Occupational lung disease

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Occupational lung diseases are work-related, lung conditions that have been caused or made worse by the materials a person is exposed to within the workplace. It includes a broad group of diseases, including occupational asthma, industrial bronchitis, chronic obstructive pulmonary disease (COPD), bronchiolitis obliterans, inhalation injury, interstitial lung diseases (such as pneumoconiosis, hypersensitivity pneumonitis, lung fibrosis), infections, lung cancer and mesothelioma. [1] [2] These diseases can be caused directly or due to immunological response to an exposure to a variety of dusts, chemicals, proteins or organisms.

Contents

Occupational cases of interstitial lung disease may be misdiagnosed as COPD, idiopathic pulmonary fibrosis, or a myriad of other diseases; leading to a delay in identification of the causative agent. [3] [4]

Types of occupational lung diseases

Asthma

Asthma is a respiratory disease that can begin or worsen due to exposure at work and is characterized by episodic narrowing of the respiratory tract. Occupational asthma has a variety of causes, including sensitization to a specific substance, causing an allergic response; or a reaction to an irritant that is inhaled in the workplace. Exposure to various substances can also worsen pre-existing asthma. People who work in isocyanate manufacturing, who use latex gloves, or who work in an indoor office environment are at higher risk for occupational asthma than the average US worker. Approximately 2 million people in the US have occupational asthma. [3]

Bronchiolitis obliterans

Bronchiolitis obliterans, also known as constrictive bronchiolitis or obliterative bronchiolitis is a respiratory disease caused by injury to the smallest airways, called bronchioles. It has been reported to occur from exposure to inhaled toxins and gases including sulfur mustard gas, nitrogen oxides, diacetyl (used in many food and beverage flavorings), 2,3-pentanedione, fly ash and fiberglass. [5]

COPD

Chronic obstructive pulmonary disease is a respiratory disease that can encompass chronic bronchitis and/or emphysema. 15% of the cases of COPD in the United States can be attributed to occupational exposure, including exposure to silica and coal dust. People who work in mining, construction, manufacturing (specifically textiles, rubber, plastic, and leather), building, and utilities are at higher risk for COPD than the average US worker. [3]

Hypersensitivity pneumonitis

Hypersensitivity pneumonitis (HP; also called allergic alveolitis, bagpipe lung, or extrinsic allergic alveolitis, EAA) is an inflammation of the alveoli within the lung caused by hypersensitivity to inhaled organic dusts. [6]

Lung cancer

Numerous categories of ionizing radiation, chemicals and mixtures, occupational exposures, metals, dust and fibers have been linked to occurrence of lung cancer. [7]

Mesothelioma

Mesothelioma is a cancer of the mesothelium, part of which is the pleura, the lining of the lungs. Mesothelioma is caused by exposure to asbestos. [3]

Pneumoconiosis

Pneumoconiosis are occupational lung diseases that are caused due to accumulation of dust in the lungs and body's reaction to its presence. Most common pneumoconiosis are silicosis, coal workers’ pneumoconiosis (CWP), and asbestosis. Other examples include minerals (such kaolin, talc, mica), beryllium lung disease, hard metal disease and silicon carbide pneumoconiosis. [8]

Smoke Inhalation

[9] Inhaling smoke and other byproducts of combustion can cause pulmonary injury. A third of all burn victims admitted to a hospital are affected by pulmonary injury from inhaling smoke and fatality from inhalation injuries is higher than burn injuries - mortality exceeds 50% for burn victims with severe burn and inhalation injury. Tissue oxygenation is significantly affected and thermal injury to the upper airways, lower airways, and lung parenchyma occurs.

Poor tissue oxygenation is a life-threatening conditions and results from inhaling carbon monoxide, cyanide, a gas mixtures devoid of  oxygen, or from an imbalance between alveolar ventilation and blood supply.

