The ACCP recently sponsored the Occupational and Environmental Lung Disease Conference 2013, held June 21 to 23 in Toronto, ON, Canada. Presentations and discussions addressed a diverse range of issues in this dynamic field.
Occupational respiratory disease continues to be relevant and important. Taking a targeted occupational history is critical to identifying work relatedness. Occupational asthma is a common cause of new onset adult asthma and should always be suspected in that setting. Work-exacerbated asthma is also common. The role of assessing airway inflammation in work-related asthma continues to evolve. The European Respiratory Society and the ACCP have recently published statements on diagnosis and treatment of work-related asthma.
There is increasing recognition of work-related COPD. Approximately 25% of people with COPD have never smoked; up to 50% of COPD in this group may be related to occupational exposures. Hypersensitivity pneumonitis, various forms of pneumoconiosis, and a range of disorders related to production agriculture continue to be relevant problems and should be considered in appropriate settings.
When evaluating impairment in patients making disability claims, it helps to be systematic and to be aware of the criteria used by the relevant compensation systems, since they vary.
Indoor environmental exposures are important causes of respiratory disease. Household exposure to biomass burning is a major worldwide cause of COPD mortality and reduced quality of life. Indoor dampness and mold are accepted risk factors for upper and lower respiratory diseases, including allergic rhinitis, asthma, hypersensitivity pneumonitis, and others. Indoor dampness and mold can generally be assessed based on visual inspection and smell. Environmental sampling is not routinely required for an indoor air quality survey and, if conducted, should address a hypothesis and be interpreted in the context of the entire investigation. Other household exposures, such as from using cleaning and personal care products or in association with hobbies, can also cause respiratory problems.
Global climate change has emerged as a key environmental issue: "The uncertainty is not that global warming will be responsible for exacerbating the global public health problems of poverty, infectious and noncommunicable diseases, but by how much." (Anstey et al. Global Health. 2013;9[9]:4). The mainstream scientific view is that human generation of greenhouse gases such as CO2 underlies global climate change. Outdoor air pollution also remains important. WHO estimates that one type of air pollution, particulate matter (PM) exposure, accounts for 800,000 deaths per year worldwide. Patients with cardiopulmonary diseases are more susceptible to PM. Treatment with some medications, such as âbeta-blockers, statins, and bronchodilators, may reduce PM effects.
New occupational respiratory diseases continue to emerge. The World Trade Center disaster has provided important lessons in the long-term health problems faced by emergency responders and the importance of planning in advance to protect them.
It is important to anticipate the potentially hazardous exposures and health impacts of new technologies, such as silica exposure during natural gas extraction by hydraulic fracturing and from nanotechnology. Thus, occupational and environmental lung disease remains highly relevant and there is still much to be done in the field.
Dr. David N. Weissman, FCCP
Director, Division of Respiratory Disease Studies
National Institute for Occupational Safety and Health
Centers for Disease Control and Prevention
Morgantown, WV
Dr. Ware G. Kuschner,, FCCP (Co-Chair)
Professor of Medicine
Division of Pulmonary and Critical Care Medicine
Stanford University School of Medicine
Chief, Pulmonary Section, Veterans Affairs
Palo Alto Health Care SystemPRIMARY SOURCE: Supply journal citation and URL; URL for abstract; URL for PowerPoints; URL at www.clinicaltrials.gov, etc. This link will be used within the live story on web.