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Airborne occupational exposures associated with pulmonary sarcoidosis: a systematic review and meta-analysis
  1. Christopher C Huntley1,2,
  2. Ketan Patel1,3,
  3. Aishah Z Mughal4,
  4. Shirley Coelho5,
  5. P Sherwood Burge2,
  6. Alice M Turner1,3,
  7. Gareth I Walters1,2
  1. 1 Institute of Applied Health Research, University of Birmingham, Birmingham, UK
  2. 2 Occupational and Interstitial Lung Disease Services, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
  3. 3 University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
  4. 4 University of Birmingham Medical School, Birmingham, UK
  5. 5 Wye Valley NHS Trust, Hereford, UK
  1. Correspondence to Dr Christopher C Huntley, University of Birmingham Institute of Applied Health Research, Birmingham, UK; C.C.Huntley{at}


The aetiology and pathophysiology of sarcoidosis is ill defined—current hypotheses centre on complex genetic–immune–environmental interactions in an individual, triggering a granulomatous process. The aim of this systematic review is to define and describe which airborne occupational exposures (aOE) are associated with and precede a diagnosis of pulmonary sarcoidosis. The methodology adopted for the purpose was systematic review and meta-analyses of ORs for specified aOE associated with pulmonary sarcoidosis (DerSimonian Laird random effects model (pooled log estimate of OR)). Standard search terms and dual review at each stage occurred. A compendium of aOE associated with pulmonary sarcoidosis was assembled, including mineralogical studies of sarcoidosis granulomas. N=81 aOE were associated with pulmonary sarcoidosis across all study designs. Occupational silica, pesticide and mould or mildew exposures were associated with increased odds of pulmonary sarcoidosis. Occupational nickel and aluminium exposure were associated with a non-statistically significant increase in the odds of pulmonary sarcoidosis. Silica exposure associated with pulmonary sarcoidosis was reported most frequently in the compendium (n=33 studies) and was the most common mineral identified in granulomas. It was concluded that aOE to silica, pesticides and mould or mildew are associated with increased odds of pulmonary sarcoidosis. Equipoise remains concerning the association and relationship of metal dusts with pulmonary sarcoidosis.

  • Lung Diseases, Interstitial
  • Meta-analysis
  • Environmental Exposure
  • Pesticides
  • Dust

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  • Contributors CCH designed and led this study and was involved with every stage including performing database searches, abstract and full text review, data extraction, data analysis, data validation and manuscript writing and preparation. KP was second reviewer for abstract screening and full-text review. AZM was second reviewer for full text review. SC was second reviewer for full text review and data extraction. PSB was a co-supervisor of this project. AMT was second reviewer for full text review and data extraction and cosupervisor of this project. GIW was the primary supervisor for this project and validated data extracted. All authors have had the opportunity to review, edit and revise draft manuscripts and agree on the final version submitted.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.