Carbon monoxide is a colorless and odorless gas, which can interfere with and impede respiration. Oxygen's tendency to bind with hemoglobin is 250 times less than carbon monoxide, severely reducing the quantity of circulating oxygen and limiting tissue oxygenation in carbon monoxide poisoning. Exposure can be deliberate (suicidal) or accidental and can come from automobile exhaust pipes, inhaling smoke during a fire accident, and poorly vented gas heaters, generators, and other appliances.[ citation needed ]

Cyanide is inhaled into the lungs in gaseous form – as hydrogen cyanide. Cyanide can also be diffused through the skin or ingested. Rapid infusion of high-dose cyanide cause cyanide poisoning. It is produced when nitroprusside is broken down into its constituents. It inhibits cells from properly utilizing oxygen by disrupting cytochrome oxidase, and can be more damaging to the brain and heart. [10]

Cyanide is a highly toxic chemical often used in industries and in laboratories. Finger nail glue remover products contain acetonitrile and its metabolic break down produces cyanide. In some plants such as in pits of apricots, cyanide can be found as glycosides can synthesize cyanide. Smoking cigarettes is a major avenue of exposure. [10]

Pulmonary Aspiration Syndromes

[9] Deglutition is the main cause for minute food and fluid to get aspirated into the lungs. Impaired consciousness and esophageal disorders can cause deglutition.

Acute Aspiration of Gastric Content (Mendelson Syndrome): pulmonary response to aspirated content depend on the quantity and constituent of aspirated gastric content. Chemical pneumonitis is severe if aspirated content is acidic and aspirated gastric acid – pH less than 2.5 – can inflame bronchial epithelium and cause bronchiolitis, hemorrhagen, and pulmonary edema.[ citation needed ]

Chronic Aspiration of Gastric Contents: disorders of the larynx and the esophagus are major causes of chronic aspiration of gastric content – achalasia, esophageal stricture, systemic sclerosis (scleroderma), esophageal carcinoma, esophagitis, and gastro-esophageal reflux. Pulmonary aspiration can result when the lower intestinal sphincter relax and spill out gastric content into the esophagus. [ citation needed ]

Smoking, consuming alcohol or caffeine, and the drug theophylline used in asthma patients are known to cause lower intestinal sphincter relaxation. Gastro-esophageal reflux and chronic aspiration are associated with few pulmonary disorders: asthma, chronic cough, bronchiectasis, and pulmonary fibrosis.[ citation needed ]

Difficulty swallowing, ageing, dental problems impeding proper chewing, consuming alcohol, and taking sedatives cause café coronary, obstruction of the upper airways by food particles. [ citation needed ]

Retaining an Aspirated Foreign Body: poor clearance of aspirated material out of the tracheobronchial tree can result in acute and chronic conditions including atelectasis, post obstructive hyperinflation, acute and recurrent pneumonia, bronchiectasis, and lung abscesses. Retained aspirated foreign body can sometimes get misdiagnosed as asthma, chronic obstructive pulmonary disease (COPD), or lung cancer[ citation needed ]

Aspirating an Inert Material: aspirating large inert material coupled with an impaired cough can cause asphyxia [ citation needed ]

Hydrocarbon Pneumonitis: secondary aspiration following vomiting ingested petroleum products – gasoline, kerosene, furniture polish, and other petroleum products used around home environment – can injure lungs and result in hydrocarbon pneumonitis[ citation needed ]

Lipoid Pneumonia: is a chronic disorder common among older people who have difficulty swallowing, with aspiration of oily material - mineral oil, cod liver oil, and oily nose drops - as its mains cause

Occupational environmental exposure

Arsenic

Arsenic is classified as an IARC Group 1 carcinogen and is a cause of lung cancer. Workers can be exposed to arsenic through work with some pesticides or in copper smelting. [3]

Asbestos

Asbestos is a mineral which was extensively used in the United States to fireproof buildings and textiles, among other items, in the 1950s-1980s. Workers are frequently exposed to asbestos during demolition and renovation work, which can cause asbestosis and/or mesothelioma. Asbestos exposure can also cause pleural effusion, diffuse pleural fibrosis, pleural plaques, and non-mesothelioma lung cancer. Smoking greatly increases the lung cancer risk of asbestos exposure. [3]

Residents and workers of asbestos mining centers such as the town of Asbest, Russia experience dangerous exposure to asbestos and asbestos dust. [11]

BCME

BCME (Bis(chloromethyl) ether) is associated with small cell lung cancer in workers who have been exposed. [3] [12] Exposure can occur via direct manufacture of BCME or its presence as a byproduct. [3]

Beryllium

Beryllium is classified as an IARC Group 1 carcinogen and can also cause interstitial lung disease. Manufacturing workers, dental technicians, machinists, jewelers, plumbers, electricians, precious metal reclamation workers, and welders are at risk for beryllium exposure. [3]

Cadmium

Cadmium is classified as an IARC Group 1 carcinogen and it is a cause of several cancers, including lung cancer. Workers can be exposed to cadmium through welding, zinc smelting, copper smelting, lead smelting, electroplating, battery manufacture, plastics manufacture, and in alloying. [3]

