Seminars in respiratory and critical care medicine
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Semin Respir Crit Care Med · Jun 2023
Importance of and Approach to Taking a History of Exposures to Occupational Respiratory Hazards.
Occupational respiratory diseases are caused by exposure to respiratory hazards at work. It is important to document those exposures and whether they are causing or exacerbating disease because these determinations can have important impacts on diagnosis, treatment, job restrictions, and eligibility for benefits. Without investigation, it is easy to miss clinically relevant exposures, especially in those with chronic diseases that can have work and nonwork causes. ⋯ With patient consent, the employer can be an important source of information about exposures and, if a problem exists, has an important role in taking corrective action. Consultation for challenging cases is available from a variety of professional and governmental entities. If a clinician identifies a significant public health issue, such as an occupational disease outbreak, it is important to notify relevant public health authorities so that steps can be taken to prevent additional exposures and appropriately care for those already exposed.
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Semin Respir Crit Care Med · Jun 2023
The Emerging Spectrum of Respiratory Diseases in the U.S. Cannabis Industry.
While the cannabis industry is one of the fastest growing job markets in the United States and globally, relatively little is known about the occupational hazards that cannabis production workers face. Based on the closely related hemp industry and preliminary studies from recreational cannabis grow facilities, there is concern for significant respiratory exposures to bioaerosols containing microbial and plant allergens, chemicals such as pesticides, volatile organic compounds, and other irritant gases. ⋯ Disentangling causal relationships is difficult given the heterogeneity of mixed exposures, diagnostic challenges, and confounding by personal cannabis use. Despite and because of these uncertainties, better regulatory guidance and exposure controls need to be defined in order to reduce the risk of work-related disease.
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Semin Respir Crit Care Med · Jun 2023
Artificial Intelligence in Quantitative Chest Imaging Analysis for Occupational Lung Disease.
Occupational lung disease manifests complex radiologic findings which have long been a challenge for computer-assisted diagnosis (CAD). This journey started in the 1970s when texture analysis was developed and applied to diffuse lung disease. Pneumoconiosis appears on radiography as a combination of small opacities, large opacities, and pleural shadows. ⋯ The tasks of CAD are systematically described as classification, detection, and segmentation of the target lesions. Alex-net, VGG16, and U-Net are among the most common algorithms used in the development of systems for the diagnosis of diffuse lung disease, including occupational lung disease. We describe the long journey in the pursuit of CAD of pneumoconioses including our recent proposal of a new expert system.
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Lung diseases caused by workplace exposure are too often mis- or underdiagnosed due in part to nonexistent or inadequate health surveillance programs for workers. Many of these diseases are indistinguishable from those that occur in the general population and are not recognized as being caused at least in part by occupational exposures. More than 10% of all lung diseases are estimated to result from workplace exposures. ⋯ Where available, prevalence and incidence data are also presented. These diseases are unique in that they are theoretically 100% preventable if appropriate exposure controls and workplace medical surveillance are implemented. This remains a continuing challenge globally and requires steadfast commitment on the part of government, industry, organized labor, and the medical profession.