Re-think what constitutes occupational lung disease

Public health

By Mardi Chapman

16 Nov 2017

Clinicians are urged to have a high degree of suspicion that the respiratory disease they see in their patients is caused by occupational exposures. And it’s not just asbestos or coal dust that are the concerns.

According to a Narrative Review in the MJA, about 15-20% of adult-onset asthma is attributable to occupational exposures, 15% of COPD and up to 30% of lung cancer.

Co-author Dr Ryan Hoy, a respiratory physician at Cabrini Health and research fellow in the School of Public Health at Monash University, told the limbic that people generally have a limited view of what constitutes occupational lung disease.

“We need to think broadly about what occupational respiratory hazards are…like flour in a bakery or animal allergens in a research laboratory. Those sorts of things can certainly cause asthma in someone who’s never had asthma before.”

“In the food industry there is quite a range of exposures. There are very clear reports that cooking crustaceans like snow crab can cause the development of occupational asthma.”

The Review also highlighted the potential for pre-existing asthma to be worsened by workplace exposures.

“It comes back to taking a good occupational history and finding out how much of a problem those non-specific things might be like a lot of physical exertion with some jobs or workplace bullying which can worsen asthma control.”

Dr Hoy, also first author on a recent report of silicosis cases in relatively young workers cutting and polishing artificial stone kitchen benchtops, said identifying workplace respiratory hazards was the first step towards informing prevention activities.

“Through identifying the cause of those cases of silicosis now hopefully intervention in that industry to reduce exposure will mean fewer workers will develop the disease.”

“The problem we have in Australia is that those cases are not well documented, there is no recording of the number of cases or the industry where they are occurring.”

He said the TSANZ and Lung Foundation Australia supported the development of a national registry of occupational lung diseases.

The Review also covered less common conditions such as obliterative bronchiolitis and interstitial lung disease, which could also be caused by occupational exposures.

“Nearly all respiratory diseases can be caused by occupational exposures so it should be a very standard part of history taking. We take a smoking history when we see anybody with a respiratory disease but we should also be taking a thorough occupational history too.”

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