Proportion of occupational progressive fibrosing interstitial lung disease in the tertiary hospitals of Thailand

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Chokan Rittidet
Naesinee Chaiear
Panaya Tumsatan
Pornanan Domthong
Warawut Sukkasem
Peter S. Burge


Idiopathic pulmonary fibrosis (IPF)-the prototypical progressive fibrosing interstitial lung diseases (PF-ILDs)-is associated with occupational exposure. Other unidentified PF-ILDs may also be work-related. This study aimed to evaluate the magnitude of occupational related causes in unknown aetiology PF-ILDs. We conducted a descriptive study with a sample of 112 patients in two tertiary hospitals in Khon Kaen, Thailand, between 2016 and 2020. Descriptive statistics were used to analyse the findings. The response rate was 26.8% (30/112). Demographic data and clinical information were reviewed from medical records. Telephone interviews were used to explore occupational histories. A multi-disciplinary team (MDT) was held to reach a consensus on the final diagnosis of 8 participants who had significant exposure per their respective interview. The result demonstrated that 16.7% (5/30) of respondents were possible occupational related PF-ILDs and the majority (3/5) were due to metal dust exposure. The result is inconsistent with the occupational burden related to the IPF but resembles the proportion of occupational ILDs in USA and Europe. Moreover, we found that only 23.7% (7/30) had occupational histories taken by their treating physician. Therefore, a multi-disciplinary approach with an occupational physician in the team was used to precisely diagnose occupational related unknown ILDs.


