Occupational lung diseases: from old and novel exposures to effective preventive strategies

Our plain-English summary of Occupational lung diseases: from old and novel exposures to effective preventive strategies, by P. Cullinan, X. Muñoz, H. Suojalehto, et al (The Lancet. Respiratory Medicine, 2017).

The study

• Authors: P. Cullinan, X. Muñoz, H. Suojalehto, R. Agius, S. Jindal, T. Sigsgaard, A. Blomberg, D. Charpin, I. Annesi-Maesano, M. Gulati, Y. Kim, A.L. Frank, M. Akgün, D. Fishwick, R.E. de la Hoz, S. Moitra
• Journal: The Lancet. Respiratory Medicine
• Published: 2017;5(5):445-455
• Type of article: Review
• Cited by: 112 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Occupational exposure is an important, global cause of respiratory disease. Unlike many other non-communicable lung diseases, the proximal causes of many occupational lung diseases are well understood and they should be amenable to control with use of established and effective approaches. Therefore, the risks arising from exposure to silica and asbestos are well known, as are the means of their prevention. Although the incidence of occupational lung disease has decreased in many countries, in parts of the world undergoing rapid economic transition and population growth-often with large informal and unregulated workforces-occupational exposures continue to impose a heavy burden of disease. The incidence of interstitial and malignant lung diseases remains unacceptably high because control measures are not implemented or exposures arise in novel ways. With the advent of innovative technologies, new threats are continually introduced to the workplace (eg, indium compounds and vicinal diketones). In developed countries, work-related asthma is the commonest occupational lung disease of short latency. Although generic control measures to reduce the risk of developing or exacerbating asthma are well recognised, there is still uncertainty, for example, with regards to the management of workers who develop asthma but remain in the same job. In this Review, we provide recommendations for research, surveillance, and other action for reducing the burden of occupational lung diseases.

Copyright © 2017 Elsevier Ltd. All rights reserved.

In plain English

This article was a narrative review, not an original study. The authors searched PubMed for publications from January 2000 to September 2016 and summarised the causes and prevention of occupational lung diseases. These included asbestos-related and silica-related disease, work-related asthma, coal workers' pneumoconiosis, chronic beryllium disease, byssinosis, and newer exposures such as indium-tin oxide and World Trade Center dust. The authors described asbestos as the most important occupational cause of respiratory tract cancers and effectively the sole cause of malignant mesothelioma. They cited a WHO estimate that about 125 million people are currently exposed to asbestos at work. A table adapted from Lim and colleagues listed 33 610 global deaths in 2010 attributed to asbestos among occupational lung cancer estimates. The authors said these figures were undoubtedly underestimates. They noted that asbestos remaining in buildings can cause continuing exposure even after a ban. They described personal protective equipment as the lowest tier of control. The authors concluded that ending asbestos use and improving control of silica exposure is likely to be how these diseases are committed to the past.

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 on occupational lung diseases and their prevention
• Who was studied: Published literature identified through PubMed, covering January 1, 2000, to September 12, 2016, with emphasis on recent publications; worldwide scope
• Exposure: A wide range of workplace exposures, including asbestos and silica, coal mine dust, workplace asthma-causing agents, beryllium, cotton dust, nanoparticles, flavouring chemicals such as diacetyl, indium-tin oxide, hydraulic fracking and World Trade Center dust
• Main results:
  • The authors described asbestos as the most important occupational cause of respiratory tract cancers.
  • The authors described asbestos as effectively the sole cause of malignant mesothelioma, and as an important, probably under-recognised cause of pulmonary fibrosis (asbestosis).
  • Citing WHO, the authors stated that approximately 125 million people worldwide are currently exposed to asbestos at work.
  • In a table of global estimates for 2010 adapted from Lim and colleagues (Global Burden of Disease project), asbestos was listed under occupational lung cancer with 26 563 deaths in men, 7 047 in women, and 33 610 in total.
  • The authors reported that one cancer hospital in Mumbai identified 32 cases of malignant mesothelioma in 1 year, while India has not officially recorded any cases.
  • The authors stated that a legal ban on asbestos might not eliminate risk completely, because asbestos persisting in buildings or industrial plants can be associated with continuing exposure, especially when disturbed during refurbishment.
  • The authors described a hierarchy of controls with elimination of the hazard preferred. Personal protective equipment such as respirators was placed at the lowest tier.
• The authors' conclusion: The authors concluded that committing asbestos-related and silica-related diseases to the past is likely to be achieved by stopping the use of asbestos and improving control of silica exposure. They also called for better dissemination of knowledge, monitoring of disease trends, evaluation of interventions, and methods for predicting new hazards.
• Limitations the authors state:
  • The authors stated that because many occupational lung diseases are not systematically recorded, the burden figures they presented are undoubtedly underestimates.
  • The authors noted that data collection on pneumoconiosis related to asbestos and silica exposure is problematic worldwide, especially in low-income countries.

Topics

Medical terms in this study, explained in our Lexicon: Occupational Lung Disease, Occupational Exposure, Interstitial, Latency.

Related studies

• SWORD '93. Surveillance of work-related and occupational respiratory disease in the UK — B.A. Sallie, D.J. Ross, et al. (1994)
• Occupational respiratory disease in mining — M.H. Ross, J. Murray (2004)
• Occupational and work-related respiratory disease attributed to cleaning products — M. Carder, M.J. Seed, et al. (2019)
• Relationships (I) of International Classification of High-resolution Computed Tomography for Occupational and Environmental Respiratory Diseases with the ILO International Classification of Radiographs of Pneumoconioses for parenchymal abnormalities — T. Tamura, N. Suganuma, et al. (2015)
• SWORD '97: surveillance of work-related and occupational respiratory disease in the UK — D.J. Ross, H.L. Keynes, et al. (1998)
• Role of chest computed tomography in prevention of occupational respiratory disease: review of recent literature — D.N. Weissman (2015)

Browse more research in The Lancet. Respiratory Medicine, or return to medical research.