New opportunities to prevent occupational lung diseases require the discovery of new occupational lung diseases, new settings for recognised occupational lung diseases, and new approaches to their prevention. Reviewing the last decade’s discoveries, we can learn how to recognise new prevention opportunities involving emerging occupational lung diseases. Since 1996, some examples of newly recognised occupational lung disease include flock workers’ lung,¹ hypersensitivity pneumonitis associated with biocontaminated synthetic metal working fluids,² severe acute respiratory syndrome (SARS), asthma associated with 3-amino-5-mercapto-1,2,4-triazole (AMT) in herbicide manufacture;³ and bronchiolitis obliterans from flavouring chemicals.⁴ If the past is paradigm, approaches to recognition and prevention can proceed without knowing how to measure causal agents and without regulating them.

Astute clinicians can play a vital role in suspecting an emerging occupational cause when they diagnose a rare disease or a cluster of more common or severe disease. For example, Dr David Kern recognised that the occurrence of interstitial lung disease in two young men from the same small nylon flock plant indicated a likely risk for other employees.¹ Similarly, Dr Alan Parmet reviewed medical records compiled by a lawyer for eight former microwave popcorn plant workers with bronchiolitis obliterans.⁴ Half of these cases were on lung transplant lists—hardly to be expected in a young worker group from one small plant—and he reported the cases to public health authorities. In automotive plants with clusters of hypersensitivity pneumonitis, labour unions pressed for investigations of work-related aetiology across the industry. At a plant in Massachusetts, herbicide workers and …