Chromium

Chromium is classified as an IARC Group 1 carcinogen and is linked to lung cancer. Workers can be exposed to chromium via welding, steel manufacturing, pigment/dye manufacturing, and electroplating. [3]

Coal dust

Exposure to coal dust is the cause of coalworker's pneumoconiosis, also called "black lung disease", is an interstitial lung disease caused by long-term exposure (over 10 years) to coal dust. Symptoms include shortness of breath and lowered pulmonary function. It can be fatal when advanced. Between 1970 and 1974, prevalence of CWP among US coal miners who had worked over 25 years was 32%; the same group saw a prevalence of 9% in 2005–2006. It can also exacerbate or cause COPD. [3]

Diesel exhaust

Diesel exhaust contains a variety of gaseous and particulate chemicals, including soot, polycyclic aromatic hydrocarbons, and other known carcinogens. [3]

Flock

Flocking is the technique of adding small pieces of nylon or other material to a backing, usually a textile, to create a contrasting texture. Inhalation of flock can cause flock worker's lung. [3]

Indium lung

Indium lung is an interstitial lung disease caused by occupational exposure to indium tin oxide. [4]

Nanoparticles

The high surface area to volume ratio of nanoparticles may make them an inhalation hazard for workers exposed to them. This is a topic of ongoing research as of 2015. [3]

Nickel

Nickel is classified by the IARC as a Group 1 carcinogen; nickel compound exposure is associated with nasal cancer as well as lung cancer. Workers may be exposed to nickel in machining/grinding industry, nickel extraction/production, welding, and electroplating. [3]

Polycyclic aromatic hydrocarbons

Polycyclic aromatic hydrocarbons (PAHs), fused-ring chemicals formed during the combustion of fossil fuels, are metabolized by the cytochrome P450 complex to highly reactive carbocations, which can mutate DNA and cause cancer. Workers may be exposed to PAHs while working in a foundry, in the roofing industry, or due to environmental tobacco smoke. [3]

Silica

Exposure to silica can cause Silicosis, which is a fibrosing interstitial lung disease caused by inhaling fine particles of silica, most commonly in the form of quartz or cristobalite. Short-term exposures of large amounts of silica or long-term (10 years or more) exposure of lower levels of silica can cause silicosis. In 1968, more than 1060 US workers died of silicosis; this number fell to 170 by 2005. [3]

Besides causing silicosis, inhalation of silica can cause or exacerbate COPD. It can also impair lung function in general and cause cancer by oxidation damage. It is classified as a "known human carcinogen" (Group 1 carcinogen) by the IARC. Exposure is common for people working in tunneling, quarrying, construction, sandblasting, roadway repair, mining, and foundry work. [3]

Silo-filler's disease

Silo-filler's disease (not to be confused with farmer's lung, associated with inhalation of biologic dusts) results from inhalation of nitrogen dioxide (NO2) gas from fresh silage. The presentation is variable depending on level of exposure. Often the gas penetrates throughout the lung and if severe can manifest as a form of acute respiratory distress syndrome, such as significant pulmonary edema, hyalinized alveolar membranes, congestion and other respiratory illnesses. [13] [14]

Tobacco smoke

Tobacco smoke is a known carcinogen. Workers in the hospitality industry may be exposed to tobacco smoke in the workplace, especially in environments like casinos and bars/restaurants. [3]

Infectious exposure

Influenza

Health care professionals are at risk of occupational influenza exposure; during a pandemic influenza, anyone in a close environment is at risk, including those in an office environment. [3]

Tuberculosis

Tuberculosis is a lung disease endemic in many parts of the world. Health care professionals and prison guards are at high risk for occupational exposure to tuberculosis, since they work with populations with high rates of the disease. [3]

Others

World Trade Center lung

World Trade Center lung is a cluster of diseases caused by exposure to fallout at Ground Zero of the September 11 attacks in 2001. These diseases include asthma, asthmatic bronchitis, terminal airways disease, sarcoidosis, and acute eosinophilic pneumonia. [4]

Examples

Related Research Articles

<span class="mw-page-title-main">Pneumoconiosis</span> Class of interstitial lung diseases

Pneumoconiosis is the general term for a class of interstitial lung disease where inhalation of dust has caused interstitial fibrosis. The three most common types are asbestosis, silicosis, and coal miner's lung. Pneumoconiosis often causes restrictive impairment, although diagnosable pneumoconiosis can occur without measurable impairment of lung function. Depending on extent and severity, it may cause death within months or years, or it may never produce symptoms. It is usually an occupational lung disease, typically from years of dust exposure during work in mining; textile milling; shipbuilding, ship repairing, and/or shipbreaking; sandblasting; industrial tasks; rock drilling ; or agriculture. It is one of the most common occupational diseases in the world.

