Abstract
Occupational respiratory diseases are caused by exposure to respiratory hazards at
work. It is important to document those exposures and whether they are causing or
exacerbating disease because these determinations can have important impacts on diagnosis,
treatment, job restrictions, and eligibility for benefits. Without investigation,
it is easy to miss clinically relevant exposures, especially in those with chronic
diseases that can have work and nonwork causes. The first and most important step
in identifying exposures to respiratory hazards at work is to take an appropriate
history. For efficiency, this is a two-step process. An initial quick screening history
is done by asking only a few questions. Follow-up questions are asked if there are
positive responses to the screening questions or if an occupational etiology is suspected
based on the clinical presentation. Electronic health records have promise for facilitating
this process. Follow-up to the screening history may include additional questions,
evaluating additional sources of information about workplace exposures, and medical
testing. Radiographic findings or tests conducted on noninvasive samples or lung tissue
can be used as biomarkers. Online resources can be used to learn more about exposures
associated with occupations and industries and to see if investigations evaluating
exposures were performed in the patient's own workplace. It is important to adhere
to the patient's wishes about contacting the employer. With patient consent, the employer
can be an important source of information about exposures and, if a problem exists,
has an important role in taking corrective action. Consultation for challenging cases
is available from a variety of professional and governmental entities. If a clinician
identifies a significant public health issue, such as an occupational disease outbreak,
it is important to notify relevant public health authorities so that steps can be
taken to prevent additional exposures and appropriately care for those already exposed.
Keywords
respiratory disease - occupational - hazardous exposure - medical history - exposure
assessment
