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M. Diane Lougheed, MD; Scott E. Turcotte, MSc; Alex Chee, MD, FCCP; Ronald Walsh, MD; F. Curry Grant, MD; Gary M. Liss, MD; Alexander H. Boag, MD; Lutz Forkert, MD
Author and Funding Information

From Queen’s University (Drs Lougheed, Chee, Grant, Boag, and Forkert and Mr Turcotte); Kingston General Hospital (Drs Lougheed, Chee, and Forkert and Mr Turcotte); Walsh & Associates Occupational Health Services, Ltd (Dr Walsh); Gage Occupational and Environmental Health Unit (Dr Liss), Dalla Lana School of Public Health, University of Toronto; and the University of Calgary (Dr Chee).

Correspondence to: M. Diane Lougheed, MD, 102 Stuart St, Kingston, ON, K7L2V6, Canada; e-mail: mdl@queensu.ca


Financial/nonfinancial disclosures: The authors have reported to CHEST the following conflicts of interest: Dr Lougheed’s research has been funded by Queen’s University (William M. Spear Endowment/Start Memorial Fund), the Government of Ontario (Asthma Plan of Action), AllerGen Network for Centres of Excellence, the Ontario Lung Association/Ontario Thoracic Society, Canadian Institutes of Health Research, and the Canadian Cystic Fibrosis Foundation. Pharmaxis Ltd has provided dry powder mannitol (Aridol) for research funded by Queen’s University and the Ontario Lung Association. Dr Lougheed has been a site investigator for multicenter clinical trials funded by Ception Therapeutics Inc (now Cephalon); MedImmune, LLC; MPEX Pharmaceuticals, Inc; and GlaxoSmithKline, Inc. Mr Turcotte received an Ontario Graduate Scholarship and a Canadian Institutes of Health Research Master’s Award A: Frederick Banting and Charles Best Canada Graduate Scholarship. Dr Walsh is president and chief executive officer of Walsh & Associates Occupational Health Services, Ltd. He was the lead occupational physician of the surveillance program developed in collaboration with employees, plant management, and a joint health and safety committee. The project was funded by the flocking company. Dr Grant provided epidemiologic support by preparing the statistical reports for the Healthy Lungs Program in collaboration with Walsh & Associates Occupational Health Services, Ltd. Dr Liss reports his research has been funded by the AllerGen Network for Centres of Excellence and the Research Advisory Council of the Workplace Safety and Insurance Board of Ontario. The remaining authors have reported no conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;145(1):186-187. doi:10.1378/chest.13-2229
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Published online
To the Editor:

Dr Kern and colleagues provided a critique of our recent publication in CHEST1 on the natural history of the index Canadian cases of interstitial lung disease in nylon flock workers. We agree our article highlights the importance of eliciting a comprehensive occupational history in individuals with diffuse interstitial lung disease and the potential for both severe and progressive pulmonary fibrosis in flock worker’s lung (FWL), which may not have been fully appreciated to date. We also agree that the lack of lung cancer cases in this cohort should not be interpreted to reflect no or low risk, and workers should be notified of this potential risk.

However, to dismiss our publication as “incomplete, poorly defined and uninterpretable” is unsubstantiated. Performance of spirometry according to American Thoracic Society standards on different spirometers should not diminish the accuracy of the raw values used in our analysis. We maintain that workers should be screened for excessive decline in FEV1. It is our understanding that rotary cutters were still in use during the decade in question. Measurement of respirable, nylon fiber-shaped fragments was undertaken by Black and Veatch Special Projects Corporation using a modified National Institute of Occupational Safety and Health 7400 protocol as part of ongoing work to validate a sampling and analytical technique to estimate exposure. We had access to, but did not publish, these data, given concerns regarding the experimental nature of this sampling method and, hence, uncertainty regarding its validity. While our original postulate of the “potential role of mycotoxins”2 proved not to be the case, lack of a definitive known cause should not deter clinicians from publishing case reports or case series. As a point of clarification, desquamative interstitial pneumonitis-like reactions are part of the spectrum of pathologic features of FWL noted by expert pathologists.3,4

We applaud CHEST for recognizing the scientific merit of our study. We sincerely hope that description of the clinical course of our index cases over time (particularly the two individuals described in our report who were instrumental in our recognition of the local cluster and whose lives were devastated and shortened by this occupational lung disease) and our efforts to collate and interpret the available longitudinal surveillance data on workers have contributed more than a little to our understanding of FWL, as well as the importance of scholarship, communication, collaboration, and patient advocacy.

References

Turcotte SE, Chee A, Walsh R, et al. Flock worker’s lung disease: natural history of cases and exposed workers in Kingston, Ontario. Chest. 2013;143(6):1642-1648. [CrossRef] [PubMed]
 
Lougheed MD, Roos JO, Waddell WR, Munt PW. Desquamative interstitial pneumonitis and diffuse alveolar damage in textile workers: potential role of mycotoxins. Chest. 1995;108(5):1196-1200. [CrossRef] [PubMed]
 
Eschenbacher WL, Kreiss K, Lougheed MD, Pransky GS, Day B, Castellan RM. Nylon flock-associated interstitial lung disease. Am J Respir Crit Care Med. 1999;159(6):2003-2008. [CrossRef] [PubMed]
 
Kern DG, Kuhn C III, Ely EW, et al. Flock worker’s lung: broadening the spectrum of clinicopathology, narrowing the spectrum of suspected etiologies. Chest. 2000;117(1):251-259. [CrossRef] [PubMed]
 

Figures

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References

Turcotte SE, Chee A, Walsh R, et al. Flock worker’s lung disease: natural history of cases and exposed workers in Kingston, Ontario. Chest. 2013;143(6):1642-1648. [CrossRef] [PubMed]
 
Lougheed MD, Roos JO, Waddell WR, Munt PW. Desquamative interstitial pneumonitis and diffuse alveolar damage in textile workers: potential role of mycotoxins. Chest. 1995;108(5):1196-1200. [CrossRef] [PubMed]
 
Eschenbacher WL, Kreiss K, Lougheed MD, Pransky GS, Day B, Castellan RM. Nylon flock-associated interstitial lung disease. Am J Respir Crit Care Med. 1999;159(6):2003-2008. [CrossRef] [PubMed]
 
Kern DG, Kuhn C III, Ely EW, et al. Flock worker’s lung: broadening the spectrum of clinicopathology, narrowing the spectrum of suspected etiologies. Chest. 2000;117(1):251-259. [CrossRef] [PubMed]
 
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