015.
Nickel is classified by the IARC as a Group 1 carcinogen; nickel compound exposure is associated with nasal cancer as well as lung cancer. Workers may be exposed to nickel in machining/grinding industry, nickel extraction/production, welding, and electroplating.
Polycyclic aromatic hydrocarbons
Polycyclic aromatic hydrocarbons (PAHs), fused-ring chemicals formed during the combustion of fossil fuels, are metabolized by the cytochrome P450 complex to highly reactive carbocations, which can mutate DNA and cause cancer. Workers may be exposed to PAHs while working in a foundry, in the roofing industry, or due to environmental tobacco smoke.
Exposure to silica can cause Silicosis, which is a fibrosing interstitial lung disease caused by inhaling fine particles of silica, most commonly in the form of quartz or cristobalite. Short-term exposures of large amounts of silica or long-term (10 years or more) exposure of lower levels of silica can cause silicosis. In 1968, more than 1060 US workers died of silicosis; this number fell to 170 by 2005.
Besides causing silicosis, inhalation of silica can cause or exacerbate COPD. It can also impair lung function in general and cause cancer by oxidation damage. It is classified as a "known human carcinogen" (Group 1 carcinogen) by the IARC. Exposure is common for people working in tunneling, quarrying, construction, sandblasting, roadway repair, mining, and foundry work.
Silo-filler's disease (not to be confused with farmer's lung associated with inhalation of biologic dusts) results from inhalation of nitrogen dioxide (NO2) gas from fresh silage. The presentation is variable depending on level of exposure. Often the gas penetrates throughout the lung and if severe can manifest as a form of Acute Respiratory Distress Syndrome, such as significant pulmonary edema, hyalinized alveolar membranes, congestion and other respiratory illnesses.
Tuberculosis is a lung disease endemic in many parts of the world. Health care professionals and prison guards are at high risk for occupational exposure to tuberculosis, since they work with populations with high rates of the disease.
World Trade Center lung
World Trade Center lung is a cluster of diseases caused by exposure to fallout at Ground Zero of the September 11 attacks in 2001. These diseases include asthma, asthmatic bronchitis, terminal airways disease, sarcoidosis, and acute eosinophilic pneumonia.
- Hypersensitivity pneumonitis
- Beckett, W. S. (2000-02-10). "Occupational respiratory diseases". The New England Journal of Medicine. 342 (6): 406–413. doi:10.1056/NEJM200002103420607. ISSN 0028-4793. PMID 10666432.
- Cullinan, Paul; Muñoz, Xavier; Suojalehto, Hille; Agius, Raymond; Jindal, Surinder; Sigsgaard, Torben; Blomberg, Anders; Charpin, Denis; Annesi-Maesano, Isabella (May 2017). "Occupational lung diseases: from old and novel exposures to effective preventive strategies". The Lancet. Respiratory Medicine. 5 (5): 445–455. doi:10.1016/S2213-2600(16)30424-6. ISSN 2213-2619. PMID 28089118.
- "Respiratory Diseases: Occupational Risks". National Institute for Occupational Safety and Health. 21 December 2012. Retrieved 23 March 2015.
- Sauler, Maor; Gulati, Mridu (December 2012). "Newly recognized occupational and environmental causes of chronic terminal airways and parenchymal lung disease". Clinics in Chest Medicine. 33 (4): 667–680. doi:10.1016/j.ccm.2012.09.002. PMC . PMID 23153608.
- Barker, Alan F.; Bergeron, Anne; Rom, William N.; Hertz, Marshall I. "Obliterative Bronchiolitis". New England Journal of Medicine. 370 (19): 1820–1828. doi:10.1056/nejmra1204664.
- Selman, Moisés; Pardo, Annie; King, Talmadge E. (2012-12-14). "Hypersensitivity Pneumonitis". American Journal of Respiratory and Critical Care Medicine. 186 (4): 314–324. doi:10.1164/rccm.201203-0513ci.
- Field, R. William; Withers, Brian L. "Occupational and Environmental Causes of Lung Cancer". Clinics in Chest Medicine. 33 (4): 681–703. doi:10.1016/j.ccm.2012.07.001. PMC .
- Murray & Nadel's textbook of respiratory medicine. Elsevier Saunders. 2016. pp. 1307–1330. ISBN 978-1-4557-3383-5.
- "Bis(chloromethyl)ether (BCME) (CASRN 542-88-1)". IRIS (Integrated Risk Information System). EPA. 31 October 2014. Retrieved 31 March 2015.
- Chan-Yeung M, Ashley MJ, Grzybowski S. Grain dust and the lungs. Can Med Assoc J. 1978 May 20;118(10):1271-4. Review. PMID 348288 Free PMC Article
- Gurney JW, et al. Agricultural disorders of the lung. Radiographics. 1991 Jul;11(4):625-34. Review. PMID 1887117