Occupational lung diseases represent a significant but often underdiagnosed health risk among workers exposed to airborne pollutants in industrial, agricultural, and healthcare environments. The lungs are organs with an extensive surface area, high vascularity, and a thin barrier between air and blood. This structure makes them a contact site for environmental agents, many of which exert local and/or systemic or immunological toxic effects. Exposures to toxic substances can cause virtually all major clinical forms of respiratory illness, implying that environmental or occupational factors may cause many lung diseases.
For these reasons, pulmonologists should consider a differential diagnosis for every major pattern of respiratory illness, including both occupational and environmental exposures. In this article, we discuss the need to evaluate individuals proactively and early at occupational risks to prevent their lung health from deteriorating over time.
By América Torres
Clinical Evaluation of Occupational Lung Disease Risk in Workers
To diagnose occupational lung diseases, physicians should obtain a comprehensive work history from the patient. Ideally, this history should include all occupations the patient has held throughout their professional life, mentioning any associated exposure to chemicals, biological products, vapors, gases, dust, and/or fumes. Additionally, patients should provide information about the approximate intensity and duration of these exposures whenever possible. Diagnosing the occupational cause of a lung disease is a very serious matter for several reasons:
- It can influence the treatment and prognosis of the disease.
- It can have legal implications for the company.
- It may entail professional decisions and financial implications for the patient.
- It can help identify a larger population at risk.
- It can contribute to research on a certain type of disease.
Physicians must assess the probable exposure dose as accurately as possible in terms of duration, measured levels, and subjective intensity. Consequently, this assessment can determine the severity of the disease in an affected individual, the incidence of the disease among other workers exposed to certain conditions, or the speed of onset, but not necessarily all three.
While it is true that occupational lung diseases are preventable and eliminating exposure will eliminate future disease, many chronic diseases — particularly interstitial lung diseases (ILDs) — can still progress once established. Therefore, even after exposure stops, disease progression may continue over time. They can continue to progress despite reducing exposure to the offending agent.
However, similar to tobacco smoke exposure, not all occupationally exposed individuals develop the disease. Individual susceptibility often depends on factors often remain unclear.
Below, we explore some of the most common lung diseases that may develop as a result of occupational exposure to pathogenic agents.
Occupational Asthma and Work-Related Respiratory Symptoms
There are two main types of work-related asthma: occupational asthma and in-work exacerbated asthma. Occupational asthma (OA) results from airborne exposures in the working environment. In work-exacerbated asthma, nonspecific workplace factors can worsen symptoms, but work does not cause the asthma. The characteristics of these two conditions are not easily distinguishable from each other.
Work-exacerbated asthma is common and is estimated to affect one fifth of asthmatic patients. Work-related asthma is common but is often under-recognized for several reasons.
- Firstly, the patient may not relate asthma symptoms to their work.
- Secondly, the physician may not think to inquire specifically about any work-related symptoms, therefore may not consider it necessary to assess work-related asthma in the patient.
Additionally, there is limited information in international asthma guidelines about OA and its causes. The following table shows some of the most common causes of occupational asthma:
Occupational COPD in Non-Smoking Workers
Tobacco smoke inhalation is the primary causative agent of COPD because it exposes the lungs to a powerful and complex mixture of respiratory toxic substances. While pulmonologists are aware of this association, research shows that a considerable proportion of COPD patients (25–35%) have never smoked. It is also known that there are exposures and risk factors for the development of the disease, which in many cases can act in conjunction with cigarette smoke.
Over time, various landmark publications established the role of occupational exposures to dust, gases, and fumes in the development of “focal emphysema,” COPD, and industrial (non-obstructive chronic) bronchitis, respectively. In 2019, a joint statement from the ATS (American Thoracic Society) and the ERS (European Respiratory Society) estimated the smoking-adjusted population attributable fraction (PAF; i.e., the proportional reduction in COPD in the population that would result from exposure elimination) for the occupational contribution to COPD at 14% (95% CI 10-18%) and 31% (95% CI 18-43%) when studies are restricted to non-smokers. For chronic bronchitis, the PAF was 13% (95% CI 6-21%).