<span class="mw-page-title-main">Asbestosis</span> Pneumoconiosis caused by inhalation and retention of asbestos fibers

Asbestosis is long-term inflammation and scarring of the lungs due to asbestos fibers. Symptoms may include shortness of breath, cough, wheezing, and chest tightness. Complications may include lung cancer, mesothelioma, and pulmonary heart disease.

<span class="mw-page-title-main">Silicosis</span> Pneumoconiosis caused by inhalation of silica, quartz or slate particles

Silicosis is a form of occupational lung disease caused by inhalation of crystalline silica dust. It is marked by inflammation and scarring in the form of nodular lesions in the upper lobes of the lungs. It is a type of pneumoconiosis. Silicosis is characterized by shortness of breath, cough, fever, and cyanosis. It may often be misdiagnosed as pulmonary edema, pneumonia, or tuberculosis. Using workplace controls, silicosis is almost always a preventable disease.

<span class="mw-page-title-main">Interstitial lung disease</span> Group of diseases

Interstitial lung disease (ILD), or diffuse parenchymal lung disease (DPLD), is a group of respiratory diseases affecting the interstitium of the lungs. It concerns alveolar epithelium, pulmonary capillary endothelium, basement membrane, and perivascular and perilymphatic tissues. It may occur when an injury to the lungs triggers an abnormal healing response. Ordinarily, the body generates just the right amount of tissue to repair damage, but in interstitial lung disease, the repair process is disrupted, and the tissue around the air sacs (alveoli) becomes scarred and thickened. This makes it more difficult for oxygen to pass into the bloodstream. The disease presents itself with the following symptoms: shortness of breath, nonproductive coughing, fatigue, and weight loss, which tend to develop slowly, over several months. The average rate of survival for someone with this disease is between three and five years. The term ILD is used to distinguish these diseases from obstructive airways diseases.

<span class="mw-page-title-main">Hypersensitivity pneumonitis</span> Medical condition

Hypersensitivity pneumonitis (HP) or extrinsic allergic alveolitis (EAA) is a syndrome caused by the repetitive inhalation of antigens from the environment in susceptible or sensitized people. Common antigens include molds, bacteria, bird droppings, bird feathers, agricultural dusts, bioaerosols and chemicals from paints or plastics. People affected by this type of lung inflammation (pneumonitis) are commonly exposed to the antigens by their occupations, hobbies, the environment and animals. The inhaled antigens produce a hypersensitivity immune reaction causing inflammation of the airspaces (alveoli) and small airways (bronchioles) within the lung. Hypersensitivity pneumonitis may eventually lead to interstitial lung disease.

<span class="mw-page-title-main">Byssinosis</span> Medical condition

Byssinosis is an occupational lung disease caused by inhalation of cotton or jute dust in inadequately ventilated working environments and can develop over time with repeated exposure. Byssinosis commonly occurs in textile workers who are employed in yarn and fabric manufacture industries. It is now thought that the cotton dust directly causes the disease and some believe that the causative agents are endotoxins that come from the cell walls of gram-negative bacteria that grow on the cotton. Although bacterial endotoxin is a likely cause, the absence of similar symptoms in workers in other industries exposed to endotoxins makes this uncertain. Current smokers are also at risk for developing byssinosis or having complications relating to byssinosis.

<span class="mw-page-title-main">Pneumonitis</span> General inflammation of lung tissue

Pneumonitis describes general inflammation of lung tissue. Possible causative agents include radiation therapy of the chest, exposure to medications used during chemo-therapy, the inhalation of debris, aspiration, herbicides or fluorocarbons and some systemic diseases. If unresolved, continued inflammation can result in irreparable damage such as pulmonary fibrosis.

Siderosis is the deposition of excess iron in body tissue. When used without qualification, it usually refers to an environmental disease of the lung, also known more specifically as pulmonary siderosis or Welder's disease, which is a form of pneumoconiosis.

<span class="mw-page-title-main">Black lung disease</span> Human disease caused by long-term exposure to coal dust

Black lung disease, also known as coal workers' pneumoconiosis (CWP) or simply black lung, is an occupational type of pneumoconiosis caused by long-term exposure to coal dust. It is common in coal miners and others who work with coal. It is similar to both silicosis from inhaling silica dust and asbestosis from inhaling asbestos dust. Inhaled coal dust progressively builds up in the lungs and leads to inflammation, fibrosis, and in worse cases, necrosis.

