Occupational Exposures and Subclinical Interstitial Lung Disease. The MESA (Multi-Ethnic Study of Atherosclerosis) Air and Lung Studies

Sack, Coralynn; Doney, Brent; Podolanczuk, Anna J.; Hooper, Laura; Seixas, Noah S.; Hoffman, Eric A.; Kawut, Steven M.; Vedal, Sverre; Raghu, Ganesh; Barr, R. Graham; Lederer, David J.; Kaufman, Joel D.

doi:10.1164/rccm.201612-2431oc

Cited by 51 publications

(28 citation statements)

References 27 publications

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“…Risk factors for the presence of ILA include increasing age, tobacco smoke exposure, other inhalational exposures (eg, vapors, gases, dusts, fumes, and traffic-related air pollution), and genetic factors (eg, gene encoding mucin 5B variant) (4,6,7,9,13,27).…”

Section: Risk Factorsmentioning

confidence: 99%

“…ILA is an important risk factor for lung injury during cancer therapies. In patients with early-stage cancers treated with surgical resection, ILA was associated with a risk of postoperative pulmonary complications such as pneumonia, acute respiratory distress syndrome, respiratory failure, bronchopleural fistula or empyema, prolonged air leakage, and pneumothorax (OR = 1.91 [95% CI: 1.02, 1.13], P = (12,13). Greater regional high-attenuation area was associated with clinical outcomes and higher odds of visually assessed ILA (OR range, 1.42-2.20, P ≤ .03) (36).…”

Section: Lung Functionmentioning

confidence: 99%

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Interstitial Lung Abnormalities: State of the Art

et al. 2021

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T he recognition of the importance of interstitial lung abnormality (ILA) at CT emerged from the systematic evaluation of large cohorts, showing a prevalence of 4%-9% in cigarette smokers and a prevalence of 2%-7% in never-smokers (Table 1) (1-9). Individuals with ILA have an increase in symptoms such as chronic cough and shortness of breath, decreased total lung capacity, reduced exercise capacity, and increased all-cause mortality. ILA may progress and may represent subclinical or early pulmonary fibrosis (Table 2) (10-16).A recent Fleischner position paper provided an updated definition of ILA, with descriptive terms, a summary of risk factors and clinical outcomes, and a proposed schema for management (2). Our purpose is to provide a practical guide for radiologists regarding ILA that includes the definition of and terms for ILA, outcomes, possible strategies for clinical management, and future directions. Entities Not Considered ILAPotential chest CT pitfalls and overlaps in ILA are summarized in Table 3. Although centrilobular nodularity (Fig 5) was included in initial descriptions of ILA The clinical importance of interstitial lung abnormality (ILA) is increasingly recognized. In July 2020, the Fleischner Society published a position paper about ILA. The purposes of this article are to summarize the definition, existing evidence, clinical management, and unresolved issues for ILA from a radiologic standpoint and to provide a practical guide for radiologists. ILA is a common incidental finding at CT and is often progressive and associated with worsened clinical outcomes. The hazard ratios for mortality range from 1.3 to 2.7 in large cohorts. Risk factors for ILA include age, smoking status, other inhalational exposures, and genetic factors (eg, gene encoding mucin 5B variant). Radiologists should systematically record the presence, morphologic characteristics, distribution, and subcategories of ILA (ie, nonsubpleural, subpleural nonfibrotic, and subpleural fibrotic), as these are informative for predicting progression and mortality. Clinically significant interstitial lung disease should not be considered ILA. Individuals with ILA are triaged into higher-and lower-risk groups depending on their risk factors for progression, and systematic follow-up, including CT, should be considered for the higher-risk group. Artificial intelligence-based automated analysis for ILA may be helpful, but further validation and improvement are needed. Radiologists have a central role in clinical management and research on ILA.

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Section: Risk Factorsmentioning

confidence: 99%

Section: Lung Functionmentioning

confidence: 99%

Interstitial Lung Abnormalities: State of the Art

et al. 2021

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“…While precise definitions of ILA have varied between studies [ 5 , 11 , 14–16 ], the definition proposed by Washko et al [ 5 ] defined ILA as non-dependent changes that affect more than 5% of any lung zone that include ground-glass or reticular abnormalities, diffuse centrilobular nodularity, non-emphysematous cysts, honeycombing, and traction bronchiectasis [ 5 , 8 ] with areas meeting criteria for emphysema not included in these estimations. Changes present in less than 5% of lung zones consisting of focal or unilateral ground-glass attenuations, focal or unilateral reticulation, and patchy ground-glass abnormalities have been defined as indeterminate for ILA [ 5 ].…”

Section: Definition and Prevalence Of Interstitial Lung Abnormalitiesmentioning

confidence: 99%

Interstitial lung abnormalities – current knowledge and future directions

Axelsson

Guðmundsson

2021

European Clinical Respiratory Journal

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“…WTC dust may be responsible for the reported PF cases as the substances known to be associated with PF in occupational studies include heavy metals (e.g., titanium), silica, and wood dust [ 13 , 14 , 15 , 16 , 17 , 18 , 19 ], which were also found in WTC dust [ 1 , 2 ]. However, little is known about the occurrence of PF in this population over time and whether the level of WTC dust exposure would be associated with PF in an observational study in which WTC responders with PF could be compared to those who do not have PF.…”

Section: Introductionmentioning

confidence: 99%

Pulmonary Fibrosis among World Trade Center Responders: Results from the WTC Health Registry Cohort

Cone

Brackbill

et al. 2019

IJERPH

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Dust created by the collapse of the World Trade Center (WTC) towers on 9/11 included metals and toxicants that have been linked to an increased risk of pulmonary fibrosis (PF) in the literature. Little has been reported on PF among WTC responders. This report used self-reported physician diagnosis of PF with an unknown sub-type to explore the association between levels of WTC dust exposure and PF. We included 19,300 WTC responders, enrolled in the WTC Health Registry in 2003–2004, who were followed for 11 years from 2004 to 2015. Exposure was defined primarily by intensity and duration of exposure to WTC dust/debris and work on the debris pile. Stratified Cox regression was used to assess the association. We observed 73 self-reported physician-diagnosed PF cases, with a PF incidence rate of 36.7/100,000 person-years. The adjusted hazard ratio (AHR) of PF was higher in those with a medium (AHR = 2.5, 95% CI = 1.1–5.8) and very high level of exposure (AHR = 4.5, 95% CI = 2.0–10.4), compared to those with low exposure. A test for exposure—response trend was statistically significant (Ptrend = 0.004). Future research on WTC dust exposure and PF would benefit from using data from multiple WTC Health Program responder cohorts for increased statistical power and clinically confirmed cases.

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Occupational Exposures and Subclinical Interstitial Lung Disease. The MESA (Multi-Ethnic Study of Atherosclerosis) Air and Lung Studies

Abstract: JEM-assigned and self-reported exposures to VGDF were associated with measurements of subclinical ILD in community-dwelling adults.

Cited by 51 publications

References 27 publications

Interstitial Lung Abnormalities: State of the Art

Interstitial Lung Abnormalities: State of the Art

Interstitial lung abnormalities – current knowledge and future directions

Pulmonary Fibrosis among World Trade Center Responders: Results from the WTC Health Registry Cohort

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