Immunology of occupational lung diseases caused by dust: an overview

The lungs are exposed to numerous injurious substances.Such injury may be the result of immunological or non-immunological mechanisms. The lung clears itself of inhaled particles by means of ciliated cells lining the airways and the macrophages.The latter play an important role in the immune process as well.Inorganic particles are ingested by macrophages and if found inert are transported for eventual expulsion.Particles such as silica are poorly handled by macrophages, they not only damage the macrophages but also impair their function. Others, such as asbestos, may stimulate fibrosis. Endogenous factors such as the presence of auto-antibodies (rheumatoid factor or anti-nuclear factor) alter the response of the host to inhaled particles.The pathological changes caused by handling inorganic dusts include intestitial fibrosis, nodular fibrosis or macule formation leading to emphysema.Occupational asthma a occurs when individuals are exposed to dusts during the course of their work. The lung responds differently to organic dust. T cells and complement are important elements in handling organic dust.The role of inhaled steroids which have no significant systemic effects in the prevention of certain occupational asthmas is worth evaluating, apart from control measures which minimise the exposure