Interstitial Lung Diseases in Developing Countries

Our plain-English summary of Interstitial Lung Diseases in Developing Countries, by P. Rivera-Ortega, M. Molina-Molina (Annals of Global Health, 2019).

The study

• Authors: P. Rivera-Ortega, M. Molina-Molina
• Journal: Annals of Global Health
• Published: 2019;85(1)
• Type of article: Review
• Cited by: 59 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

More than 100 different conditions are grouped under the term interstitial lung disease (ILD). A diagnosis of an ILD primarily relies on a combination of clinical, radiological, and pathological criteria, which should be evaluated by a multidisciplinary team of specialists. Multiple factors, such as environmental and occupational exposures, infections, drugs, radiation, and genetic predisposition have been implicated in the pathogenesis of these conditions. Asbestosis and other pneumoconiosis, hypersensitivity pneumonitis (HP), chronic beryllium disease, and smoking-related ILD are specifically linked to inhalational exposure of environmental agents. The recent Global Burden of Disease Study reported that ILD rank 40th in relation to global years of life lost in 2013, which represents an increase of 86% compared to 1990. Idiopathic pulmonary fibrosis (IPF) is the prototype of fibrotic ILD. A recent study from the United States reported that the incidence and prevalence of IPF are 14.6 per 100,000 person-years and 58.7 per 100,000 persons, respectively. These data suggests that, in large populated areas such as Brazil, Russia, India, and China (the BRIC region), there may be approximately 2 million people living with IPF. However, studies from South America found much lower rates (0.4-1.2 cases per 100,000 per year). Limited access to high-resolution computed tomography and spirometry or to multidisciplinary teams for accurate diagnosis and optimal treatment are common challenges to the management of ILD in developing countries.

© 2019 The Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC-BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. See http://creativecommons.org/licenses/by/4.0/.

In plain English

This article is a review, not a new study. The authors summarized published data on interstitial lung diseases (ILD), over 100 lung conditions, focusing on developing countries. They discussed asbestos, silica and coal dust as causes of pneumoconiosis, cotton dust in byssinosis, air pollution as a possible ILD contributor, and smoking as a risk factor for idiopathic pulmonary fibrosis. They cited World Health Organization estimates of more than 107,000 deaths a year from asbestos-related diseases. They noted that asbestos is banned in most developed countries but still used in many developing nations. Citing earlier work, they wrote that asbestos exposure more often leads to pleural plaques, diffuse pleural thickening and asbestosis than to mesothelioma or lung cancer. Most reported 'take home' exposure cases, they wrote, involved families of highly exposed workers and nearly always amphibole fibers. Cited estimates suggested about 2 million people with idiopathic pulmonary fibrosis in Brazil, Russia, India and China. The authors concluded that ILD data from developing countries are scarce and encouraged centers there to join global registries and access expert diagnostic teams.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: narrative review of published literature and official estimates (no new data collected)
• Who was studied: published studies, registries and agency estimates on interstitial lung diseases worldwide, with emphasis on developing countries (e.g., Turkey, India, Saudi Arabia, Mexico, Brazil, South Africa)
• Exposure: exposures discussed in relation to ILD and other occupational lung diseases: asbestos (asbestosis), silica (silicosis) and coal dust as causes of pneumoconiosis; cotton, flax and hemp dust (byssinosis); organic antigens (hypersensitivity pneumonitis); air pollution as a possible contributor; tobacco smoking as a risk factor for IPF
• Main results:
  • Citing the World Health Organization, the review reported more than 107,000 deaths each year and 1,523,000 disability adjusted life years attributable to asbestos-related diseases worldwide
  • The authors stated that asbestos has been banned in most developed countries but is still used in many developing nations
  • Citing an earlier review, the authors wrote that asbestos exposure more frequently results in benign conditions such as pleural plaques, diffuse pleural thickening and asbestosis than in mesothelioma or lung cancer
  • The authors stated that relatively high levels of asbestos inhalation are required to produce asbestosis, although asbestosis has been reported after moderate exposure
  • On para-occupational ('take home') exposure, the authors wrote that the vast majority of reported cases occurred among family members of workers in high-exposure industries, nearly always involving amphibole fibers
  • A cited European estimate for 2000 put the number of pneumoconiosis cases related to occupational exposure to asbestos, silica and coal dust at 7,200
  • The authors described air pollution as possibly associated with the development, progression or exacerbation of ILD
  • The authors described tobacco smoking as the most well-established environmental risk factor for IPF
  • The cited Global Burden of Disease Study reported an 86% increase in ILD-related years of life lost between 1990 and 2013
  • Cited estimates suggested that the BRIC countries (Brazil, Russia, India, China) may have 2 million cases of idiopathic pulmonary fibrosis. Cited South American studies suggested a low incidence of 0.4 to 1.2 cases per 100,000 people per year
• The authors' conclusion: The authors concluded that few data are available on ILD in developing countries. They stated that centers in those countries should be encouraged to take part, for example through global ILD registries and greater access to expert multidisciplinary teams, to help with diagnosis and treatment.

Topics

Medical terms in this study, explained in our Lexicon: Interstitial Lung Disease, Multidisciplinary Team, Occupational Exposure, Pneumoconiosis, Pneumonitis, Idiopathic, Pulmonary Fibrosis, Spirometry.

Related studies

• Asbestos: old foe in 21st century developing countries — L.V. Harris, I.A. Kahwa (2003)
• Occupational and environmental exposures and cancers in developing countries — D. Hashim, P. Boffetta (2014)
• Asbestos-related hazards in developing countries — B.S. Levy, A. Seplow (1992)
• The evidence of benefits of exercise training in interstitial lung disease: a randomised controlled trial — L.M. Dowman, C.F. McDonald, et al. (2017)
• Year in review 2011: acute lung injury, interstitial lung diseases, physiology, sleep and lung cancer — K. Takahashi, N.D. Eves, et al. (2012)
• Role of oxidants in interstitial lung diseases: pneumoconioses, constrictive bronchiolitis, and chronic tropical pulmonary eosinophilia — W.N. Rom (2011)

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