Occupational lung diseases include a large number of respiratory disorders that result from inhalation of specific particles, gases, fumes or smoke. Before workplace safety guidelines were established, occupational diseases were a major cause of morbidity and mortality. In some areas, adequate workplace interventions have reduced exposure to, for example, inorganic dusts such as silica or asbestos. However, due to its long latency, the incidence of occupational lung cancer causally attributable to these particular agents is still very high. As another example, reduction of exposure to latex in hospital settings has resulted in a decrease in latex-induced asthma, but this reduction has been effected only in some countries and not in others. In many workplaces, exposure to a variety of irritative, sensitising, fibrogenic and carcinogenic agents is still a major challenge. Overall, occupational agents are responsible for about 15% (in men) and 5% (in women) of all respiratory cancers, 17% of all adult asthma cases, 15–20% of chronic obstructive pulmonary disease (COPD) cases and 10% of interstitial lung disease cases. Since occupational diseases are, in principle, preventable, it is very important that clinicians take occupational histories in order to identify potential causes and build the basis for prevention of future disease.
This chapter will focus on potentially hazardous exposures: the corresponding diseases are discussed in chapter 24.
The contribution of the workplace environment to diseases of the airways and lungs has been, and is still, changing in many countries. Disabling pneumoconiosis with associated tuberculosis has become uncommon in developed countries, but is still highly prevalent in places of rapid industrialisation. In developed countries, asbestos use has decreased considerably, but it is still used widely in developing countries (figure 1). Thus, the mortality toll in developing countries can be predicted. On the other hand, in Europe, exposure to (for example) diisocyanates and to beryl is still increasing, and the consequent cases of asthma and berylliosis are currently being seen in our clinics.