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Evaluation of the patient with an exposure-related disease: the occupational and environmental history

Purpose of review: Although the process of taking an occupational and environmental history has remained largely the same, the context in which it is done has changed dramatically over recent years. This review examines the role of the occupational and environmental history in the context of the changing nature of medical practice and discusses methods for evaluating patients with contemporary exposure-related respiratory illnesses.

Recent findings: Surveillance for occupational lung disease using mnemonic devices, screening questions and the use of structured questionnaires can significantly increase the likelihood and accuracy of detection. Electronic health records likewise can be adapted to include the most important elements of the occupational and environmental history. Summary: The ...

Medical imaging in occupational and environmental lung disease

Purpose of review: The purpose of this review is to provide an up-to-date summary of developments in medical imaging in the diagnosis, surveillance, treatment, and screening of occupational and environmental lung diseases, focusing on articles published within the past 2 years.

Recent findings: Many new exposures resulting in lung disease have been described worldwide; medical imaging, particularly computed tomography (CT), is often pivotal in recognition and characterization of these new patterns of lung injury. Chest radiography remains important to surveillance studies tracking the long-term evolution of disease and effectiveness of air quality regulation. Finally, studies are proving the utility of screening with low-dose CT, and technical advances offer the prospect of further CT dose...

Chronic hypersensitivity pneumonitis: important considerations in the work-up of this fibrotic lung disease

Purpose of review: Chronic hypersensitivity pneumonitis is increasingly recognized as an important mimic of other fibrotic lung diseases. This review will summarize recent data regarding the importance and difficulty of determining causative exposures both for accurate diagnosis and prognosis, and describe the expanded pathologic spectrum of the disease, the effects of fibrosis on prognosis and challenges in the diagnostic evaluation.

Recent findings: Several recent publications show the potential pathologic patterns induced by chronic hypersensitivity pneumonitis are broader than the classic triad of bronchiolitis, interstitial infiltrates and granulomas. Other pathologic patterns include nonspecific interstitial pneumonia, usual interstitial pneumonia, organizing pneumonia, bronchiolitis...

Asbestosis and environmental causes of usual interstitial pneumonia

This article explores the epidemiologic and clinical challenges to establishing exposure associations, the current literature regarding exposure disease relationships and the diagnostic work-up of IPF and asbestosis patients.

Recent findings: IPF patients demonstrate a histopathologic pattern of usual interstitial pneumonia. In the absence of a known cause or association, a usual interstitial pneumonia pattern leads to an IPF diagnosis, which is a progressive and often terminal fibrotic lung disease. It has long been recognized that asbestos exposure can cause pathologic and radiographic changes indistinguishable from IPF.

Several epidemiologic studies, primarily case control in design, have found that a number of other exposures that can increase risk of developing IPF include cigarette s...

Respiratory disability and impairment: what is new?

Purpose of review: This review summarizes recent advances concerning respiratory impairment and disability. Recent findings: The traditional impairment assessment approach, depending heavily on clinical pulmonary function testing to estimate the match between the patient's sustainable oxygen consumption and the workplace requirements, continues to be widely used. Recent work indicates the need to reassess underlying concepts for several reasons: The relationship between basic pulmonary function tests and sustainable oxygen consumption varies among patients and conditions.

Studies of the respiratory demands of modern workplaces need to be updated. The concepts are less easily applied to asthma than other disorders. Research studies present differing definitions of ‘disability’, and ther...

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