Occupational Interstitial Lung Disease Research Articles

Occupational interstitial lung diseases

Avariety of workplace exposures (organic or inorganic dusts as well as gases, fumes, or vapors) can cause diffuse interstitial lung disease. The latency period until onset of the disease can exceed 30years. The disease course varies greatly and depends on the quantity of the inhaled substance and its fibrogenic effect. Pulmonary high-resolution computed tomography (HRCT) patterns do not differ significantly from those of interstitial lung diseases (ILD) of other etiologies. Therefore, without knowledge of the occupational history, work-related ILDs are often classified as idiopathic. In addition, there is increasing evidence in the recent literature that high exposure to silica dust can trigger autoimmune diseases (also involving the lungs). For this reason, aqualified occupational history is now an indispensable part of the interdisciplinary diagnosis of ILDs.

‘Evaluation of occupational and nonoccupational interstitial lung disease in railway workers’

Introduction Occupational lung diseases include a wide variety of respiratory diseases with clinical manifestations and diagnostic test results that have features similar to nonoccupational diseases. Aim To determine the prevalence of occupational Interstitial lung diseases (ILD) among confirmed ILD patients admitted to the chest department of Egyptian Railway Medical Centre and the assessment of the outcome. Patients and methods A total of 155 patients with confirmed ILD, were subdivided into two groups: group (A) 79 patients with occupational exposure and group (B) 76 patients with nonoccupational exposure. Both groups were subjected to a detailed history, radiological assessment, arterial blood gases, and Spirometry. Data of days of hospital stay were also recorded. Results The prevalence of confirmed cases of ILD among occupational exposure was 1.49% versus 1.1% in the nonoccupational. Range of age in occupational group was between (31and 68 years). Chest X ray (CXR) findings were positive in 58.2% and 30.2% of occupational and nonoccupational group, respectively. Among group (A), 47.1% of the patients stayed between 11 and 15 days), 15.76% admitted to ICU, and 5.2% were mechanically ventilated. While 48% of hospitalized nonoccupational patients stayed between 6 and 10 days, 8% were admitted to ICU and 4% were mechanically ventilated, Conclusion The prevalence of interstitial lung diseases with occupational exposure was 1.49%, higher than non-occupational interstitial lung diseases. They were younger in age, had history of domiciliary oxygen therapy, frequent exacerbations, and previous hospital admissions. They had prolonged length of hospital stay, particularly those not using protective measures.

Features of tuberculosis’ course in fibrosing occupational interstitial lung disease

ABSTRACT. Our own observation of the course of tuberculosis in fibrosing occupational interstitial lung disease – ILD (idiopathic fibrosing alveolitis – IFA) in a patient who was being treated at the Zaporizhzhia Regional Phthisiopulmonology Clinical Treatment and Diagnostic Center is presented. The patient had a long work experience (about 7 years) at a dangerous enterprise related to the filling and repair service of powder fire extinguishers. It is possible to determine the following features of the course of tuberculosis in fibrosing professional ILD (IFA) in the presented case: tuberculosis was diagnosed in patient with untreated IFA and progressively increasing respiratory and heart failure, which led to the progression of the tuberculosis process; tuberculosis was initially chemoresistant (RifTB) and was accompanied by fibrinous endobronchitis; dissemination on the X-ray in the lungs had the following character: small multiple foci that merge and cover the pulmonary pattern mainly next to the lungs’ roots and basal parts of the lungs. Considering the presence of a long professional route at a dangerous enterprise, increasing shortness of breath, the patient was not given a timely computed tomography of the lungs, which is the most important component of the IFA diagnosis. As a result, IFA was not diagnosed in a time, which led to the lack of necessary IFA treatment (hormonal therapy and cytostatics). A sharp progression of IFA began after the addition of chemoresistant disseminated tuberculosis. Due to this, respiratory and heart failure progressively increased, which became the direct cause of death.

Occupational interstitial lung diseases.

