Merck Manual

Please confirm that you are not located inside the Russian Federation

honeypot link

Overview of Environmental and Occupational Lung Disease

By

Carrie A. Redlich

, MD, MPH, Yale Occupational and Environmental Medicine Program Yale School of Medicine;


Efia S. James

, MD, MPH, Yale School of Medicine;


Brian Linde

, MD, MPH, Yale Occ and Env Medicine Program

Reviewed/Revised Nov 2023
VIEW PROFESSIONAL VERSION
Topic Resources

Environmental and occupational lung diseases result from inhalation of dusts, chemicals, gases, fumes, and other airborne exposures. The lungs are continually exposed to the external environment and are susceptible to many occupational and environmental challenges. Disease resulting from environmental or occupational exposures can involve any part of the lungs, including the

  • Airways, which are the organs (such as the throat, trachea, and bronchi) that bring air to the lungs

  • Alveoli, which are the tiny air sacs of the lungs

  • Pleura, which are membranes that line the chest cavity and surround the lungs

As examples, the airways are affected in work-related asthma Work-Related Asthma Work-related asthma is a reversible narrowing of the airways caused by inhaling particles or vapors in the workplace, which act as irritants or cause an allergic reaction. Work-related asthma... read more Work-Related Asthma , reactive airways dysfunction syndrome Reactive airways dysfunction syndrome Asthma is a condition in which the airways narrow—usually reversibly—in response to certain stimuli. Coughing, wheezing, and shortness of breath that occur in response to specific triggers are... read more Reactive airways dysfunction syndrome , toxic inhalations Irritant Gas Inhalation Injury Irritant gas inhalation injury is the result of gases that, when inhaled, dissolve in the water of the respiratory tract mucosa and cause an inflammatory response. Symptoms depend on which gas... read more , air pollution–related illness Air Pollution–Related Illness Air pollution–related illness is disease caused by harmful pollutants in the air or worsening of preexisting disease by air pollutants. Some air pollutants cause the airways to narrow, leading... read more , or byssinosis Byssinosis Byssinosis is a narrowing of the airways (asthma-like syndrome) caused by inhaling cotton, flax, or hemp particles. Byssinosis may cause shortness of breath, wheezing, and tightness in the chest... read more . Alveoli are affected in pneumoconioses (such as coal worker pneumoconiosis Coal Worker Pneumoconiosis Coal worker pneumoconiosis is a lung disease caused by deposits of coal mining dust in the lungs. Symptoms include cough and shortness of breath which can progress over time. Chest x-rays and... read more ), hypersensitivity pneumonitis Hypersensitivity Pneumonitis Hypersensitivity pneumonitis is a type of inflammation in and around the tiny air sacs (alveoli) and smallest airways (bronchioles) of the lung caused by a hypersensitivity reaction to inhaled... read more , or silicosis Silicosis Silicosis is permanent scarring of the lungs caused by inhaling silica (quartz) dust. People develop difficulty breathing during activity that sometimes progresses to shortness of breath at... read more . The pleura are affected in asbestos-related diseases Overview of Asbestos-Related Disorders Asbestos is the collective name for a group of naturally occurring silicates (which are a type of mineral) whose heat-resistant and structural properties are useful in construction and insulating... read more .

Doctors who suspect an environmental or occupational lung disease ask specifically about industry and job tasks, past and current exposures, and whether symptoms seem to be related to work, home, or other environments.

Table

Prevention

Prevention of environmental and occupational lung diseases centers on reducing or eliminating exposure to substances that can cause disease. In the order of most to least effective, exposure can be reduced or eliminated with these measures:

  • Removing the hazard from the workplace

  • Substituting with safer, less toxic materials

  • Implementing engineering controls (that is, controlling the environment, for example, with enclosures, ventilation systems, safe clean-up procedures)

  • Using administrative controls (for example, limiting the number of people exposed to hazardous conditions)

  • Using personal protective equipment (for example, a respirator or dust mask)

Although respirators reduce exposure, they are generally the least preferred type of preventive measure. They should be considered when more effective interventions are not feasible or do not sufficiently reduce the hazard. Respiratory protection typically is worn for high-risk specific tasks and not for an entire workday.

When a respirator is required to protect a worker's health, the worker should be enrolled in the employer-mandated written respiratory protection program, which includes medical evaluation and annual respirator fit testing to ensure proper fit. Medical evaluation includes assessment of whether the person is able to wear the type of respirator that will be used in the workplace.

Medical surveillance is another element of prevention. In medical surveillance, scheduled evaluations of a worker, such as with lung function tests Pulmonary Function Testing (PFT) Pulmonary function tests measure the lungs' capacity to hold air, to move air in and out, and to absorb oxygen. Pulmonary function tests are better at detecting the general type and severity... read more Pulmonary Function Testing (PFT) or chest imaging Chest Imaging Chest imaging studies include X-rays Computed tomography (CT) CT angiography Magnetic resonance imaging (MRI) read more , are conducted to identify disorders early when exposure reduction and other interventions might help reduce long-term consequences. The United States Occupational Safety and Health Administration (OSHA) mandates medical surveillance for select exposures, such as asbestos and silica.

More Information

The following English-language resources may be useful. Please note that THE MANUAL is not responsible for the content of these resources.

NOTE: This is the Consumer Version. DOCTORS: VIEW PROFESSIONAL VERSION
VIEW PROFESSIONAL VERSION
quiz link

Test your knowledge

Take a Quiz!
iOS ANDROID
iOS ANDROID
iOS ANDROID
TOP