Chronic disease in the workplace and the environment. Lung disease: lessons from the past--keys to the future

A rich experience has provided specific and sensitive methods for identifying adverse effects of environmental agents. Many classic lessons have come from occupational health. We must now decide how to apply these to the unsolved problems of the prevalent chronic pulmonary diseases: asthma, chronic bronchitis (with small airway obstruction or obliteration), emphysema, and fibrosis. Current and potential exposure problems which should be investigated include fiberglass and other fibers, welding, solvents, and pesticides. The dilemma of personal vs. societal action needs to be resolved. An integrated strategy could provide quick warnings and initiation of studies for precise answers. Such strategy consists of workplace surveillance and networking of morbidity reporting, combined with observations across time which are collected in tandem with measurements of exposure. Some pilot studies and experiments are needed to perfect such a systematic program.