Millions of workers are exposed to substances known to cause occupational interstitial lung diseases (ILDs), particularly in developing countries. However, the burden of the disease is likely to be underestimated due to under-recognition, under-reporting or both. The diagnosis of occupational ILD requires a high level of suspicion and a thorough occupational history, as occupational and non-occupational ILDs may be clinically, functionally and radiologically indistinguishable, leading to delayed diagnosis and inappropriate management. A potential occupational aetiology should always be considered in the differential diagnosis of ILD, as removal from the workplace exposure, with or without treatment, is a key therapeutic intervention and may lead to significant improvement. In this article, we provide an overview of the 'traditional' inorganic dust-related ILDs but also address idiopathic pulmonary fibrosis and the immunologically mediated chronic beryllium disease, sarcoidosis and hypersensitivity pneumonitis, with emphasis on the importance of surveillance and prevention for reducing the burden of these conditions. To this end, health-care professionals should be specifically trained about the importance of occupational exposures as a potential cause of ILD.

Interstitial lung disease related to occupational hard metal exposure: two case reports

BackgroundHard metal lung disease (HMLD) is a relatively less known occupational interstitial lung disease, and instances of HMLD resulting from para-occupational exposure are rarely reported.Case presentationThis paper presents two cases of interstitial lung disease caused by exposure to hard metal. The first case involves a 37-year-old Taiwanese man who had worked at a grinder station for hard metal materials for 12 years without respiratory protective equipment. He experienced a dry cough and exertional dyspnea, and his chest imaging and pathology findings were consistent with the features of usual interstitial pneumonia. Analysis of his lung tissue revealed the presence of tungsten and cobalt. The second case involves a 68-year-old Taiwanese woman, the mother of the first patient, who had hand-washed her son’s workwear. She experienced a dry cough and had similar imaging findings to her son. After her son left his job, they both exhibited improved symptoms and lung functions with nintedanib treatment. These findings suggest a diagnosis of HMLD and interstitial lung disease resulting from para-occupational exposure to hard metal dust.ConclusionsThe diagnosis of HMLD relies on obtaining a detailed occupational exposure history. If HMLD is diagnosed, discontinuing exposing to hard metal dusts can lead to improved lung function.

Global Trends in Occupational Lung Disease

Lung diseases caused by workplace exposure are too often mis- or underdiagnosed due in part to nonexistent or inadequate health surveillance programs for workers. Many of these diseases are indistinguishable from those that occur in the general population and are not recognized as being caused at least in part by occupational exposures. More than 10% of all lung diseases are estimated to result from workplace exposures. This study reviews recent estimates of the burden of the most important occupational lung diseases using data published by United Nations specialized agencies as well as the Global Burden of Disease studies. We focus on occupational chronic respiratory disease of which chronic obstructive lung disease and asthma are the most significant. Among occupational cancers, lung cancer is the most common, and is associated with more than 10 important workplace carcinogens. Classic occupational interstitial lung diseases such as asbestosis, silicosis, and coal workers' pneumoconiosis still comprise a substantial burden of disease in modern industrial societies, while other occupational causes of pulmonary fibrosis and granulomatous inflammation are frequently misclassified as idiopathic. Occupational respiratory infections gained prominence during the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) pandemic, eclipsing influenza and tuberculosis and other less common workplace infectious agents. The most significant risks are workplace exposures to particulate matter, gases, and fumes as well as occupational carcinogens and asthmagens. We present data on the burden of disease measured by deaths attributable to occupational respiratory disease as well as disability-adjusted years of life lost. Where available, prevalence and incidence data are also presented. These diseases are unique in that they are theoretically 100% preventable if appropriate exposure controls and workplace medical surveillance are implemented. This remains a continuing challenge globally and requires steadfast commitment on the part of government, industry, organized labor, and the medical profession.

