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Occupational and Environmental Medicine

Asthma/RADS/Upper airway disease

Tarlo SM, Lemiere C. Occupational asthma. New Engl J Med 2014; 370:640-9. This succinct review provides an overview of the diagnosis, management, and prevention of sensitizer-induce and irritant-induced asthma.

PMID: 24521110

Vandenplas O, Wiszniewska M, Raulf M, et al. EAACI position paper: irritant-induced asthma. Allergy 2014; 69:1141-53. Expert panel provides revised classification of irritant (occupational) asthma including replacement of reactive airways dysfunction syndrome with the term acute-onset irritant-induced asthma. Diagnosis, natural history, treatment, and prevention are also addressed.

PMID: 24854136

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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.

PMID: 931178

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.

PMID: 483205

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Lau A, Tarlo SM. Work-related upper-airway disorders. Clin Chest Med. 2020; 41:651-660. This review provides an overview of the presentation, diagnosis, and treatment of work related rhinitis and laryngeal syndromes. Noteworthy aspects include discussion of how laryngeal syndromes can mimic, as well as coexist with, occupational asthma and the role of occupational irritants in chronic cough that extends beyond working hours.

PMID: 33153685

De Matteis S, Ronsmans S, Nemery B. Respiratory health effects of exposure to cleaning products. Clin Chest Med. 2020; 41:641-650. Review summarizes presentation and pathogenesis, as well as the challenges with determining the epidemiology, diagnosis, and treatment.

PMID: 33153684


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.

PMID: 5694532

Krefft S, Wolff J, Rose C. Silicosis: An update and guide for clinicians. Clin Chest Med. 2020; 41:709-722. This review summarizes the current epidemiology of silicosis as well as the wide array of pulmonary and extrapulmonary manifestations of exposure.

PMID: 33153689


Moitra S, Puri R, Paul D, et al. Global perspectives of emerging occupational and environmental lung diseases. Curr Opin Pulm Med 2015; 21:114-20. Timely review of emerging environmental and occupational lung diseases from silicosis due to sandblasting jeans to potential health effects of hydraulic fracturing (fracking).

PMID: 25575364

King MS, Eisenberg R, Newman JH, et al. Constrictive bronchiolitis in soldiers returning from Iraq and Afghanistan. N Engl J Med. 2011; 365:222-30. Case series of 80 soldiers presenting with dyspnea on exertion who had inhalation exposures during service in Iraq and Afghanistan. Of the 49 who underwent lung biopsy, 38 showed diffuse constrictive bronchiolitis, suggesting a relationship to inhalation exposure.

PMID: 21774710

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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. N Engl J Med 1993; 329:1753-9. This seminal article linked fine particulate air-pollution with lung cancer and cardiopulmonary mortality, associations that have been duplicated in subsequent studies and been highly influential in public health policy.

PMID: 8179653

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Liu C, Chen R, Sera F, et al. Ambient particulate air pollution and daily mortality in 652 cities. N Engl J Med. 2019; 381:705-715. Study of 652 cities in 24 countries or regions. On average, an increase in 10 μg per cubic meter of both inhalable and fine particulate matter was associated with increased daily all-cause mortality, daily cardiovascular mortality, and daily respiratory mortality.

PMID: 31433918

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Gan WQ, FitzGerald JM, Carlsten C, et al. Associations of ambient air pollution with chronic obstructive pulmonary disease hospitalization and mortality. Am J Respir Crit Care Med 2013; 187:721-7. This prospective longitudinal cohort study is noteworthy for finding long-term exposure to traffic-related fine particulate pollution and woodsmoke pollution increased the risk of COPD.


Bayram H,, Bauer AK, Abdalati W, et al. Environment, global climate change, and cardiopulmonary health. Am J Respir Crit Care Med. 2017; 195:718-724. Review article describing major cardiopulmonary impacts of climate change. They provide suggestions to initiate improved education for pulmonary physicians, clinician scientists, and public health officials to enable them with appropriate resources to develop an understanding of climate change impacts on human health to increase future advocacy.

PMID: 27654004

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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 nonsmoking 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.

PMID: 9851475

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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.

PMID: 17032987

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