Impact of occupational exposures in patients with chronic obstructive pulmonary disease: current understanding and knowledge gaps

Purpose of reviewChronic obstructive pulmonary disease (COPD) is thought of as a disease caused by tobacco exposure, but numerous occupational exposures have been identified as risk factors for development of disease and exacerbations, although these remain underappreciated and underdiagnosed. We highlight evidence of occupational exposures and how they relate to COPD, while also looking at gaps in how the changing workplace might affect the occupational COPD landscape.Recent findingsHistorical exposures linked to COPD included inorganic dusts like coal and silica and organic dusts like cotton and wood. Other data associated agricultural exposures, cleaning agents, air pollution, and construction work with COPD. As the workplace has evolved to include more work from home and growing industries like ridesharing and delivery, items like radon and indoor and outdoor air quality must be factored into the equation as occupational exposures with the potential to cause COPD and increase its morbidity. Despite this, causal conclusions with many risk factors are challenging due to the complex interaction between patient susceptibilities and environmental factors, both occupation-related and nonoccupation related.SummaryAdditional studies are needed, not only to better evaluate occupational exposures and COPD pathogenesis, but also to look at more solution-oriented areas like precision medicine and interventions targeting a healthier workplace.