The epidemiology of occupational interstitial lung diseases in Russia

Introduction. Occupational interstitial lung diseases (ILD) include exogenous allergic alveolitis (EAA), exogenous toxic alveolitis (ETA), pneumoconiosis. The scientists have established the fact of exposure to external factors in 35% of patients with ILD. We have confirmed the association of the disease with the profession in 10% of cases. The study aims to assess the prevalence and clarify the reasons for the unsatisfactory diagnosis of occupational diseases (ILD) in Russia. Materials and methods. The researchers have conducted the analysis of officially registered occupational morbidity in the Russian Federation and the North-Western Federal District (NWFD) for 2018-2020 and the study of the effectiveness of the examination of the connection of the disease with the profession in case of suspected occupational disease in 121 patients with an established diagnosis of EAA. Results. We have established that among the occupational diseases ILD first identified in the Russian Federation in 2020, pneumoconiosis occupied the leading place - 92.7%, of which a third of cases (34.6%) were silicosis. Coniotuberculosis was in 0.8% of cases, EAA - in 6% of cases, while in 9 patients (4%) the diagnosis was as "EAA", and in 5 patients (2%) - as "Hypersensitive pneumonitis". Toxic pneumosclerosis was 0.4%. In the NWFD, experts have registered all occupational diseases of the respiratory system: ILD - 18.5% (2018), 8.6% (2019), in 20.4% of cases (2020), of which pneumoconiosis took the leading place. There were only 3 cases of exogenous alveolitis. The researchers have analyzed the reasons of insufficient registration of professional exogenous alveolites. The low detectability of professional exogenous alveolitis is due to both the insufficient commitment of patients to the establishment of an occupational disease, and the poor quality of periodic medical examinations of employees due to the concealment of complaints by patients, the use of low-informative fluorography, incorrect interpretation of the results of the examination. Conclusion. Thus, among occupational ILDs, pneumoconiosis was on the leading position. Incomplete registration of cases of occupational exogenous alveolitis is due to insufficient diagnosis, terminological inconsistency in the designation of EAA and ETA, inadequate coding of ETA from exposure of industrial chemical factors. Ethics. This study did not require the conclusion of the Ethics committee.

КОМП’ЮТЕРНА ТОМОГРАФІЧНА ДЕНСИТОМЕТРІЯ ЛЕГЕНЬ В АЛГОРИТМІ ДІАГНОСТИКИ ІНТЕРСТИЦІАЛЬНИХ ЗАХВОРЮВАНЬ ЛЕГЕНЬ, В ТОМУ ЧИСЛІ ПРОФЕСІЙНОЇ ЕТІОЛОГІЇ ТА ЕКОЛОГІЧНО ОБУМОВЛЕНИХ

DENSITOMETRY OF THE LUNGS IN THE ALGORITHM FOR THE DIAGNOSIS OF INTERSTITIAL LUNG DISEASES, INCLUDING OCCUPATIONAL AND ECOLOGICAL DISEASES A. V. Basanets, N. V. Kurdil Abstract Interstitial lung diseases are among the most common diseases of the respiratory system. A significant proportion of them are occupational diseases with pneumoconiosis as the most prevalent condition. Determination of lung density by computed densitometry (CD) allows to quantify the degree of density of lung tissue in a different lung diseases. This review focuses on world and domestic literature on the application of CD for the diagnosis and monitoring of management of interstitial lung diseases such as pulmonary sarcoidosis, pulmonary tuberculosis, idiopathic pulmonary fibrosis, pulmonary embolism, systemic sclerosis, pneumoconiosis, etc. The method of determining of lung density index, its effectiveness depending on the method of CT and the algorithm of examination of the patients are described. Peculiarities of changes in lung density index depending on the form and pathogenesis of the disease, its correlation with lung function and morphological changes have been analyzed. The most reproducible and perfect indicators of CD are those determined by inspiratory CT, which should be taken into account in the further improvement of research protocols. The standardization of the CT imaging protocol should be implemented taking into account the need for possible reduction of the radiation dose. Conclusions. The technique of CD is recognized as a revolutionary diagnostic tool for quantifying the density of the lung parenchyma, which can be effectively used to diagnose and verify the diagnosis of interstitial lung diseases, including occupational diseases. Improving methods of occupational and environmental interstitial lung diseases diagnosing, preventing their progression and development of complications will improve the quality of healthcare service for workers, decrease morbidity, reduce treatment and disability reimbursement costs. Key words: interstitial lung diseases, occupational diseases, computed lung densitometry, computed tomography

Sex and gender in interstitial lung diseases.

