Occupation, avocation, and interstitial lung disease

Interstitial lung disease (ILD) may be caused by a large number of agents encountered in the workplace or in the home or recreational environment. These exposures account for up to 20% of all ILDs and the disease they cause is preventable and in some cases treatable. Diagnosing these illnesses is challenging and misdiagnosis is common. However, making a correct diagnosis is crucial for several reasons including the possibility of disease prevention in other individuals sharing the exposure, the possibility of effective treatment in some cases and because of the different prognosis when compared with idiopathic ILD. The key to making these diagnoses is suspecting an exposure-related ILD and then taking a complete occupational and environmental history. This article reviews the diagnostic approach to this challenging group of illnesses. It reviews the clues to the diagnosis and attribution found on history, pulmonary function testing, imaging, and pathology. It also discusses how to proceed from knowledge of exposure to attribution, including the role of surgical lung biopsy and finally briefly reviews treatment.