<span class="mw-page-title-main">Respiratory disease</span> Disease of the respiratory system

Respiratory diseases, or lung diseases, are pathological conditions affecting the organs and tissues that make gas exchange difficult in air-breathing animals. They include conditions of the respiratory tract including the trachea, bronchi, bronchioles, alveoli, pleurae, pleural cavity, the nerves and muscles of respiration. Respiratory diseases range from mild and self-limiting, such as the common cold, influenza, and pharyngitis to life-threatening diseases such as bacterial pneumonia, pulmonary embolism, tuberculosis, acute asthma, lung cancer, and severe acute respiratory syndromes, such as COVID-19. Respiratory diseases can be classified in many different ways, including by the organ or tissue involved, by the type and pattern of associated signs and symptoms, or by the cause of the disease.

<span class="mw-page-title-main">High-resolution computed tomography</span> Diagnostic imaging test

High-resolution computed tomography (HRCT) is a type of computed tomography (CT) with specific techniques to enhance image resolution. It is used in the diagnosis of various health problems, though most commonly for lung disease, by assessing the lung parenchyma. On the other hand, HRCT of the temporal bone is used to diagnose various middle ear diseases such as otitis media, cholesteatoma, and evaluations after ear operations.

Occupational asthma is new onset asthma or the recurrence of previously quiescent asthma directly caused by exposure to an agent at workplace. It is an occupational lung disease and a type of work-related asthma. Agents that can induce occupational asthma can be grouped into sensitizers and irritants.

<span class="mw-page-title-main">Obstructive lung disease</span> Category of respiratory disease characterized by airway obstruction

Obstructive lung disease is a category of respiratory disease characterized by airway obstruction. Many obstructive diseases of the lung result from narrowing (obstruction) of the smaller bronchi and larger bronchioles, often because of excessive contraction of the smooth muscle itself. It is generally characterized by inflamed and easily collapsible airways, obstruction to airflow, problems exhaling, and frequent medical clinic visits and hospitalizations. Types of obstructive lung disease include; asthma, bronchiectasis, bronchitis and chronic obstructive pulmonary disease (COPD). Although COPD shares similar characteristics with all other obstructive lung diseases, such as the signs of coughing and wheezing, they are distinct conditions in terms of disease onset, frequency of symptoms, and reversibility of airway obstruction. Cystic fibrosis is also sometimes included in obstructive pulmonary disease.

Restrictive lung diseases are a category of extrapulmonary, pleural, or parenchymal respiratory diseases that restrict lung expansion, resulting in a decreased lung volume, an increased work of breathing, and inadequate ventilation and/or oxygenation. Pulmonary function test demonstrates a decrease in the forced vital capacity.

<span class="mw-page-title-main">Asbestos-related diseases</span> Medical condition

Asbestos-related diseases are disorders of the lung and pleura caused by the inhalation of asbestos fibres. Asbestos-related diseases include non-malignant disorders such as asbestosis, diffuse pleural thickening, pleural plaques, pleural effusion, rounded atelectasis and malignancies such as lung cancer and malignant mesothelioma.

<span class="mw-page-title-main">Flock worker's lung</span> Occupational disease

Flock worker's lung is an occupational lung disease caused by exposure to flock, small fibers that are glued to a backing in order to create a specific texture. People who work in flocking are at risk of inhaling small pieces of the flock fibers, which causes interstitial lung disease. The disease was initially described in 1998, when a group of workers at a flocking plant developed interstitial lung disease of unknown cause.

<span class="mw-page-title-main">Emphysema</span> Medical condition

Emphysema, or pulmonary emphysema, is a lower respiratory tract disease, characterised by air-filled spaces (pneumatoses) in the lungs, that can vary in size and may be very large. The spaces are caused by the breakdown of the walls of the alveoli and they replace the spongy lung parenchyma. This reduces the total alveolar surface available for gas exchange leading to a reduction in oxygen supply for the blood. Emphysema usually affects the middle aged or older population because it takes time to develop with the effects of tobacco smoking, and other risk factors. Alpha-1 antitrypsin deficiency is a genetic risk factor that may lead to the condition presenting earlier.

