Abstract

In this issue of the Southern Medical Journal, Modi et al¹ describe how working in a popcorn factory led to a devastating, irreversible lung disease: bronchiolitis obliterans.

Environmental and occupational insults causing respiratory disorders are often difficult to diagnose, because recognition requires a certain amount of detective work by the physician. Although a thorough environmental and occupational exposure is part of a complete patient history, it is often lost in today’s fast-paced medical visits. However, because the consequences of these potentially deadly exposures may not be obvious for years or even decades after the exposure, early detection and removal of the offending agent can be potentially life saving. Occupationally related injuries and illnesses have been estimated to affect upwards of 4.3 to 13.3 million Americans annually, with 5,800 to 63,000 job-related deaths and 862,200 work-related illness in 2004.^2,3 Unfortunately, the presentation of these work-related illnesses is often protean, mimicking or exacerbating common illnesses such as asthma. Furthermore, the disorder may develop slowly with no acute illness, and the patient may be unaware of the developing disease until it is too late. Thus, the only “clue” to a job-related etiology for a current acute illness, exacerbation of a preexisting illness, or risk for a future disease is the occupational and environmental exposure history.