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The Occupational Burden of Nonmalignant Respiratory Diseases An Official American Thoracic Society and European Respiratory Society Statement

Journal article
Authors P. D. Blanc
I. Annesi-Maesano
J. R. Balmes
K. J. Cummings
D. Fishwick
D. Miedinger
N. Murgia
R. N. Naidoo
C. J. Reynolds
T. Sigsgaard
Kjell Torén
D. Vinnikov
C. A. Redlich
Published in American Journal of Respiratory and Critical Care Medicine
Volume 199
Issue 11
Pages 1312-1334
ISSN 1073-449X
Publication year 2019
Published at Institute of Medicine
Pages 1312-1334
Language en
Keywords occupational, workplace, nonmalignant respiratory diseases, interstitial fibrosis, sarcoidosis, pulmonary alveolar proteinosis, health-care workers, cryptogenic, fibrosing alveolitis, chronic beryllium disease, community-acquired, pneumonia, interstitial lung-diseases, environmental risk-factors, new-onset asthma, bronchoalveolar lavage fluid, acute eosinophilic, pneumonia
Subject categories Environmental Health and Occupational Health, Respiratory Medicine and Allergy


Rationale: Workplace inhalational hazards remain common worldwide, even though they are ameliorable. Previous American Thoracic Society documents have assessed the contribution of workplace exposures to asthma and chronic obstructive pulmonary disease on a population level, but not to other chronic respiratory diseases. The goal of this document is to report an in-depth literature review and data synthesis of the occupational contribution to the burden of the major nonmalignant respiratory diseases, including airway diseases; interstitial fibrosis; hypersensitivity pneumonitis; other noninfectious granulomatous lung diseases, including sarcoidosis; and selected respiratory infections. Methods: Relevant literature was identified for each respiratory condition. The occupational population attributable fraction (PAF) was estimated for those conditions for which there were sufficient population-based studies to allow pooled estimates. For the other conditions, the occupational burden of disease was estimated on the basis of attribution in case series, incidence rate ratios, or attributable fraction within an exposed group. Results: Workplace exposures contribute substantially to the burden of multiple chronic respiratory diseases, including asthma (PAF, 16%); chronic obstructive pulmonary disease (PAF, 14%); chronic bronchitis (PAF, 13%); idiopathic pulmonary fibrosis (PAF, 26%); hypersensitivity pneumonitis (occupational burden, 19%); other granulomatous diseases, including sarcoidosis (occupational burden, 30%); pulmonary alveolar proteinosis (occupational burden, 29%); tuberculosis (occupational burden, 2.3% in silica-exposed workers and 1% in healthcare workers); and community-acquired pneumonia in working-age adults (PAF, 10%). Conclusions: Workplace exposures contribute to the burden of disease across a range of nonmalignant lung conditions in adults (in addition to the 100% burden for the classic occupational pneumoconioses). This burden has important clinical, research, and policy implications. There is a pressing need to improve clinical recognition and public health awareness of the contribution of occupational factors across a range of nonmalignant respiratory diseases. RAHAM J L, 1986, Applied Pathology, V4, P138

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