Occupational and environmental exposures play major roles in causing many forms of respiratory disease. All humans are exposed to potential occupational or environmental toxins such as indoor or ambient air pollutants or unique respiratory toxins occurring in the workplace. No longer are occupational toxin exposures limited to blue-collar jobs in heavy industries such as mining and manufacturing; significant hazards exist in modem industries and office environments. The disorders resulting from these exposures are diverse in nature, ranging from acute lung injury from toxic gas inhalation to subtle effects of environmental pollutants upon persons with asthma. All aspects of the respiratory system, from the nose to the alveoli, can be affected by inhaled environmental agents; therefore this book seeks to address the full range of respiratory effects of environmental exposures. The respiratory system does not distinguish whether an inhaled agent came from a workplace or a community (nonoccupational) source. For this reason, a unitary approach, jointly considering occupational and environmental respiratory disease, is employed in this book. However, exposure assessment methods and control strategies often differ between workplace and community environments; these differences are discussed. There are many perspectives and approaches to understanding occupational and environmental respiratory diseases. These include clinical approaches, focused upon the diagnosis and treatment of disease in an individual patient; environmental monitoring perspectives, emphasizing evaluation of the potential exposures; epidemiologic assessment, evaluating patterns of health and disease in groups of persons; biologic considerations of the mechanisms by which environmental agents produce disease; and public policy aspects, emphasizing control by regulation and law. This book is predicated on the belief that approaches to understanding respiratory disease are intertwined, and all must be integrated to prevent and manage such disorders. There is also a strong emphasis on the relationship between disease and exposure, recognizing that disease prevention is directly related to controlling exposure. However, discussion of fundamental biologically oriented research, without direct clinical or public health implications, has been deemphasized. These topics are covered in more detail in other texts.
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