Medical surveillance for the emerging occupational and environmental respiratory diseases.

PURPOSE OF REVIEW: To highlight the important issues to consider in deciding whether to pursue and how to conduct medical surveillance for the emerging occupational and environmental respiratory diseases. It provides several recent examples illustrating implementation and usefulness of medical surveillance and the lessons learned from these experiences. RECENT
FINDINGS: Medical surveillance conducted after sentinel outbreaks of constrictive bronchiolitis in microwave popcorn and flavoring production plants have shown the usefulness of this approach in documenting the burden of disease, identifying particular problem areas as targets for preventive interventions, and in tracking the progress. They have also identified the usefulness of longitudinal spirometry, which allows comparison of the individuals' results to their own previous tests. The importance of recognizing a sentinel outbreak needing greater investigation is demonstrated by the cluster of cases of constrictive bronchiolitis recognized in military veterans returning from Iraq and Afghanistan. The World Trade Center disaster has demonstrated the importance of having baseline lung function data for future comparison and the importance of rapidly identifying exposed populations at greatest risk for health effects, and thus potentially having the greatest benefit from medical surveillance.
SUMMARY: When used appropriately, medical surveillance is a useful tool in addressing the emerging occupational and environmental respiratory diseases by facilitating improvements in primary prevention and enabling interventions to help individuals through secondary prevention.