In addition to occupational exposures, research shows the role of environmental exposures (such as indoor air pollution from biomass burning, secondhand smoke, or outdoor air pollution). Furthermore, clinicians must consider genetic susceptibility factors and factors or events that affect lung development in early life, including dysanapsis (disproportion of airway dimensions in relation to lung alveoli). They must also consider accelerated aging. Lung diseases throughout life, such as asthma (especially in individuals with occupational asthma), tuberculosis, rheumatoid arthritis, HIV, and other viral and non-viral infections, must be considered as well.
Agents with solid evidence of association with COPD include coal mine dust, silica, grains, and textiles. Evidence is weaker in cases of exposure to:
- Agricultural dusts
- Asbestos
- Cadmium
- Carbon black
- Refractory ceramic fibers
- Endotoxin
- Flour
- Isocyanates
- Welding fumes
- Coke oven emissions
- Diesel exhaust
- Tunnel dust and fumes
Occupational Interstitial Lung Diseases from Workplace Exposure
Interstitial lung diseases (ILDs) manifest through variable combinations of parenchymal inflammation and/or fibrosis. There are some inhalation exposures encountered in the workplace that are well-established causes of ILD. In these cases, both exposure and disease are easily identified. For example, exposure to coal dust and pneumoconiosis. However, in other ILDs, the association between occupational exposures and disease may not be evident. Especially if the clinical or radiological picture of the patient is nonspecific. This can result in patients experiencing symptoms without an identified etiology. Therefore, they may not receive appropriate clinical management or advice regarding the health risk posed by their employment.
The following table shows the agents responsible for the most common interstitial lung diseases (ILDs) and the professionals who suffer exposure to these agents.
Spirometry and Oscillometry for Occupational Lung Disease Detection
There are many cases where clinicians cannot clearly determine whether occupational factors cause a patient’s lung disease. Therefore, physicians — from primary care to pulmonology specialists — need diagnostic tools that provide accurate and timely assessments.
SCHILLER-GANSHORN offer two valuable tests that, when used together, provide physicians with information that can be decisive. We refer to spirometry and oscillometry, two tests that, by themselves, provide relevant data:
- Spirometry (with the ultrasonic spirometer, SpiroScout) allows for the measurement of lung flows and volumes but does not provide information on how these flows and volumes are moving.
- Oscillometry (with the tremoflo® airwave oscillometry system) provides information about the resistance present in the airways but does not provide data about the amount of air moving in the lungs.
Watch the video to learn the advantages of each test and how oscillometry complements spirometry to provide a more comprehensive assessment of lung function in at-risk workers.
When clinicians perform only one test, they gain valuable insights but only part of the clinical picture. To truly understand lung health, they must measure both airflow and airway resistance. For this reason, spirometry and oscillometry function as complementary — rather than alternative — diagnostic tools.
Book a one-on-one demo today to discover how combining both tests can enhance your occupational health screening and improve diagnostic confidence in your daily practice.
Frequently Asked Questions: Occupational Lung Disease Screening
What are occupational lung diseases?
Occupational lung diseases are respiratory conditions caused or worsened by inhaling hazardous substances in the workplace, such as dust, chemical fumes, vapors, gases, or biological agents. Common examples include occupational asthma, occupational COPD, and interstitial lung diseases (ILDs). Early identification of work-related exposure is critical to prevent irreversible lung damage and disease progression.
How do clinicians diagnose occupational lung diseases?
Clinicians diagnose occupational lung diseases by combining clinical evaluation with a detailed occupational history and pulmonary function testing. Physicians assess exposure type, duration, and intensity alongside symptoms and imaging findings. Spirometry and oscillometry help detect airflow limitation and airway resistance, which may indicate early respiratory impairment associated with workplace exposure.
Can occupational exposure cause COPD in non-smokers?
Yes. Long-term exposure to occupational agents such as silica dust, grain dust, welding fumes, and diesel exhaust can contribute to COPD development in non-smokers. Studies estimate that occupational exposure accounts for up to 30% of COPD cases among individuals without a history of tobacco use.
What role does spirometry play in occupational health screening?
Spirometry measures lung volumes and airflow to identify obstructive or restrictive respiratory patterns in workers exposed to airborne pollutants. It supports early detection of functional impairment in at-risk individuals and enables clinicians to monitor disease progression over time.
Why should oscillometry complement spirometry in pulmonary assessment?
Oscillometry measures airway resistance and peripheral lung mechanics that spirometry may not detect. When clinicians combine oscillometry with spirometry, they obtain a more comprehensive evaluation of respiratory function, improving diagnostic sensitivity in workers exposed to occupational respiratory hazards.