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[1] Olson A, Hartmann N, Patnaik P, Wallace L, Schlenker-Herceg R, Nasser M, et al. Estimation of the prevalence of progressive fibrosing interstitial lung diseases: systematic literature review and data from a physician survey. Adv Ther. 2021;38(2):854-867.
[2] Hoffmann-Vold AM, Fretheim H, Halse AK, Seip M, Bitter H, Wallenius M, et al. Tracking impact of interstitial lung disease in systemic sclerosis in a complete nationwide cohort. Am J Respir Crit Care Med. 2019;200(10):1258-1266.
[3] Park JH, Kim DS, Park IN, Jang SJ, Kitaichi M, Nicholson AG, et al. Prognosis of fibrotic interstitial pneumonia: idiopathic versus collagen vascular disease-related subtypes. Am J Respir Crit Care Med. 2007;175(7):705-711.
[4] Baumgartner KB, Samet JM, Coultas DB, Stidley CA, Hunt WC, Colby TV, et al. Occupational and environmental risk factors for idiopathic pulmonary fibrosis: a multicenter case-control study. Collaborating Centers. Am J Epidemiol. 2000;152(4):307-315.
[5] Hubbard R. Occupational dust exposure and the aetiology of cryptogenic fibrosing alveolitis. Eur Respir J Suppl. 2001;32:119s-121s.
[6] Hubbard R, Lewis S, Richards K, Johnston I, Britton J. Occupational exposure to metal or wood dust and aetiology of cryptogenic fibrosing alveolitis. Lancet. 1996;347(8997):284-289.
[7] Iwai K, Mori T, Yamada N, Yamaguchi M, Hosoda Y. Idiopathic pulmonary fibrosis. Epidemiologic approaches to occupational exposure. Am J Respir Crit Care Med. 1994;150(3):670-675.
[8] Scott J, Johnston I, Britton J. What causes cryptogenic fibrosing alveolitis? a case-control study of environmental exposure to dust. BMJ. 1990;301(6759):1015-1017.
[9] Reynolds C, Feary J, Cullinan P. Occupational contributions to interstitial lung disease. Clin Chest Med. 2020;41(4):697-707.
[10] Flaherty KR, King TE Jr, Raghu G, Lynch JP 3rd, Colby TV, Travis WD, et al. Idiopathic interstitial pneumonia: what is the effect of a multidisciplinary approach to diagnosis?. Am J Respir Crit Care Med. 2004;170(8):904-910.
[11] Jo HE, Glaspole IN, Levin KC, McCormack SR, Mahar AM, Cooper WA, et al. Clinical impact of the interstitial lung disease multidisciplinary service. Respirology. 2016;21(8):1438-1444.
[12] Furini F, Carnevale A, Casoni GL, Guerrini G, Cavagna L, Govoni M, et al. The role of the multidisciplinary evaluation of interstitial lung diseases: systematic literature review of the current evidence and future perspectives. Front Med (Lausanne). 2019;6:246.
[13] Coultas DB, Zumwalt RE, Black WC, Sobonya RE. The epidemiology of interstitial lung diseases. Am J Respir Crit Care Med. 1994;150(4):967-972.
[14] Duchemann B, Annesi-Maesano I, Jacobe de Naurois C, Sanyal S, Brillet PY, Brauner M, et al. Prevalence and incidence of interstitial lung diseases in a multi-ethnic county of Greater Paris. Eur Respir J. 2017;50(2): 1602419.
[15] Blanc PD, Annesi-Maesano I, Balmes JR, Cummings KJ, Fishwick D, Miedinger D, et al. The occupational burden of nonmalignant respiratory diseases. An Official American Thoracic Society and European Respiratory Society Statement. Am J Respir Crit Care Med. 2019;199(11):1312-1334.
[16] Assad N, Sood A, Campen MJ, Zychowski KE. Metal-Induced pulmonary fibrosis. Curr Environ Health Rep. 2018;5(4):486-498.
[17] Raghu G, Remy-Jardin M, Myers JL, Richeldi L, Ryerson CJ, Lederer DJ, et al. Diagnosis of idiopathic pulmonary fibrosis. An Official ATS/ERS/JRS/ALAT Clinical Practice Guideline. Am J Respir Crit Care Med. 2018;198(5):e44-68.
[18] Richardson C, Agrawal R, Lee J, Almagor O, Nelson R, Varga J, et al. Esophageal dilatation and interstitial lung disease in systemic sclerosis: a cross-sectional study. Semin Arthritis Rheum. 2016;46(1):109-114.
[19] Awadalla NJ, Hegazy A, Elmetwally RA, Wahby I. Occupational and environmental risk factors for idiopathic pulmonary fibrosis in Egypt: a multicenter case-control study. Int J Occup Environ Med. 2012;3(3):107-116.
[20] Koo JW, Myong JP, Yoon HK, Rhee CK, Kim Y, Kim JS, et al. Occupational exposure and idiopathic pulmonary fibrosis: a multicentre case-control study in Korea. Int J Tuberc Lung Dis. 2017;21(1):107-112.
[21] Miyake Y, Sasaki S, Yokoyama T, Chida K, Azuma A, Suda T, et al. Occupational and environmental factors and idiopathic pulmonary fibrosis in Japan. Ann Occup Hyg. 2005;49(3):259-265.
[22] Gotway MB, Golden JA, Warnock M, Koth LL, Webb R, Reddy GP, et al. Hard metal interstitial lung disease: high-resolution computed tomography appearance. J Thorac Imaging. 2002;17(4):314-318.
[23] Kim KI, Kim CW, Lee MK, Lee KS, Park CK, Choi SJ, et al. Imaging of occupational lung disease. Radiographics. 2001;21(6):1371-1391.
[24] Pranav PK, Biswas M. Mechanical intervention for reducing dust concentration in traditional rice mills. Ind Health. 2016;54(4):315-323.
[25] Sirajuddin A, Kanne JP. Occupational Lung Disease. J Thorac Imaging. 2009;24(4):310-320.
[26] Manotham M, Chaiear N, Yimtae K, Thammaroj T. Completeness of occupational history taking record for out-patients with potential work-related disorders at a university hospital in Northeast of Thailand. Srinagarind Med J. 2015;30(6):562-571.
[27] Politi BJ, Arena VC, Schwerha J, Sussman N. Occupational medical history taking: how are today's physicians doing? a cross-sectional investigation of the frequency of occupational history taking by physicians in a major US teaching center. J Occup Environ Med. 2004;46(6):550-555.
[28] Cimrin AH, Sevinc C, Kundak I, Ellidokuz H, Itil O. Attitudes of medical faculty physicians about taking occupational history. Med Educ. 1999;33(6):466-467.
[29] Ramsey PG, Curtis JR, Paauw DS, Carline JD, Wenrich MD. History-taking and preventive medicine skills among primary care physicians: an assessment using standardized patients. Am J Med. 1998;104(2):152-158.
[30] Schechter GP, Blank LL, Godwin HA Jr, LaCombe MA, Novack DH, Rosse WF. Refocusing on history-taking skills during internal medicine training. Am J Med. 1996;101(2):210-216.