Department of Medicine, Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN.
Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington Medical Center, Seattle, WA.
Chest. 2021 Jul;160(1):219-230. doi: 10.1016/j.chest.2021.02.021. Epub 2021 Feb 18.
A relationship between inhalational exposure to materials in the environment and development of interstitial lung disease (ILD) is long recognized. Hypersensitivity pneumonitis is an environmentally -induced diffuse parenchymal lung disease. In addition to hypersensitivity pneumonitis, domestic and occupational exposures have been shown to influence onset and progression of other ILDs, including idiopathic interstitial pneumonias such as idiopathic pulmonary fibrosis. A key component of the clinical evaluation of patients presenting with ILD includes elucidation of a complete exposure history, which may influence diagnostic classification of the ILD as well as its management. Currently, there is no standardized approach to environmental evaluation or remediation of potentially harmful exposures in home or workplace environments for patients with ILD. This review discusses evidence for environmental contributions to ILD pathogenesis and draws on asthma and occupational medicine literature to frame the potential utility of a professional evaluation for environmental factors contributing to the development and progression of ILD. Although several reports suggest benefits of environmental assessment for those with asthma or certain occupational exposures, lack of information about benefits in broader populations may limit application. Determining the feasibility, long-term outcomes, and cost-effectiveness of environmental evaluation and remediation in acute and chronic ILDs should be a focus of future research.
吸入环境物质与间质性肺疾病（ILD）之间的关系早已得到认可。过敏性肺炎是一种由环境引起的弥漫性实质性肺疾病。除了过敏性肺炎外，还已经证明家庭和职业暴露会影响其他 ILD 的发病和进展，包括特发性间质性肺炎，如特发性肺纤维化。对出现 ILD 的患者进行临床评估的一个关键组成部分包括阐明完整的暴露史，这可能会影响 ILD 的诊断分类及其治疗。目前，对于 ILD 患者的家庭或工作场所环境中的潜在有害暴露，尚无标准化的环境评估或修复方法。本文讨论了环境因素对 ILD 发病机制的影响，并借鉴哮喘和职业医学文献来阐述对环境因素进行专业评估对 ILD 发展和进展的潜在作用。尽管有几项报告表明对哮喘或某些职业暴露患者进行环境评估有益，但关于更广泛人群中获益的信息不足可能会限制其应用。确定急性和慢性 ILD 中环境评估和修复的可行性、长期结果和成本效益应成为未来研究的重点。
