Occupational dust exposure and the aetiology of cryptogenic fibrosing alveolitis

Cryptogenic fibrosing alveolitis (CFA), synonymous with idiopathic pulmonary fibrosis, is probably a disease entity of increasing frequency. Epidemiological investigations into the aetiology of CFA are at an early age; yet there are several indications that exposures associated with traditionally male manufacturing occupations may be a cause of CFA. Specifically, metal exposure, and to a lesser extent wood dust exposure, was increased in patients with CFA and may explain some cases of CFA. Indeed, the four case-control studies in the literature, to date, have all found an identical occupational exposure to metal or working with metal as a risk factor for CFA and there is now further evidence confirming this association from a case-control study nested within an occupational cohort. There is also evidence from three of the case-control studies that working with wood may be a risk factor for CFA. However, these exposures clearly only explain a minority of cases of cryptogenic fibrosing alveolitis. Further studies amongst different populations with different occupational demographics are required to fully assess the impact of several exposures on the occurrence of cryptogenic fibrosing alveolitis.