Sex and gender differences influence key domains of research, lung health, healthcare access and healthcare delivery. In interstitial lung diseases (ILDs), mouse models of pulmonary fibrosis are clearly influenced by sex hormones. Additionally, short telomeres, a biomarker of telomere regulation gene mutations, are impacted by sex, while heritability unexplained by genetic variation may be attributable to gendered environmental factors that drive epigenetic control. Diseases like idiopathic pulmonary fibrosis, hypersensitivity pneumonitis, occupational ILDs, connective tissue-associated ILDs and lymphangioleiomyomatosis have different prevalence and prognosis between men and women. These differences arise from a complex interplay between biological sex and sociocultural gender influencing genetics, epigenomic modifiers, hormones, immune function, response to treatment and interaction with healthcare systems. Much work remains to be done to systematically integrate sex and gender analysis into relevant domains of science and clinical care in ILD, from strategic considerations for establishing research priorities to guidelines for establishing best clinical practices. Accounting for sex and gender in ILD is essential to the practice of individualised, patient-centred medicine.

A pilot study of the ultrathin cryoprobe in the diagnosis of peripheral pulmonary ground-glass opacity lesions

BackgroundIt is very difficult to obtain samples of peripheral pulmonary ground-glass opacity lesions (GGOs) by traditional transbronchial biopsy. This study was conducted to evaluate the diagnostic efficacy and safety of transbronchial cryobiopsy (TBCB) of GGOs using a newly developed ultrathin cryoprobe with an outer diameter of 1.1 mm.MethodsWe retrospectively analyzed 20 patients with 23 GGOs who underwent TBCB using the ultrathin cryoprobe from October 2018 to November 2019 in the Shanghai Chest Hospital. The TBCB procedure was performed under the guidance of virtual bronchoscopic navigation (VBN), electromagnetic navigation bronchoscopy (ENB), endobronchial ultrasound, and fluoroscopy. We collected the baseline information of participants, reported diagnostic yield and complications, and analyzed factors may have affected the diagnostic yield.ResultsA total of 23 GGOs (12 pure GGOs, 11 mixed GGOs), with an average diameter of 21.58±11.88 mm, underwent TBCB, and the diagnostic yield was 82.61% (19/23). Of the 19 GGOs diagnosed by TBCB, 12 were adenocarcinomas, 5 were inflammation, 1 was occupational interstitial lung disease, and 1 was a pulmonary meningothelial-like nodule. The remaining 4 undiagnosed lesions were confirmed to be adenocarcinomas by further analysis. The diagnostic yield was unchanged by factors including size (GGOs ≥20 mm, GGOs <20 mm), navigation (VBN, ENB), fluoroscopic visibility (visible, invisible), GGO-component (pure GGOs, mixed GGOs), and guide sheath (K-201, K203). There was no presentation of pneumothorax or severe hemorrhage.ConclusionsThe ultrathin cryoprobe is feasible, safe, and has a high diagnostic yield in the diagnosis of pulmonary GGOs. There is vast potential for the ultrathin cryoprobe as a tool for the diagnosis of GGOs, especially for cases suspicious of early-stage lung cancer.Trial registrationClinicalTrials.gov. No: NCT03716284. Registered: 20 October, 2018. URL: ClinicalTrials.gov.

Fibrosis and Damage Markers in Occupational Interstitial Lung Diseases

The investigation of biomarkers for fibrosis and lung tissue damage is very important for the diagnosis and prognosis of interstitial lung disease, as well as treatment strategies. The biomarkers secreted by Type II pneumocytes and cells of the bronchiolar epithelium are most reflective of the formation of pulmonary fibrosis and the degree of damage to the lung tissue. The levels of Krebs von den Lungen-6 (KL-6), alveolomucin (mucin-antigen 3EG5), and Clara cell secretory protein in occupational interstitial lung diseases (e.g., exogenous alveolitis, pneumoconiosis), caused by exposure to organic and inorganic factors, were analysed in dependence of disease activity phase. The level of alveolomucin in pneumoconiosis and in occupational alveolitis remission may reflect the extent of pulmonary fibrosis, which is a prognostic sign of the outcome of the disease. Higher specificity and lower sensitivity of alveolomucin compared to KL-6 can be used as a screening test for exogenous alveolitis. KL-6 and alveolomucin are more useful biomarkers than Clara cell secretory protein for diagnosis, exacerbation, and progression of occupational alveolitis.

