Role of the occupational disease consultant in the multidisciplinary discussion of interstitial lung diseases

Our plain-English summary of Role of the occupational disease consultant in the multidisciplinary discussion of interstitial lung diseases, by S. Carlier, M. Nasser, E. Fort, et al (Respiratory Research, 2022).

The study

• Authors: S. Carlier, M. Nasser, E. Fort, C. Lamouroux, S. Si-Mohamed, L. Chalabreysse, J.M. Maury, R. Diesler, V. Cottin, B. Charbotel
• Journal: Respiratory Research
• Published: 2022;23(1):332
• Cited by: 11 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Diffuse interstitial lung diseases (ILD) constitute a heterogeneous group of conditions with complex etiological diagnoses requiring a multidisciplinary approach. Much is still unknown about them, particularly their relationship with occupational exposures. The primary objective of this study was to investigate the distribution of occupational exposures according to type of ILD. The secondary objectives were to estimate the proportion of ILDs possibly related to occupational exposure and to evaluate the added value of the participation of an occupational disease consultant in ILD multidisciplinary discussions (MDD).

Methods: From May to December 2020, all consecutive patients with ILD whose cases were reviewed during a MDD in a referral centre for ILD were prospectively offered a consultation with an occupational disease consultant.

Results: Of the 156 patients with ILD whose cases were reviewed in MDD during the study period, 141 patients attended an occupational exposure consultation. Occupational exposure was identified in 97 patients. Occupational exposure to asbestos was found in 12/31 (38.7%) patients with idiopathic pulmonary fibrosis (IPF) and in 9/18 (50.0%) patients with unclassifiable fibrosis. Occupational exposure to metal dust was found in 13/31 (41.9%) patients with IPFs and 10/18 (55.6%) patients with unclassifiable fibrosis. Silica exposure was found in 12/50 (24.0%) patients with autoimmune ILD. The link between occupational exposure and ILD was confirmed for 41 patients after the specialist occupational consultation. The occupational origin had not been considered (n = 9) or had been excluded or neglected (n = 4) by the MDD before the specialised consultation. A total of 24 (17%) patients were advised to apply for occupational disease compensation, including 22 (15.6%) following the consultation. In addition, a diagnosis different from the one proposed by the MDD was proposed for 18/141 (12.8%) patients.

Conclusions: In our study, we found a high prevalence of occupational respiratory exposure with a potential causal link in patients with ILD. We suggest that a systematic specialised consultation in occupational medicine could be beneficial in the ILD diagnostic approach.

© 2022. The Author(s).

In plain English

This prospective French study looked at workplace exposures in people with interstitial lung disease (ILD), a group of lung conditions that often involve scarring. Between May and December 2020, 156 consecutive patients reviewed by a multidisciplinary team at an expert centre for rare lung diseases were offered a consultation with an occupational disease specialist. Of these, 141 (90%) took part; patients with sarcoidosis were not included. The specialist found an occupational exposure in 97 (68.8%) patients, most often metal dusts (50), silica (40), non-chlorinated solvents (39) and asbestos (39). The article does not name asbestos fiber types. Among 31 patients with idiopathic pulmonary fibrosis, 12 (38.7%) had asbestos exposure, as did 9 of 18 (50.0%) with unclassifiable fibrosis. The specialist judged the exposure related to the disease in 41 (29.1%) patients. The specialist also proposed a different or refined diagnosis for 18 (12.8%), asbestosis in 13. The authors concluded that occupational exposures were highly prevalent among these patients. They noted that the specialist knew the team's diagnosis, which could have biased questioning, and that a single senior consultant assessed job histories and exposures.

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: Prospective study of consecutive patients offered a specialised occupational disease consultation after multidisciplinary review
• Who was studied: Patients with interstitial lung disease (sarcoidosis excluded) whose cases were reviewed by a multidisciplinary team at an expert centre for rare lung diseases in France, May to December 2020. 156 were invited and 141 took part. Mean age was 66 years and 89 (63.1%) were male.
• Exposure: Occupational and environmental exposures assessed by interview and a questionnaire of known or suspected fibrogenic substances: metal dusts (aluminium, tin, iron, welding, hard metals), silica, asbestos (fiber type not specified), solvents, wood, plastics, mineral wool, cement, cutting oils and refractory ceramic fibres.
• Main results:
  • An occupational exposure was found in 97 of 141 patients (68.8%).
  • Among 31 patients with idiopathic pulmonary fibrosis (IPF): 12 (38.7%) had occupational asbestos exposure, 13 (41.9%) metal dust and 11 (35.5%) silica.
  • Among 18 patients with unclassifiable fibrosis: 9 (50.0%) had occupational asbestos exposure, 10 (55.6%) metal dust and 9 (50.0%) silica.
  • Among 50 patients with ILD associated with autoimmune disease, 12 (24.0%) had occupational silica exposure.
  • The occupational disease consultant considered the exposure related to the ILD in 41 (29.1%) patients. Of these, 28 had already been suspected of an occupational origin by the multidisciplinary team, and 13 were additional patients.
  • Patients judged to have an occupational origin were more often exposed to asbestos (p less than 0.0001), among other exposures. The team's diagnoses of IPF (p = 0.0256) and asbestosis (p = 0.0233) were statistically significantly associated with the specialist's conclusion of an occupational origin.
  • The consultant proposed an alternative diagnosis or refined the diagnosis for 18 (12.8%) patients, asbestosis in 13 of these.
  • After the consultation, 15 patients received an initial medical certificate for occupational disease. Among the 41 with a confirmed occupational origin, the authors estimated 24 could claim compensation.
• The authors' conclusion: The authors concluded that occupational exposures were highly prevalent among patients with ILD and that this warrants reinforced preventive measures. They called for further studies comparing exposure profiles with a control population.
• Limitations the authors state:
  • The consulting physician knew the multidisciplinary team's diagnosis, so questioning may have focused on substances linked to that ILD subtype.
  • Job history and exposure assessment relied on a single senior occupational disease consultant. The authors said the evaluation could be improved by involving an industrial hygienist.
  • Pneumoconiosis may be mistaken for idiopathic ILD, so occupational exposure may be overestimated and wrongly linked to ILD.
  • The study did not follow whether patients completed compensation claims or obtained compensation.

Topics

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

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