Occupational and Environmental Medicine

Asthma/RADS

Nicholson PJ, Cullinan P, Taylor AJ, et al. Evidence-based guidelines for the prevention, identification, and management of occupational asthma.  Occup Environ Med 2005;62:290-9. This comprehensive review gives strong evidence behind classic admonitions, including those to reduce asthmagens at the source and to provide ample surveillance. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15837849&query_hl=14&itool=pubmed_docsum

Blanc PD, Toren K. How much adult asthma can be attributed to occupational factors? Am J Med 1999;107:580-7. Based on a critical review and synthesis of the published literature, the authors estimate occupational factors are associated with 10% of adult asthma cases. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=10625027

Burge PS, O’Brien IM, Harries MG. Peak flow rate records in the diagnosis of occupational asthma due to isocyanates. Thorax 1979;34:317-24.  Landmark study was the first to show peak flow is a suitable alternative to provocation testing in the diagnosis of OA. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=483205

Chan-Yeung M. Fate of occupational asthma. A follow-up study of patients with occupational asthma due to Western Red Cedar (Thuja Plicata). Am Rev Respir Dis 1977;116:1023-6.This classic article demonstrated the frequent persistence of occupational asthma even months after removal from exposure to western red cedar.  Subsequent studies found similar findings for other OA asthmagens, prompting heightened vigilance. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=931178&query_hl=16&itool=pubmed_DocSum

Brooks SM, Weiss MA, Bernstein IL. Reactive airways dysfunction syndrome (RADS): persistent asthma syndrome after high-level irritant exposures. Chest 1985;88:376-84. Landmark article describing 10 patients in which the term “RADS” was coined.   In the majority of cases respiratory symptoms and hyper reactivity persisted for greater than 1 year after a large exposure to vapor, fumes, or smoke.  http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=4028848 

Zock JP, Jarvis D, Luczynska C, et al. Housing characteristics, reported mold exposure, and asthma in European Community Respiratory Health Survey. J Allergy Clin Immunol 2002;110:285-92. Multicenter study looked at the association between mold exposure (based on questionnaire) and asthma (based on symptoms and methacholine challenge) and concluded that mold growth has an adverse effect on adult asthma. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12170270 

Associations with interstitial lung disease and neoplasia

Selikoff IJ, Hammond EC, Churg J. Asbestos exposure, smoking, and neoplasia. JAMA 1968;204:106-12. Landmark study showing the synergistic effect of smoking and asbestos exposure on developing lung cancer.  http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=5694532

Wagner JC, Sleggs CA, Marchand P. Diffuse pleural mesothelioma and asbestos exposure in the NW Cape Province. Br J Ind Med 1960;17:260-71. Landmark study linking mesothelioma to asbestos exposure.  http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=13782506

Adverse effects of crystalline silica exposure. American thoracic society committee of the scientific assembly on environmental occupational health. Am J Respir Crit Care Med 1997; 155:761-8. Reviews the epidemiology and prevention of silica-associated lung diseases including silicosis, asthma, tuberculosis, and extrapulmonary diseases. This document is also available in Up-To-Date. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=9032226

Rossman MD, Kern JA, Elias JA, et al. Proliferative response of bronchoalveolar lymphocytes to beryllium. A test for chronic beryllium disease. Ann Intern Med 1988;108:687-93. Article noteworthy for establishing the use of the lymphocyte proliferation test in the diagnosis of chronic beryllium disease. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=3282464

Infante PF, Newman LS. Beryllium exposure and chronic beryllium disease. Lancet 2004;363:415-6. The authors highlight the lack of adequate protection for workers, the underdiagnosis of CBD by providers, and the growing number of industries in which exposure occurs. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=14962519

Air pollution and cardiopulmonary disease

Dockery DW, Pope CA 3rd, Xu X, et al. An association between air pollution and mortality in six U.S. cities. New Engl J Med 1993; 329:1753-9. This seminal article linked fine particular air-pollution with lung cancer and cardiopulmonary mortality, associations that have been duplicated in
subsequent studies and been highly influential in public health policy. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=8179653&query_hl=18&itool=pubmed_DocSum

Samet JM, Dominici F, Curriero FC, et al. Fine particulate air pollution and mortality in 20 U.S. cities, 1987-1994. New Engl J Med 2000; 343:1742-9. This article supports the findings of Dockery et al and provides a more sophisticated analysis allowing for a 'dose-response' characterization of particulate levels and of specific air pollution components. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=11114312&query_hl=20&itool=pubmed_DocSum

Banauch GI, Hall C, Weiden M, et al. Pulmonary function after exposure to the World Trade Center collapse in the New York City Fire Department.  Am J Respir Crit Care Med 2006; 174:312-9.  This study found a large average adjusted decline in FEV1 among firefighters in the year following 9-11 (372 ml).  Exposure intensity correlated linearly with exposure time.  http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=16645172&query_hl=19&itool=pubmed_docsum

Environmental tobacco smoke

The following 2 articles are good examples of research documenting the impact of legislation to limit secondhand smoke on the health of non-smoking bar workers.  See also “Smoking Cessation”.

Eisner MD, Smith AK, Blanc PD. Bartenders’ respiratory health after establishment of smoke-free bars and taverns.  JAMA  1998; 280:1909-14. This study of 53 bartenders found a substantial reduction in respiratory and nasopharyngeal irritation symptoms along with modest improvements in spirometry. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=9851475

Menzies D, Nair A, Williamson PA, et al. Respiratory symptoms, pulmonary function, and markers of inflammation among bar workers before and after a legislative ban on smoking in public places.  JAMA 2006; 296:1742-8.  This study of 77 non-smoking, asthmatic and non-asthmatic, bar workers found a significant decline in respiratory symptoms and improvement in FEV1 (FEV1 % predicted improved by 5.1%) in the first 2 months following a smoking ban.  Asthmatics experienced greater improvement in FEV1 than non-asthmatics and had a significant reduction in exhaled nitric oxide. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=17032987&query_hl=22&itool=pubmed_docsum