Fibrosis and Damage Markers in Occupational Interstitial Lung Diseases

The investigation of biomarkers for fibrosis and lung tissue damage is very important for the diagnosis and prognosis of interstitial lung disease, as well as treatment strategies. The biomarkers secreted by Type II pneumocytes and cells of the bronchiolar epithelium are most reflective of the formation of pulmonary fibrosis and the degree of damage to the lung tissue. The levels of Krebs von den Lungen-6 (KL-6), alveolomucin (mucin-antigen 3EG5), and Clara cell secretory protein in occupational interstitial lung diseases (e.g., exogenous alveolitis, pneumoconiosis), caused by exposure to organic and inorganic factors, were analysed in dependence of disease activity phase. The level of alveolomucin in pneumoconiosis and in occupational alveolitis remission may reflect the extent of pulmonary fibrosis, which is a prognostic sign of the outcome of the disease. Higher specificity and lower sensitivity of alveolomucin compared to KL-6 can be used as a screening test for exogenous alveolitis. KL-6 and alveolomucin are more useful biomarkers than Clara cell secretory protein for diagnosis, exacerbation, and progression of occupational alveolitis.

Study of Clinico-Radiological Profiles of Patients with Occupational Interstitial Lung Disease in a Tertiary Care Center.

Study of Clinico-Radiological Profiles of Patients with Occupational Interstitial Lung Disease in a Tertiary Care Center.

Harmonization of classifications of occupational interstitial lung diseases, solutions from pulmonologist’s point of view

Introduction. Modern international and domestic classifications of occupational interstitial lung diseases in comparison with pulmonology are presented. The necessity of revision of the List of occupational diseases is substantiated. The ways to optimize the classification of occupational interstitial lung diseases are proposed.

Occupational Lung Diseases: Underreported Diagnosis in Radiological Practice

Underreporting of occupational lung diseases is a widespread problem in clinical practice. In Europe there is not a common regulation even for the recognition of occupational cancers. Furthermore epidemiologic data on occupational interstitial lung diseases, in general, is limited by no standardized diagnostic criteria, varied physician awareness and training, limitations inherent to the various data sources, and the long latency period. Therefore, to optimize the management of the patient with occupational pathology, the collaboration and skills of the multidisciplinary at the service of the patient, play a fundamental role. In particular, radiologists should give substance to a clinical suspicion on an anamnestic basis and at the same time should recognize patterns of illness that can lead to the emergence of stories of misunderstood exposures. This article aims to provide an overview of the main occupational lung diseases with attention to diagnostic possibilities of the different imaging techniques. The issue of the radiological error is investigated, providing tools to minimize it in the daily practice.

Contemporary views on risks of occupational interstitial lung diseases

Interstitial lung diseases caused by exposure to agents appearing at workplace is an important group of diseases that could be prevented. A term “occupational interstitial lung diseases” in national literature occurs rarely: traditionally these are defined as pneumoconioses. Occupational interstitial lung diseases are caused by various agents some of which are known in details, but others are hardly described. The article covers description of new risks and forms of occupational interstitial lung diseases occurrence, research and analysis of foreign literature matching requirements of evidence-based medicine. PubMed database was tested via following key words: professional ILD, pneumoconiosis, extrinsic allergic alveolitis, idiopathic pulmonary fibrosis, occupational risk. The data analysis demonstrated that occurrence of new risk factors necessitates occupational therapists to study occupational route and interdisciplinary character of the disease diagnosis, for registration of each type of interstitial lung disease.

Prevalence and incidence of interstitial lung diseases in a multi-ethnic county of Greater Paris.

