Occupational and Environmental Lung Diseases: Diseases from Work, Home, Outdoor and Other Exposures

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Next Chapter. Balmes J. Balmes, John R. Occupational and Environmental Lung Disease. Emissions can also move in from other regions. There is strong evidence that exposure to outdoor air pollution causes lung cancer. The more air pollution you are exposed to, the greater your risk of developing lung cancer.

Research shows that the different components of outdoor air pollution cause cancer. These components include diesel engine exhaust, benzene, particulate matter and some PAHs. People who had lung cancer have a higher risk of developing lung cancer again. You may also have a slightly higher risk for lung cancer if you have a first-degree relative a brother, sister, child or parent who had lung cancer. The increased risk could be due to a number of factors, such as shared behaviours like smoking or living in the same place where there are carcinogens like radon.

Certain lung diseases or conditions can scar the lungs and increase the risk for lung cancer.

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Examples of these conditions include: chronic obstructive pulmonary disease COPD , which is long-term damage to the lungs that is often caused by smoking emphysema and chronic bronchitis, which are types of COPD tuberculosis TB , which is a lung infection caused by tuberculosis bacteria lung infection caused by Chlamydophila pneumoniae. People who were treated with radiation therapy to the chest for certain cancers, such as Hodgkin lymphoma or breast cancer, have a higher risk for lung cancer. These people have an even higher risk if they smoke.

People who were exposed to ionizing radiation during atomic bomb explosions or nuclear accidents have a greater risk of developing lung cancer. Arsenic can get into drinking water from natural sources in the soil or from certain types of industries, such as mining. The risk is even greater in people who smoke. Some types of cooking and heating can release pollutants that increase the risk for lung cancer. The levels of these pollutants can be very high in spaces that have poor air flow. Burning coal indoors for cooking and heating is most strongly linked to lung cancer. Burning wood and other fuels, such as dung or grass, and frying foods in oil at high temperatures can also increase the risk for lung cancer.

Having a suppressed immune system increases their risk of developing lung cancer. Systemic lupus erythematosus SLE or lupus is an autoimmune disease. Lupus can affect various parts of the body and cause inflammation of the skin, joints, blood vessels, nervous system and internal organs such as the heart, lungs and kidneys.

People with lupus have a higher risk for lung cancer. Beta carotene is a type of antioxidant. Some clinical trials found that people who smoked more than 1 pack per day and who were given high-dose beta carotene supplements had a greater risk of developing lung cancer. The following factors have been linked with lung cancer, but there is not enough evidence to show they are known risk factors. More research is needed to clarify the role of these factors for lung cancer.

Researchers are trying to find out if the following chemicals increase the risk for lung cancer: bitumen used in paving dioxin used in pesticides strong chemical acid mists fibrous silicon carbide. Research shows that some families have a strong history of lung cancer, which may mean that they have a mutation in a certain gene that may cause lung cancer.

Researchers are trying to find out if a specific gene or genes may increase the risk for lung cancer. Studies are also trying to find very small changes in genes called genetic polymorphisms that may increase the risk for lung cancer or make people, especially non-smokers, more sensitive to known risks for lung cancer. The evidence suggesting a link between long-term smoking of cannabis marijuana and cancer is not as strong or as comprehensive as the evidence linking smoking tobacco and cancer.

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Some studies found that long-term recreational smoking of cannabis can increase the risk for lung cancer. Research suggests that people who are not physically active may have a higher risk for lung cancer, whether they smoke or not. To optimize data collection and reduce recall bias, the questionnaires were completed with the help of an occupational physician or another trained professional.

Questionnaires were also couched in terms that were familiar to the workers, in order to optimize their estimation of exposure. In addition, the questionnaires about the 11 selected occupations were based on the JEM model. Moreover, case-control studies are the most efficient study design for investigating the etiology of rare diseases or ones with an extremely low incidence [ 30 ].

The present study nonetheless had several limitations.

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Recognizing Occupational Disease—Taking an Effective Occupational History

Its multicenter nature may have introduced a selection bias and differences in how the data were collected. We limited this risk by training all the professionals who played a part in the study. Recall bias is presumably inevitable in any retrospective study, but in our study in particular, data on working life, the different occupations and, more especially, their respective durations, relied on the memory of our participants.

Using a comprehensive questionnaire administered by an occupational physician partly minimized this bias. Our greatest challenge was to collect enough participants to create the pairs needed to meet the study criteria. This is why we included individuals who were either younger or older than we had originally planned. Stricter matching criteria would have required a far longer recruitment phase eight years instead of 16 months.


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Despite matching, age was associated with an increased risk of developing COPD. Some occupations were underrepresented, such as firefighting, glassware and pottery. Significant results were found in the best represented occupations.

The literature suggests that we would have had more significant results had there been more cases and controls in each sector. Some personal risk factors were not taken into account in our study, such as passive smoking in the home. Finally, like many studies of occupational risk factors, the healthy worker effect probably decreased the role of occupational exposure in the development of COPD. This study once more demonstrates the importance of occupational factors in the genesis of COPD, especially among smelters.

Several studies have suggested that COPD patients with occupational exposure have a poorer prognosis and higher mortality than patients with no such exposure [ 13 ]. The removal of respiratory irritants and the substitution of nontoxic agents for toxic ones are the best ways of eliminating work-related COPD risk, as they are in the fight against active and passive smoking.

Moreover, clinicians must be aware of these risks and ask all new patients with COPD about their occupational history in order to improve their prognosis by stopping all exposure, trigger the payment of work-related insurance compensation, and participate in public health surveillance.

Educating employees about the dangers of their occupational exposure, the collective and individual forms of protection required, and also the first signs of COPD, are also part of prevention. To reduce the burden of COPD worldwide, it is essential to continue research on occupational risk factors. New case-control studies within specific occupations are needed to deepen our understanding and complement the work accomplished in the present study. The present study uncovered a high prevalence of COPD in smelters. A major global health problem, COPD is a chronic, progressive and disabling disease with multiple risk factors.

Mortality, plus the direct and indirect costs of its care in industrialized countries, largely justifies research to increase our knowledge of these occupational risks in order to prevent them more effectively. Conceived and designed the experiments: FJD. Performed the experiments: FL. Analyzed the data: MD. Browse Subject Areas? Click through the PLOS taxonomy to find articles in your field. Methods Eleven occupations involving different types of exposure were observed in this multicenter case-control study.

Results A total of 1, participants were initially recruited between September and September Conclusions This study demonstrates the importance of occupational factors in the genesis of COPD, especially among smelter workers.