Workplace Hazards Account for One in Four Cases of IPF, US and European Societies Warn

Ana Pena, PhD avatar

by Ana Pena, PhD |

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As many as one in four people with idiopathic pulmonary fibrosis (IPF) may have the illness as a result of inhaling vapors, gas, dust, or fumes at work, according to an official statement by the American Thoracic Society (ATS) and the European Respiratory Society (ERS).

Such occupational hazards account for more than one in 10 people with lung diseases not related to cancer, ranging from asthma and chronic obstructive pulmonary disease (COPD) to IPF and several airway infections.

These findings, researchers say, call for policy makers to take serious measures to provide protection for workers around the globe who are exposed to recognized hazards.

The article, “The Occupational Burden of Nonmalignant Respiratory Diseases. An Official American Thoracic Society and European Respiratory Society Statement,” was based on a pooled analysis of available studies focusing on occupational burden for non-cancerous lung diseases. It was published in the American Journal of Respiratory and Critical Care Medicine.

“The role of occupational factors in most lung disease is under-recognized,” Paul D. Blanc, MD, MSPH, chief of division of occupational and environmental medicine at the University of California San Francisco, and one of the study leaders, said in a press release.

“Failure to appreciate the importance of work-related factors in such conditions impedes diagnosis, treatment and, most importantly of all, prevention of further disease,” Blanc added.

For the analysis, 13 clinical and research experts from the two respiratory societies teamed up to assess studies conducted in several parts in the world, over more than two decades. These studies rated the relationship between occupational hazards and several types of nonmalignant lung disease.

Some conditions were excluded from the analysis, like cancer of the lung and pleura (the membrane covering the lungs), asbestosis, silicosis, or coal workers’ pneumoconiosis (black lung), given its well-known relationship with work-related hazards.

For each of the lung diseases analyzed, the team estimated the occupational population attributable fraction (PAF), which is an estimate of how many cases of the disease had exposure to work hazards as a root cause.

Using data from 11 case-control studies, including a total of 39 risk estimates, researchers determined the pooled PAFs in IPF patients for five exposure categories: metal dust, wood dust, silica dust, agricultural dust, and VGDF. VGDF normally stands for inhalation of vapors, gas, dust, or fumes, but here represents a combination of all of the other exposures.

All the workplace hazards, with the exception of agricultural work, contributed significantly to the burden of IPF. The analysis found 3% of patients had the disease due to inhalation of silica dust, 4% due to wood dusts, 8% linked to metal dusts or fumes, and 26% due to any of these exposures, or VGDF.

This VGDF estimate means that more than one in four patients with IPF could have developed the disease due to inhalation of hazardous material during work.

“[W]orkplace exposures contribute substantially to the burden of multiple chronic respiratory diseases,” the researchers said.

Blanc emphasized that these data reveal “a newly appreciated magnitude of risk” for IPF in particular.

The team stressed that “greater attention should be given to reducing this occupational disease burden by identifying and implementing effective preventive interventions.”

“Policy makers, especially those who set regulatory standards and oversee their enforcement, should reassess current protections for workers around the world who are exposed to recognized hazardous inhalational exposures,” they concluded.

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