Occupational and Environmental Contributions to Lung Disease.

It has been nearly a decade since the last issue of Clinics in Chest Medicine focused on Occupational and Environmental Lung Disease was published. In the ensuing years, we have witnessed appalling outbreaks of preventable pneumoconioses and come to recognize that the implications of climate change for respiratory health are myriad, complex, and already well underway.2, 3, 4 In light of such developments and the advances in our understanding of the impact of work and environmental exposures on respiratory health, it is important to revisit the topic.

Kristin J. Cummings, MD, MPH, Editor

Peggy S. Lai, MD, MPH, Editor

Carrie A. Redlich, MD, MPH, Editor

It is perhaps fitting that we write during the COVID-19 pandemic, an event whose origin and overwhelming consequences are both linked to changing environmental and workplace factors. The coronavirus that causes COVID-19, severe acute respiratory coronavirus 2 (SARS-CoV-2), is the latest and most devastating in a long line of zoonotic viruses: SARS, Middle East respiratory syndrome, and Ebola among them, whose reach is increasing as climate change, population growth, work practices, and travel across borders bring people in closer contact with wildlife and one another. Furthermore, the global spread of COVID-19 has led to infections and deaths among those whose work must continue despite the risk of transmission: health care workers, correctional officers, meat processors, and others deemed “essential.”6, 7, 8 Arguably, no other event in recent memory has so vividly highlighted the relevance of environment, occupation, and racial and income disparities to respiratory disease. The COVID-19 pandemic also reinforces the importance of prevention, early recognition, and surveillance, cornerstones of occupational health practice.

We attempt to integrate practical clinical approaches throughout the issue. Dr Redlich and colleagues present a collection of cases that highlights the importance of considering occupational and environmental factors for both diagnosis and effective management. Drs Hobbs and Walkoff provide a practical guide to radiologic findings of occupational lung disease, complete with an outstanding collection of images. Dr Markowitz explores occupational contributions to lung cancer and opportunities for screening. Dr De Perio and colleagues address the role of work in respiratory infections. Drs Harber and Leroy discuss the advances in informatics that are impacting practice today and those that hold promise for the future.

Occupational exposures collectively impact the entire respiratory system. Drs Lau and Tarlo examine the upper airway with a focus on work-related rhinitis and laryngeal disorders, increasingly recognized for their adverse impact on productivity and quality of life. Dr Nett and colleagues discuss recent advances in our understanding of occupational bronchiolitis, including new risk factors. Drs Reynolds and colleagues focus on the lung parenchyma, building on a recently published review to describe the state of knowledge regarding occupational contributions to interstitial lung disease.

Drs Guo and Cohen provide an update on mining-related lung diseases, emphasizing the resurgence of coal workers’ pneumoconiosis. Dr Krefft and colleagues provide a focused review of silicosis for the practicing clinician, including discussion of underrecognized clinical presentations. Dr De Matteis and colleagues summarize the growing body of literature on the respiratory health effects of cleaning and disinfecting products for professional cleaners. Their article is particularly timely in light of COVID-19 and the expanded use of such products in the workplace and by the general public. Dr Navarro explores the respiratory effects of smoke exposure on wildland firefighters, who are increasingly called upon year round as climate change extends the fire season.

Another group of articles focuses on the important impact of environmental exposures on lung disease in the broader population. Dr Balmes, in a companion piece to Dr Navarro’s, details the effects of wildfire smoke on the public and provides practical recommendations for vulnerable subpopulations on how to minimize exposure. Drs Shankar and Rice review the effects of climate change on environmental exposures and respiratory health. Drs Wolf and Lai discuss the ways that next-generation sequencing has shifted our understanding of how bacterial and fungal exposures impact health. Dr Adamkiewicz and colleagues detail the effects of outdoor air pollution on health, and Dr Raju and colleagues highlight the adverse impact of indoor air pollution, stratified by studies in high- versus low- and middle-income settings. Dr Baldassarri reviews the impact of electronic cigarettes on smoking cessation and nicotine addiction, as well as the risks of vaping-associated lung disease, with detailed answers to patient-centered questions about this new and widely prevalent exposure. Finally, there is growing awareness of disparities in harmful environmental exposures that impact lung disease, which is reviewed by Dr Brigham and colleagues.

It is clear that a wide range of work and environmental exposures plays a vital role in the development and progression of most lung diseases. Yet, the clinical impact of these exposures is greatly underappreciated, hindering treatment and broader preventive efforts. We must do better. We hope this issue on Occupational and Environmental Lung Disease will help clinicians and public health practitioners recognize, manage and prevent work and environmental-related lung diseases.