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Occupational and Environmental Medicine

Asthma/RADS/Upper airway disease

Tarlo SM, Lemiere C. Occupational asthma. New Engl J Med 2014; 370:640-9. This succinct review provides an overview of the diagnosis, management, and prevention of sensitizer-induce and irritant-induced asthma.

PMID: 24521110

Vandenplas O, Wiszniewska M, Raulf M, et al. EAACI position paper: irritant-induced asthma. Allergy 2014; 69:1141-53. Expert panel provides revised classification of irritant (occupational) asthma including replacement of reactive airways dysfunction syndrome with the term acute-onset irritant-induced asthma. Diagnosis, natural history, treatment, and prevention are also addressed.

PMID: 24854136

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Chan-Yeung M. Fate of occupational asthma. A follow-up study of patients with occupational asthma due to Western Red Cedar (Thuja Plicata). Am Rev Respir Dis 1977;116:1023-6.This classic article demonstrated the frequent persistence of occupational asthma even months after removal from exposure to western red cedar. Subsequent studies found similar findings for other OA asthmagens, prompting heightened vigilance.

PMID: 931178

Burge PS, O’Brien IM, Harries MG. Peak flow rate records in the diagnosis of occupational asthma due to isocyanates.Thorax 1979;34:317-24. Landmark study was the first to show peak flow is a suitable alternative to provocation testing in the diagnosis of OA.

PMID: 483205

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Anderson JA. Work-associated irritable larynx syndrome. Curr Opin Allergy Clin Immunol 2015; 15:150–155. Your patients with work-associated cough, hoarseness, globus, and dyspnea but no asthma may have this syndrome.  This review covers pathogenesis, presentation, evaluation, and treatment.

PMID: 25961388

Associations with interstitial lung disease and neoplasia

Wagner JC, Sleggs CA, Marchand P. Diffuse pleural mesothelioma and asbestos exposure in the NW Cape Province. Br J Ind Med 1960;17:260-71. Landmark study linking mesothelioma to asbestos exposure.

PMID: 13782506

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Selikoff IJ, Hammond EC, Churg J. Asbestos exposure, smoking, and neoplasia. JAMA 1968;204:106-12. Landmark study showing the synergistic effect of smoking and asbestos exposure.

PMID: 5694532

Leung CC, Yu IT, Chen W. Silicosis. Lancet 2012; 379:2008-18.


Moitra S, Puri R, Paul D, et al. Global perspectives of emerging occupational and environmental lung diseases. Curr Opin Pulm Med 2015; 21:114-20. Timely review of emerging environmental and occupational lung diseases from silicosis due to sandblasting jeans to potential health effects of hydraulic fracturing (fracking).

PMID: 25575364

King MS, Eisenberg R, Newman JH, et al. Constrictive bronchiolitis in soldiers returning from Iraq and Afghanistan. N Engl J Med. 2011; 365:222-30. Case series of 80 soldiers presenting with dyspnea on exertion who had inhalation exposures during service in Iraq and Afghanistan. Of the 49 who underwent lung biopsy, 38 showed diffuse constrictive bronchiolitis, suggesting a relationship to inhalation exposure.

PMID: 21774710

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Air pollution and cardiopulmonary disease

Dockery DW, Pope CA 3rd, Xu X, et al. An association between air pollution and mortality in six U.S. cities. N Engl J Med 1993; 329:1753-9. This seminal article linked fine particulate air-pollution with lung cancer and cardiopulmonary mortality, associations that have been duplicated in subsequent studies and been highly influential in public health policy.

PMID: 8179653

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Banauch GI, Hall C, Weiden M, et al. Pulmonary function after exposure to the World Trade Center collapse in the New York City Fire Department. Am J Respir Crit Care Med 2006; 174:312-9. This study found a large average adjusted decline in FEV1 among firefighters in the year following 9 -11 (372 ml). Exposure intensity correlated linearly with exposure time.

PMID: 16645172

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Pope CA 3rd, Ezzati M, Dockery DW. Fine-particulate air pollution and life expectancy in the United States. N Engl J Med 2009; 360:376-86. Investigation compared air pollution exposure in the late 1970s and early 1980s to the late 1990s and early 2000s and found a reduction in ambient fine-particulate air pollution accounted for as much as 15% of the overall increase in life expectancy in the areas studied.

PMID: 19164188

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Brook RD, Rajagopalan S, Pope A, et al. Particulate matter air pollution and cardiovascular disease: an update to the scientific statement from the AHA. Circulation 2010;121:2331-78. This update of the 2004 AHA statement on the role of particulate matter in increasing cardiovascular morbidity and mortality is a bit daunting in size, but provides an excellent overview of new evidence linking particulate matter exposure to cardiovascular disease and discusses the implications for healthcare providers.

PMID: 20458016

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Lim SS, Vos T, Flaxman AD, et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012;380: 2224-60. This study is noteworthy for firmly establishing the role of ambient particulate matter in causing disease, particularly ischemic heart disease, on a global level.

PMID: 23245609

Gan WQ, FitzGerald JM, Carlsten C, et al. Associations of ambient air pollution with chronic obstructive pulmonary disease hospitalization and mortality. Am J Respir Crit Care Med 2013; 187:721-7. This prospective longitudinal cohort study is noteworthy for finding long-term exposure to traffic-related fine particulate pollution and woodsmoke pollution increased the risk of COPD.


Bayram H, Bauer AK, Abdalati W, et al. Environment, Global Climate Change, and Cardiopulmonary Health. Am J Respir Crit Care Med. 2017; 195(6):718-724. Review article describing major cardiopulmonary impacts of climate change. They provide suggestions to initiate improved education for pulmonary physicians, clinician scientists, and public health officials to enable them with appropriate resources to develop an understanding of climate change impacts on human health to increase future advocacy.

PMID: 27654004

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Environmental tobacco smoke

The following 2 articles are good examples of research documenting the impact of legislation to limit secondhand smoke on the health of nonsmoking bar workers. See also Smoking Cessation.

Eisner MD, Smith AK, Blanc PD. Bartenders’ respiratory health after establishment of smoke-free bars and taverns. JAMA 1998; 280:1909-14. This study of 53 bartenders found a substantial reduction in respiratory and nasopharyngeal irritation symptoms along with modest improvements in spirometry.

PMID: 9851475

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Menzies D, Nair A, Williamson PA, et al. Respiratory symptoms, pulmonary function, and markers of inflammation among bar workers before and after a legislative ban on smoking in public places. JAMA 2006; 296:1742-8. This study of 77 non-smoking, asthmatic and non-asthmatic, bar workers found a significant decline in respiratory symptoms and improvement in FEV1 (FEV1 % predicted improved by 5.1%) in the first 2 months following a smoking ban. Asthmatics experienced greater improvement in FEV1 than non-asthmatics and had a significant reduction in exhaled nitric oxide.

PMID: 17032987

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