<span class="mw-page-title-main">Occupational dust exposure</span>

Occupational dust exposure can occur in various settings, including agriculture, forestry, and mining. Dust hazards include those that arise from handling grain and cotton, as well as from mining coal. Wood dust, commonly referred to as "sawdust", is another occupational dust hazard that can pose a risk to workers' health.

Occupational hazards of fire debris cleanup are the hazards to health and safety of the personnel tasked with clearing the area of debris and combustion products after a conflagration. Once extinguished, fire debris cleanup poses several safety and health risks for workers. Employers responsible for fire debris cleanup and other work in areas damaged or destroyed by fire are generally obliged by occupational safety and health legislation of the relevant national or regional authority to identify and evaluate hazards, correct any unsafe or unhealthy conditions and provide any necessary training and instruction and personal protective equipment to employees to enable them to carry out the task without undue exposure to hazards. Many of the approaches to control risk in occupational settings can be applied to preventing injuries and disease. This type of work can be completed by general construction firms who may not be fully trained specifically for fire safety and on fire hazards.

References

  1. ↑ Beckett, W. S. (2000-02-10). "Occupational respiratory diseases". The New England Journal of Medicine. 342 (6): 406–413. doi:10.1056/NEJM200002103420607. ISSN   0028-4793. PMID   10666432.
  2. ↑ Cullinan, Paul; Muñoz, Xavier; Suojalehto, Hille; Agius, Raymond; Jindal, Surinder; Sigsgaard, Torben; Blomberg, Anders; Charpin, Denis; Annesi-Maesano, Isabella (May 2017). "Occupational lung diseases: from old and novel exposures to effective preventive strategies". The Lancet. Respiratory Medicine. 5 (5): 445–455. doi:10.1016/S2213-2600(16)30424-6. hdl: 10044/1/65052 . ISSN   2213-2619. PMID   28089118.
  3. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 "Respiratory Diseases: Occupational Risks". National Institute for Occupational Safety and Health. 21 December 2012. Retrieved 23 March 2015.
  4. 1 2 3 Sauler, Maor; Gulati, Mridu (December 2012). "Newly recognized occupational and environmental causes of chronic terminal airways and parenchymal lung disease". Clinics in Chest Medicine. 33 (4): 667–680. doi:10.1016/j.ccm.2012.09.002. PMC   3515663 . PMID   23153608.
  5. ↑ Barker, Alan F.; Bergeron, Anne; Rom, William N.; Hertz, Marshall I. (2014). "Obliterative Bronchiolitis". New England Journal of Medicine. 370 (19): 1820–1828. doi:10.1056/nejmra1204664. PMID   24806161.
  6. ↑ Selman, Moisés; Pardo, Annie; King, Talmadge E. (2012-12-14). "Hypersensitivity Pneumonitis". American Journal of Respiratory and Critical Care Medicine. 186 (4): 314–324. doi:10.1164/rccm.201203-0513ci. PMID   22679012.
  7. ↑ Field, R. William; Withers, Brian L. (2012). "Occupational and Environmental Causes of Lung Cancer". Clinics in Chest Medicine. 33 (4): 681–703. doi:10.1016/j.ccm.2012.07.001. PMC   3875302 . PMID   23153609.
  8. ↑ Murray & Nadel's textbook of respiratory medicine. Elsevier Saunders. 2016. pp. 1307–1330. ISBN   978-1-4557-3383-5.
  9. 1 2 "Medically Sound: Working on the Loom, Smelting Iron, Hoarding Produce, Digging Coal, Making a Pop Corn – While on the Job…". Medically Sound. 2020-10-03. Retrieved 2020-11-01.
  10. 1 2 "CDC | Facts About Cyanide". emergency.cdc.gov. 2019-05-15. Retrieved 2022-04-01.
  11. ↑ Higgins, Andrew (7 April 2019). "In Asbest, Russia, Making Asbestos Great Again". The New York Times. Retrieved 13 April 2019.
  12. ↑ "Bis(chloromethyl)ether (BCME) (CASRN 542-88-1)". IRIS (Integrated Risk Information System). EPA. 31 October 2014. Retrieved 31 March 2015.
  13. ↑ Chan-Yeung M, Ashley MJ, Grzybowski S (1978). "Grain dust and the lungs". Can Med Assoc J. 118 (10): 1271–4. PMC   1818652 . PMID   348288.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  14. ↑ Gurney JW; et al. (Jul 1991). "Agricultural disorders of the lung". Radiographics. 11 (4): 625–34. doi: 10.1148/radiographics.11.4.1887117 . PMID   1887117.
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