The objective of the study was to estimate the prevalence and incidence of interstitial lung diseases (ILDs) in Seine-Saint-Denis, a multi-ethnic county of Greater Paris, France.Patients with ILDs were identified between January and December 2012 by using several sources; all potentially involved medical specialists from public and private hospitals, community-based pulmonologists and general practitioners, and the Social Security system. Diagnoses were validated centrally by an expert multidisciplinary discussion.1170 ILD cases were reported (crude overall prevalence: 97.9/105 and incidence: 19.4/105/year). In the 848 reviewed cases, the most prevalent diagnoses were sarcoidosis (42.6%), connective tissue diseases associated ILDs (CTDs-ILDs) (16%), idiopathic pulmonary fibrosis (IPF) (11.6%), and occupational ILDs (5.0%), which corresponded to a crude prevalence of 30.2/105 for sarcoidosis, 12.1/105 for CTDs-ILDs and 8.2/105 for IPF. The prevalence of fibrotic idiopathic interstitial pneumonias, merging IPF, nonspecific interstitial pneumonia and cases registered with code J84.1 was 16.34/105 An adjusted multinomial model demonstrated an increased risk of sarcoidosis in North Africans and Afro-Caribbeans and of CTDs-ILDs in Afro-Caribbeans, compared to that in Europeans.This study, with a comprehensive recruitment and stringent diagnostic criteria, emphasises the importance of secondary ILDs, particularly CTDs-ILDs and the relatively low prevalence of IPF, and confirms that sarcoidosis is a rare disease in France.

Management of a patient undergoing sitting position craniotomy for acoustic neuroma with co-existing interstitial lung disease

AbstractA 38-year-old woman with acoustic neuroma associated with occupational interstitial lung disease (ILD) was successfully managed for sitting position craniotomy using carefully titrated desflurane-based anaesthesia. The anaesthetic challenges included maintenance an adequate depth of anaesthesia, reducing perioperative airway events and ensuring smooth recovery. While dealing with ILD patient in sitting position, careful risk assessment is important because it will help us predict the course of the perioperative events. Balanced general anaesthesia using desflurane fulfilled the requirement of good depth and smooth recovery in this patient. Though there are reports of maintenance of anaesthesia with other inhalational agents, there are scanty reports of using desflurane in these cases.

Elemental analysis of occupational and environmental lung diseases by electron probe microanalyzer with wavelength dispersive spectrometer

Occupational and environmental lung diseases are a group of pulmonary disorders caused by inhalation of harmful particles, mists, vapors or gases. Mineralogical analysis is not generally required in the diagnosis of most cases of these diseases. Apart from minerals that are encountered rarely or only in specific occupations, small quantities of mineral dusts are present in the healthy lung. As such when mineralogical analysis is required, quantitative or semi-quantitative methods must be employed. An electron probe microanalyzer with wavelength dispersive spectrometer (EPMA-WDS) enables analysis of human lung tissue for deposits of elements by both qualitative and semi-quantitative methods. Since 1993, we have analyzed 162 cases of suspected occupational and environmental lung diseases using an EPMA-WDS. Our institute has been accepting online requests for elemental analysis of lung tissue samples by EPMA-WDS since January 2011. Hard metal lung disease is an occupational interstitial lung disease that primarily affects workers exposed to the dust of tungsten carbide. The characteristic pathological findings of the disease are giant cell interstitial pneumonia (GIP) with centrilobular fibrosis, surrounded by mild alveolitis with giant cells within the alveolar space. EPMA-WDS analysis of biopsied lung tissue from patients with GIP has demonstrated that tungsten and/or cobalt is distributed in the giant cells and centrilobular fibrosing lesion in GIP. Pneumoconiosis, caused by amorphous silica, and acute interstitial pneumonia, associated with the giant tsunami, were also elementally analyzed by EPMA-WDS. The results suggest that commonly found elements, such as silicon, aluminum, and iron, may cause occupational and environmental lung diseases.

Genotype and phenotype in susceptibility to coal workers' pneumoconiosis. The use of cytokines in perspective

The readily available technique of screening for gene polymorphisms could be used to explain inter-individual variability in a classic occupational interstitial lung disease, such as coal workers' pneumoconiosis (CWP).The objective of this paper is to describe candidate genes selected from the wide pool of cytokines and growth factors, and to discuss the applications and pitfalls when using them as biomarkers for susceptibility to CWP. The selection of candidate genes is mainly based on observed phenotypic changes in bronchoalveolar lavage (BAL) fluid or BAL cells of patients with CWP, or on animal experiments that use quartz as the fibrogenic agent.This paper also reviews the studies that have been performed to validate tumour necrosis factor genotype and phenotype with respect to CWP.Finally, it is proposed that a multiple marker approach to susceptibility to CWP should be used. This involves the measurement of two cytokines (tumour necrosis factor and transforming growth factor‐β) to improve denomination of high- and low-risk groups.