Update in environmental and occupational lung diseases 2013.

Abstract

In this update, recent publications within the field of environmental and occupational medicine, from this journal and others, are highlighted. Effects of ambient air pollution on a diverse range of airways disease continue to be discovered, reiterating the impressive potency of this near-ubiquitous and largely anthropogenic toxicant. Air pollution is now recognized as the third leading cause of disability-adjusted life years due to chronic respiratory disease globally (1). Studies in the past year have significantly strengthened the link between air pollution exposure and adverse health outcomes including mortality (2–4), lung cancer (4–6), infections (7–9), and obstructive lung disease (including asthma) (10, 11). Important underlying mechanistic details were illuminated in several animal models (12–17). The association between poor indoor air quality and lung diseases is a topic of increasing interest and was investigated in several reports in 2013 (18–21). Controlled human exposure experiments were in the spotlight, in part because of ethical concerns about the justification of this approach. An important position paper by leading researchers and a biomedical ethicist strongly supports the usefulness of controlled exposures, which continue to provide new insights into adverse health effects of different pollutants (22). Asbestos exposure is a well-recognized risk factor for pleural mesothelioma, and two epidemiology studies were published that explored the interaction between exposure to asbestos, other mineral fibers, and cigarette smoking in mesothelioma, asbestosis, and lung cancer (23, 24). Arsenic is increasingly recognized as a groundwater contaminant, with potential effects on lung development and function. An important paper provided strong evidence that even low levels of arsenic exposure are associated with reduced lung function (25). The adverse health effects of global warming are becoming apparent, and one paper provided a sobering reminder that elevated ambient temperatures are a strong risk factor for respiratory morbidity (26). Unfortunately, the adverse effects of environmental and occupational exposures on lung health occur disproportionately in ethnic minorities and those with lower socioeconomic status, underscoring the urgent need to address these important health disparities (27). Although our understanding of the adverse effects of environmental and occupational exposures on lung health continues to expand, more research is needed to understand mechanisms involved and discover the optimal public health measures to mitigate risk.