Exposure-Related Diffuse Lung Disease

ABSTRACT

Practicing pulmonologists are often faced with the question of whether a lung disease is related to something in the patient's workplace, home, or recreational environment. Recognizing a lung disease as exposure related creates both opportunities and obligations for clinicians. In addition to managing the patient, the obligation to consider risks to others and to prevent ongoing exposure is a challenge that requires diagnostic clarity and collaboration between multiple specialists. We present five illustrative case studies of patients with diffuse lung diseases from environmental and occupational exposures in which communication between the pulmonologist, radiologist, and pathologist was essential for both medical and public health management. Diagnostic and treatment strategies as well as social and preventive interventions are reviewed, with key points for the practicing pulmonologist.

KEYWORDS

Hypersensitivity pneumonitis - chronic beryllium disease - mixed dust pneumoconiosis - welder's lung - hot tub lung - occupational lung cancer.

REFERENCES

• 1 Nelson H H, Kelsey K T. The molecular epidemiology of asbestos and tobacco in lung cancer.  Oncogene. 2002;  21 7284-7288
• 2 Steenland K, Loomis D, Shy C, Simonsen N. Review of occupational lung carcinogens.  Am J Ind Med. 1996;  29 474-490
• 3 Newman L S, Mroz M M, Ruttenber A J. Lung fibrosis in plutonium workers.  Radiat Res. 2005;  164 123-131
• 4 Kim H Y, Shim Y M, Lee K S, Han J, Yi C A, Kim Y K. Persistent pulmonary nodular ground-glass opacity at thin-section CT: histopathologic comparisons.  Radiology. 2007;  245 267-275
• 5 Rickman O B, Ryu J H, Fidler M E, Kalra S. Hypersensitivity pneumonitis associated with Mycobacterium avium complex and hot tub use.  Mayo Clin Proc. 2002;  77 1233-1237
• 6 Glazer C S, Martyny J W, Rose C. Hot tub associated granulomatous lung disease from mycobacterial bioaerosols.  Clinical Pulmonary Medicine. 2008;  15 138-144
• 7 Hartman T E, Jensen E, Tazelaar H D, Hanak V, Ryu J H. CT findings of granulomatous pneumonitis secondary to Mycobacterium avium-intracellulare inhalation: “hot tub lung”.  AJR Am J Roentgenol. 2007;  188 1050-1053
• 8 Rose C S, Martyny J W, Newman L S et al.. “Lifeguard lung”: Endemic granulomatous pneumonitis in an indoor swimming pool.  Am J Public Health. 1998;  88 1795-1800
• 9 Newman L S, Buschman D L, Newell Jr J D, Lynch D A. Beryllium disease: assessment with CT.  Radiology. 1994;  190 835-840
• 10 Middleton D C, Lewin M D, Kowalski P J, Cox S S, Kleinbaum D. The BeLPT: algorithms and implications.  AmJ Ind Med. 2006;  49 36-44
• 11 Newman L S, Bobka C, Schumacher B et al.. Compartmentalized immune response reflects clinical severity of beryllium disease.  Am J Respir Crit Care Med. 1994;  150 135-142
• 12 Munakata M, Tanimura K, Ukuta H. Smoking promotes insidious and chronic farmer's lung disease, and deteriorates the clinical outcome.  Intern Med. 1995;  34 966-971
• 13 Lillienberg L, Zock J P, Kromhout H et al.. A population-based study on welding exposures at work and respiratory symptoms.  Ann Occup Hyg. 2008;  52 107-115
• 14 Sferlazza S J, Beckett W S. The respiratory health of welders.  Am Rev Respir Dis. 1991;  143 1134-1148
• 15 Akira M. Uncommon pneumoconioses: CT and pathologic findings.  Radiology. 1995;  197 403-409
• 16 Vahlensieck M, Overlack A, Muller K M. Computed tomographic high-attenuation mediastinal lymph nodes after aluminum exposition.  Eur Radiol. 2000;  10 1945-1946