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Allison Inserro
A recent joint American Thoracic Society and the European Respiratory Society statement urged policymakers and clinicians to take seriously the role that inhaled vapors, gas, dust, or fumes have in creating occupational respiratory disease. 
Respiratory dangers in the workplace may cause more than 1 in 10 people worldwide to become ill with a range of non-cancerous lung diseases, according to a recent joint American Thoracic Society and the European Respiratory Society statement published in the ATS's American Journal of Respiratory and Critical Care Medicine.

Inhaling vapors, gas, dust, or fumes at work cause disease beyond asthma and chronic obstructive pulmonary disease (COPD), according to the statement, which reported an in-depth literature review and data synthesis. Previous reports have focused on asthma and COPD. Additional strategies are needed to improve the recognition and prevention of the development of these diseases through the workplace, the statement said. The disease burden includes airway diseases; interstitial fibrosis; hypersensitivity pneumonitis; other noninfectious granulomatous lung diseases, including sarcoidosis; and selected respiratory infections.

The occupational population attributable fraction (PAF) was estimated for conditions where sufficient population-based studies allowed for pooled estimates. For other conditions, the occupational burden of disease was estimated on the basis of attribution in case series, incidence rate ratios, or attributable fraction within an exposed group.

Researchers did not study cancer of the lung and pleura, the membrane surrounding the lungs, because the occupational burden for those conditions has already been reported. Diseases that are entirely work-related, including asbestosis, silicosis, and coal workers' pneumoconiosis (black lung), were not included.

The impact of workplace exposures includes asthma (PAF, 16%); COPD (PAF, 14%); chronic bronchitis (PAF, 13%); idiopathic pulmonary fibrosis (PAF, 26%); hypersensitivity pneumonitis (occupational burden, 19%); other granulomatous diseases, including sarcoidosis (occupational burden, 30%); pulmonary alveolar proteinosis (occupational burden, 29%); tuberculosis (occupational burden, 2.3% in silica-exposed workers and 1% in healthcare workers); and community-acquired pneumonia in working-age adults (PAF, 10%).

"The role of occupational factors in most lung disease is under-recognized," said Paul D. Blanc, MD, MSPH, chief of the Division of Occupational and Environmental Medicine at the University of California San Francisco, in a statement. "Failure to appreciate the importance of work-related factors in such conditions impedes diagnosis, treatment and, most importantly of all, prevention of further disease."

Blanc said that some of these findings, particularly those for asthma and COPD, reinforce earlier estimates, while others, such as those for idiopathic pulmonary fibrosis and community-acquired pneumonia, show a greater degree of risk. The researchers hope that the statement will cause clinicians to consider the patient's occupation when treating for respiratory conditions and "will move policy makers to take seriously the prevention of such diseases among working women and men around the globe."

Reference

Blanc PB,  Annesi-Maesano I,  Balmes JR, et al. The occupational burden of nonmalignant respiratory diseases. An official American Thoracic Society and European Respiratory Society statement [published online June 1, 2019]. Am J Respir Crit. doi: 10.1164/rccm.201904-0717ST.    

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