Italian Society of Tobaccology (SITAB), Bologna, Italy.
Section of Occupational Medicine, Respiratory Diseases and Toxicology, University of Perugia, Perugia, Italy.
Lung. 2021 Feb;199(1):13-19. doi: 10.1007/s00408-020-00416-4. Epub 2021 Jan 11.
Tobacco worker's lung (TWL) is a type of hypersensitivity pneumonitis (HP) affecting workers exposed to tobacco leaves and molds in the humidified environment of the tobacco production industry. Limited epidemiological data point to a prevalence of TWL that is not negligible and probably underestimated. As in other types of HP, an acute vs. chronic presentation depends on the pattern of the exposure. Therefore, the clinical presentation can vary from an acute influenza-like syndrome, mostly self-limiting with the removal of the exposure, to an insidious onset of cough, exertional dyspnea, fatigue and weight loss in chronic presentations, where fibrotic changes may be observed. The main treatment strategy is the removal of the exposure to tobacco dust and molds, while the main aim of corticosteroid therapy is to reduce morbidity and prevent complications, namely the development of pulmonary fibrosis and permanent lung dysfunction. Despite the fact that TWL is quite well described, preventive measures are not usually adopted in the tobacco production industry. We present here a state of the art review of this neglected, preventable, but still prevalent and occupational-related subtype of HP.
烟草工人肺（TWL）是一种影响暴露于烟叶和霉菌的工人的过敏性肺炎（HP），这些工人处于烟草生产行业的潮湿环境中。有限的流行病学数据表明，TWL 的患病率不可忽视，而且可能被低估了。与其他类型的 HP 一样，急性与慢性表现取决于暴露模式。因此，临床表现可以从急性流感样综合征（主要是在接触去除后自行缓解）到慢性表现的隐匿性咳嗽、运动性呼吸困难、疲劳和体重减轻不等，在慢性表现中可能会观察到纤维化变化。主要的治疗策略是去除烟草粉尘和霉菌的暴露，而皮质类固醇治疗的主要目的是降低发病率和预防并发症，即肺纤维化和永久性肺功能障碍的发展。尽管 TWL 已经得到了很好的描述，但烟草生产行业通常不采取预防措施。我们在此介绍了这种被忽视的、可预防的、但仍普遍存在的与职业相关的 HP 亚类的最新研究进展。
