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Overview of Environmental Lung Diseases

By

Abigail R. Lara

, MD, University of Colorado

Last full review/revision May 2020| Content last modified May 2020
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Environmental lung diseases are caused by harmful particles, mists, vapors, or gases that are inhaled, usually while people work. If the lung disease is due to inhaled particles, the term pneumoconiosis is often used.

Where within the airways or lungs an inhaled substance ends up and what type of lung disease develops depend on the size and kind of particles inhaled. Large particles may get trapped in the nose or large airways, but very small ones may reach the lungs. There, some particles dissolve and may be absorbed into the bloodstream. Most solid particles that do not dissolve are removed by the body’s defenses.

The body has several means of getting rid of inhaled particles (see also Defense Mechanisms of the Respiratory System). In the airways, an accumulation of secretions (mucus) coats particles so that they can be coughed up more easily. Additionally, cells lining the airways have tiny filaments called cilia that stick out into the airways, and these filaments can brush inhaled particles upward, out of the lungs. In the small air sacs of the lungs (alveoli), special scavenger cells (macrophages) engulf most particles and render them harmless.

Many different kinds of particles can harm the lungs. Some are organic, meaning that they are made of materials that contain carbon and are part of living organisms (such as grain dusts, cotton dust, or animal dander). Some are inorganic, meaning that they usually come from nonliving sources, such as metals or minerals (for example, asbestos or silica).

Risk of environmental lung disease

Different types of particles produce different reactions in the body. Some particles—animal dander, for example—can cause allergic reactions, such as hay fever–like symptoms or a type of asthma. Other particles cause harm not by triggering allergic reactions but by being toxic to the cells of the airways and air sacs in the lung. Some particles, such as quartz dust and asbestos, may cause chronic irritation that can lead to scarring of lung tissue (pulmonary fibrosis). Certain toxic particles, such as asbestos, can cause lung cancer, especially in people who smoke, or cancer of the lining of the chest and lung (mesothelioma), regardless of the person’s smoking history.

The specific type of environmental lung disease depends on the environment to which the person is exposed:

In people who already have lung diseases such as chronic obstructive pulmonary disease or asthma, exposure to substances in the environment may cause worsening symptoms even if the substance itself does not cause lung disease.

Table
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Workers at Risk of Environmental Lung Disease

Disease

Affected Workers

Construction workers and home remodelers who install or remove materials (including insulation) that contain asbestos

Shipyard workers

Workers who mine, mill, or manufacture asbestos

Pneumoconiosis

Barium workers

Iron miners

Tin workers

Welders

Aerospace workers

Metallurgical (castings) workers

Bronchiolitis obliterans

Flavorings workers (popcorn workers’ lung)

Military personnel deployed to Iraq or Afghanistan

Cotton, hemp, jute, and flax workers

Coal workers

Graphite workers

Office workers when the air-conditioning systems become contaminated by certain fungi and bacteria

Swimming pool and spa workers (because of contaminated sprays)

Farmers, mushroom workers, milling and construction workers, bird keepers, people exposed to isocyanates (urethanes)

People who work with grains, western red cedar wood, castor beans, isocyanates (urethanes), dyes, antibiotics, epoxy resins, tea, and enzymes used in manufacturing detergent, malt, leather goods, latex, jewelry, abrasives and paints used in automobile body repairs, animals, shellfish, irritating gases, vapors, and mists

Military personnel deployed to Iraq or Afghanistan

Certain coal miners (for example, those who drill or blast rock)

Foundry workers

Lead, copper, silver, and gold miners

Potters

Sandblasters

Sandstone or granite cutters

Tombstone makers

Tunnel workers

Workers who make abrasive soaps

Workers who fabricate or install countertops manufactured from engineered silicates

Silo filler’s disease

Farmers

Symptoms

Environmental lung diseases tend to cause symptoms similar to those of many other lung disorders, such as difficulty breathing and sometimes cough or chest pain. For some disorders (for example, coal workers’ pneumoconiosis), the symptoms may not occur immediately and may develop over months to years. Environmental lung diseases that make the lungs and airways narrow when a person breathes air that contains irritants and other substances (called airway hyperreactivity) may cause difficulty breathing that is sudden, wheezing, and, in people who have asthma or COPD, attacks (exacerbations) of those disorders.

Environmental lung disorders that cause repeated, chronic problems increase the risk of developing chronic lung disorders (such as COPD or interstitial lung disorders) and permanently decreasing lung function. Some environmental lung disorders cause other symptoms and complications.

Diagnosis

  • Lung function tests

  • Imaging

Specific diagnostic tools are used to identify environmental lung diseases. As the initial step in the evaluation, the doctor asks about jobs and other activities that may be associated with exposure to lung irritants. Tests of lung function and imaging tests such as chest x-rays and computed tomography (CT) are used in most cases.

Prevention

Prevention of occupational and environmental lung diseases, particularly in the workplace, include steps to limit exposure, including

  • Administrative controls, such as limiting the number of people exposed

  • Engineering controls, such as use of ventilation systems, enclosures, and safe clean-up procedures

  • Product substitution, such as use of safer materials

  • Protective devices, such as use of respirators, dust masks, and other equipment

  • Educational controls, such as teaching workers about risks and how to limit exposure

Respirators and other measures do provide some protection; however, protection may not be complete and the protection varies from person to person. Respirators need to be checked once per year to ensure proper fit. Also, not all people can easily use protective measures. For example, respirators may limit the ability of people with heart or lung disorders to carry out job functions.

Doctors encourage people who may be exposed to substances that can damage the lungs to be screened regularly so that disorders can be identified as early as possible. Specific screening tests and the frequency of the screening depend on the substances to which the person is exposed. Screening can include medical examinations and measuring the person's breathing using spirometry and measuring the amount of oxygen in the blood. Imaging of the lungs using chest x-rays or computed tomography (CT) may also be done.

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