Expanding the spectrum of particle-and fiber-associated interstitial lung diseases
While interstitial lung disease (ILD) is common, less than five percent of diagnoses appear to be related to occupational and environmental exposures to particles and fibers; these injuries are most frequently recognized as pneumoconioses and hypersensitivity pneumonitides. As a result of this small contribution to recognized ILD, the association of particles and fibers with this group of diseases is frequently deemed of little consequence. However, it has been proposed that some portion of ILD without a recognized cause (i.e. idiopathic disease) can also be related to exposures to particles and fibers. Many of these diagnoses are determined without benefit of microscopic examination of lung tissue. Even when tissue is available, the conventional examination for the presence of particles and fibers is used. This approach employing optical microscopy is insensitive and leads to misdiagnosis. A review of previous investigation demonstrates associations of idiopathic pulmonary fibrosis, desquamative interstitial pneumonia, pulmonary alveolar proteinosis, sarcoidosis, and eosinophilic granuloma with particle and fiber exposures. It is recommended that scanning electron microscopy in combination with the use of electron dispersive X-ray analysis be employed whenever the question of a possible relationship between ILD and particle and fiber exposure arises. © 2014 by Turkish Thoracic Society.
