Evaluation of the patient for occupational immunologic lung disease

Careful evaluation of the worker patient is essential to detect occupational immunologic disease (OILD) and to define the source of the illness. The history is essential, especially in view of the temporal relationships between symptoms and exposure: the presence of variable latent periods between exposure and symptoms must be considered. Once OILD is suspected, additional evaluation is of value. Physical examination may be normal or may detect features of asthma or interstitial disease, depending on the stage of the illness. Chest x-ray evaluation may also reflect the type and stage of illness. Serologic studies may detect precipitating antibodies against environmental antigens. Skin tests with common antigens are useful in detecting an atopic background. Environmental studies may reveal particular antigens in the form of fungi, thermophilic actinomycetes, or chemicals that are volatile, soluble, or could be aerosolized. Pulmonary function studies before and after the work shift or after a period of avoidance may provide clues as to the environmental nature of the illness. Bronchopulmonary challenge with occupational environmental materials may be valuable in obtaining a definitive diagnosis. Therapy of OILD depends on the worker's response, degree of illness, and feasibility of avoidance of protection.