Less Common Respiratory Conditions: Occupational Lung Diseases

Abstract

Occupational lung diseases are caused by workplace inhalation of chemicals, dusts, or fumes. They include asbestosis, silicosis, coal workers' pneumoconiosis (CWP), and occupational asthma. These diseases have nonspecific respiratory symptoms and are only identified if an occupational history is taken. Asbestosis typically is diagnosed 20 to 30 years after peak exposure, often when pleural plaques are noted on chest x-ray (CXR). Asbestosis is associated with an increased cancer risk, which is higher in smokers. Silicosis results from exposure to silica dust from sand, stone, and quartz. It is a fibrotic lung disease with acute, chronic, or accelerated presentations; CXR findings show interstitial fibrosis or nodular opacities. Silicosis increases risk of mycobacterial and fungal infections. In CWP, patients may present with mild symptoms and CXR findings showing small fibrous nodules; progressive massive fibrosis may develop, and there is a risk of mycobacterial and fungal infections. Occupational asthma (OA) can occur de novo from inhaling sensitizers that induce immunoglobulin E-mediated airway reactions, or from inhaling irritants such as smoke, dust, and fumes. OA also can be due to sensitizers/irritants aggravating preexisting asthma. There are no cures for these occupational lung diseases, so prevention, including elimination/control of workplace exposures, and early diagnosis are key.