Reply to Lee and Strek: Occupational Burden in Chronic Respiratory Disease: Call for Recognition, Training, and Data Capture

From the Authors:

We welcome the comments by Dr. Lee and Dr. Strek calling for increased recognition, training, and data capture to address unrecognized occupational attributions in response to the recently published work entitled “The Occupational Burden of Nonmalignant Respiratory Diseases. An Official American Thoracic Society and European Respiratory Society Statement.” Indeed, those were implicit goals that led our international taskforce members to undertake this in-depth review (1). From the onset, we recognized that in focusing on selected nonmalignant respiratory conditions, there would be other occupational associations that we would not be able to address in depth. For example, Table E2 in the online supplement of Reference 1 describes a number of other pulmonary disorders associated with occupational exposures (with supporting citations in the main publication). These include acute eosinophilic pneumonia, bronchiolitis (obliterative, proliferative, and lymphocytic), cryptogenic organizing pneumonia, desquamative interstitial pneumonia, diffuse pulmonary hemorrhage, lipoid pneumonia, nonspecific interstitial pneumonia, and respiratory bronchiolitis interstitial lung disease (1). Many of these disorders fall into the interstitial lung disease group emphasized in the letter by Dr. Lee and Dr. Strek.

The authors also raise the important point that autoimmune conditions such as rheumatoid arthritis may not be appreciated as occupationally triggered by silica and other workplace exposures. In that context, it is important to note that concomitant lung disease may not be overt in such syndromes (2). It is our hope that further research and in-depth reviews will continue to shed light on underappreciated occupational contributors to disease and prioritize a reduction in the burden of these preventable conditions.