Asbestosis and environmental causes of usual interstitial pneumonia

Abstract

Purpose of review Recent epidemiologic investigations suggest that occupational and environmental exposures contribute to the overall burden of idiopathic pulmonary fibrosis (IPF). 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 smoke, wood dust, metal dust, sand/silica and agricultural exposures. Lung mineralogic analyses have provided additional support to causal associations. Genetic variation may explain differences in disease susceptibility among the population. Summary An accumulating body of literature suggests that occupational and environmental exposure can contribute to the development of IPF. The impact of exposure on the pathogenesis and clinical course of disease requires further study.

In vivo probe‐based confocal laser endomicroscopy in chronic interstitial lung diseases: Specific descriptors and correlation with chest CT

“…On the other hand, the fibrotic features, including the presence of septal fibres, small alveolar mouths, thickened axial fibres and a disorganized, dense and rigid elastic network, appear to be associated with the remodelling of the elastic fibre network by the fibrotic process . This fibrotic pCLE pattern was observed in both IPF and asbestosis.…”

Presentation, diagnosis and clinical course of the spectrum of progressive-fibrosing interstitial lung diseases

“…ILDs related to other occupational exposures are caused by inhalation and retention in the lungs of various dusts. The most common of these conditions are: asbestosis, which is caused by asbestos fibres; and silicosis, which is related to free crystalline silicon dioxide or silica [107][108][109]. Exposure to farming, livestock, metal dust, coal, sand and dust arising from the preparation of dental prosthetics have also been linked to the development of ILDs [110].…”

“…However, some patients with silicosis present with a UIP pattern [111,112]. In fibrosing asbestosis, HRCT findings resemble those seen in IPF [108]; some patients may have pleural thickening and/or plaques, which are suggestive of asbestos exposure. Additionally, histology may reveal iron-coated asbestos fibres ("asbestos bodies") embedded in the peribronchiolar interstitium and alveolar spaces, which are the hallmark of asbestosis [113].…”

The enduring legacy of black lung: environmental health and contested illness in Appalachia

“…In addition to industrial waste, there are numerous commercial products that have been linked to illness. For example, mesothelioma is a form of cancer affecting the chest and lungs that is primarily caused by the inhalation of asbestos (Gulati and Redlich ). Notably, over 125 million workers in the US alone have been exposed to asbestos.…”