Occupational Interstitial Lung Diseases.

OBJECTIVE: Evidence-based diagnostic and treatment guidelines for occupationally related interstitial lung diseases (ILDs) have been developed and are summarized herein. METHODS: Comprehensive literature reviews were conducted with article abstraction, critiquing, objective grading, and evidence table compilation. A multidisciplinary expert panel drafted evidence- and consensus-based guidance. External peer-review was incorporated. RESULTS: Recommendations for diagnosis (n = 12) and management (n = 4) of ILD were developed. Spirometric testing, chest radiographs, and high-resolution computerized tomographic scans were recommended based upon evidence. In addition to a detailed clinical history, carbon monoxide diffusion capacity, sputum sampling, exposure assessment, 6-minute walk test, and bronchoalveolar lavage were also recommended. There was no recommendation regarding chest magnetic resonance imaging due to lack of evidence. CONCLUSIONS: Recommendations for diagnosis and management of ILD are supported by quality evidence. These guidelines may be useful to help guide providers who are tasked with diagnosing and/or treating patients with occupationally related ILD.

Work-Related Asthma.

OBJECTIVE: Summarize developed evidence-based diagnostic and treatment guidelines for work-related asthma (WRA). METHODS: Comprehensive literature reviews conducted with article critiquing and grading. Guidelines developed by a multidisciplinary expert panel and peer-reviewed. RESULTS: Evidence supports spirometric testing as an essential early test. Serial peak expiratory flow rates measurement is moderately recommended for employees diagnosed with asthma to establish work-relatedness. Bronchial provocation testing is moderately recommended. IgE and skin prick testing for specific high-molecular weight (HMW) antigens are highly recommended. IgG testing for HMW antigens, IgE testing for low-molecular weight antigens, and nitric oxide testing for diagnosis are not recommended. Removal from exposure is associated with the highest probability of improvement, but may not lead to complete recovery. CONCLUSION: Quality evidence supports these clinical practice recommendations. The guidelines may be useful to providers who diagnose and/or treat WRA.

Relationships between body mass indices and surgical replacements of knee and hip joints.

BACKGROUND: Osteoarthritis is both the most common form of arthritis and the most common reason for joint replacement surgery. Obese persons are believed to be more likely to develop generalized osteoarthritis that leads not only to knee but also to hip joint replacement surgeries. We hypothesized that obesity is also a risk for partial joint replacements and surgical revisions. METHODS: A frequency-matched case-control study was conducted in Utah. Between 1992 and 2000, 840 hip and 911 knee joint replacement surgery patients, aged 55 to 74 years, were included in this study. Cases were randomly matched to 5578 controls, defined as Utah residents enrolled in a cancer screening trial. Odds ratios (ORs) were calculated using ICD-9 (International Classification of Diseases, 9th revision) procedural codes and body mass index (BMI) groups. RESULTS: There was a strong association between increasing BMI and both total hip and knee replacement procedures. In males, the highest OR was for those weighing 37.50 to 39.99 kg/m(2) (total hip: OR=9.37, 95% confidence interval [CI] 2.64-33.31; total knee: OR=16.40; 95% CI 5, 19-51.86). In females, the highest OR was for those weighing > or =40 kg/m(2) (total hip: OR=4.47; 95% CI, 2.13-9.37; total knee: OR=19.05; 95% CI, 9.79-37.08). There were slight gender-specific differences in risk found for partial hip replacement procedures. Unexpectedly, no statistically significant association was found between obesity and the risk for hip or knee revision procedures. CONCLUSIONS: While there is an association between obesity and hip and knee joint replacement surgeries, obesity does not appear to confer an independent risk for hip or knee revision procedures.