{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T07:54:10Z","timestamp":1791359650397,"version":"4.3.1"},"reference-count":34,"publisher":"PAGEPress Publications","license":[{"start":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T00:00:00Z","timestamp":1791331200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Monaldi Arch Chest Dis"],"abstract":"<jats:p>Given the etiologic importance of inhalational exposures in specific interstitial lung disease (ILD) subtypes like hypersensitivity pneumonitis (HP) and pneumoconiosis, this study systematically evaluates exposure patterns across all ILD subtypes and assesses the utility of a standardized questionnaire for improved exposure identification.\u00a0\nIn this cross-sectional study, ILD patients were recruited between July 2023 and March 2024. Demographic, clinical, pulmonary function, radiological, and immunological parameters were recorded, and ILD subtypes were assigned by multidisciplinary discussion. Inhalational exposures were evaluated using a standardized questionnaire through in-person or telephonic interviews.\nOut of 139 total ILD patients, 107 (77%) reported at least one inhalational exposure, and 67 (48.2%) reported multiple exposures. These exposures were prevalent across multiple ILD subtypes beyond HP. Biomass (39.6%) and hay\/grain (25.9%) were the most common. Blue-collar occupations were linked with higher odds of having any (81.8%) and multiple exposures (55.6%). Significant associations with HP were observed for animal hair and avian exposures, while tobacco smoke was associated with idiopathic pulmonary fibrosis. Having multiple exposures was associated with a significant reduction in forced vital capacity\u00a0% predicted. Use of the standardized exposure questionnaire revealed more exposures per patient vs. routine history [median 1 (interquartile range 1-3) vs. 0 (interquartile range 0-1)], with 77% of participants classified as exposed vs. 41.7% by routine history (p&lt;0.001).\u00a0\nInhalational exposures are widely prevalent across ILD subtypes, including those not classically exposure-related, and standardized exposure assessment using questionnaires improves their detection.<\/jats:p>","DOI":"10.4081\/monaldi.2026.4008","type":"journal-article","created":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T07:44:25Z","timestamp":1791359065000},"source":"Crossref","is-referenced-by-count":0,"title":["Prevalence and patterns of inhalational exposures in patients with interstitial lung diseases: a cross-sectional study"],"prefix":"10.4081","author":[{"given":"Tharini","family":"Ravichandran","sequence":"first","affiliation":[{"name":"Department of Pulmonary Medicine, St. John's National Academy of Health Sciences, Bengaluru, Karnataka"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Divya","family":"Saxena","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine, St. John's National Academy of Health Sciences, Bengaluru, Karnataka"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chitra","family":"Veluthat","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine, St. John's National Academy of Health Sciences, Bengaluru, Karnataka"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Uma","family":"Devaraj","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine, St. John's National Academy of Health Sciences, Bengaluru, Karnataka"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Priya","family":"Ramachandran","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine, St. John's National Academy of Health Sciences, Bengaluru, Karnataka"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Uma Maheswari","family":"Krishnaswamy","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine, St. John's National Academy of Health Sciences, Bengaluru, Karnataka"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kavitha","family":"Venkatnarayan","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine, St. John's National Academy of Health Sciences, Bengaluru, Karnataka"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2549","published-online":{"date-parts":[[2026,10,7]]},"reference":[{"key":"88124","doi-asserted-by":"crossref","unstructured":"Althobiani MA, Russell AM, Jacob J, et al. Interstitial lung disease: a review of classification, etiology, epidemiology, clinical diagnosis, pharmacological and non-pharmacological treatment. Front Med 2024;11:1296890.","DOI":"10.3389\/fmed.2024.1296890"},{"key":"88125","doi-asserted-by":"crossref","unstructured":"Ma X, Zhu L, Xiao H, et al. Global, regional, and national burden of interstitial lung disease and pulmonary sarcoidosis from 1990 to 2023, and projections to 2050: A systematic analysis for the Global Burden of Disease Study 2023. Chin Med J Pulm Crit Care Med 2025;3:300-7.","DOI":"10.1016\/j.pccm.2025.11.008"},{"key":"88126","doi-asserted-by":"crossref","unstructured":"Grewal JS, Morisset J, Fisher JH, et al. Role of a regional multidisciplinary conference in the diagnosis of interstitial lung disease. Ann Am Thorac Soc 2019;16:455-62.","DOI":"10.1513\/AnnalsATS.201811-794OC"},{"key":"88127","doi-asserted-by":"crossref","unstructured":"Gogali A, Kostikas K, Tzouvelekis A. Initiation of antifibrotic treatment in fibrosing interstitial lung disease: is the clock ticking till proven progression? Eur Respir Rev 2025;34:250023.","DOI":"10.1183\/16000617.0023-2025"},{"key":"88128","doi-asserted-by":"crossref","unstructured":"Dhooria S, Sehgal IS, Agarwal R, et al. Incidence, prevalence, and national burden of interstitial lung diseases in India: Estimates from two studies of 3089 subjects. PLoS One 2022;17:e0271665.","DOI":"10.1371\/journal.pone.0271665"},{"key":"88129","doi-asserted-by":"crossref","unstructured":"Gandhi SA, Min B, Fazio JC, et al. The impact of occupational exposures on the risk of idiopathic pulmonary fibrosis: a systematic review and meta-analysis. Ann Am Thorac Soc 2024;21:486-98.","DOI":"10.1513\/AnnalsATS.202305-402OC"},{"key":"88130","doi-asserted-by":"crossref","unstructured":"Kongsupon N, Walters GI, Sadhra SS. Occupational causes of hypersensitivity pneumonitis: a systematic review and compendium. Occup Med 2021;71:255-9.","DOI":"10.1093\/occmed\/kqab082"},{"key":"88131","doi-asserted-by":"crossref","unstructured":"Lee CT, Strek ME, Adegunsoye A, et al. Inhalational exposures in patients with fibrotic interstitial lung disease: presentation, pulmonary function and survival in the canadian registry for pulmonary fibrosis. Respirology 2022;27:635-44.","DOI":"10.1111\/resp.14267"},{"key":"88132","doi-asserted-by":"crossref","unstructured":"Lee CT, Adegunsoye A, Chung JH, et al. Characteristics and prevalence of domestic and occupational inhalational exposures across interstitial lung diseases. Chest 2021;160:209-18.","DOI":"10.1016\/j.chest.2021.02.026"},{"key":"88133","doi-asserted-by":"crossref","unstructured":"Copeland CR, Collins BF, Salisbury ML. Identification and remediation of environmental exposures in patients with interstitial lung disease. Chest 2021;160:219-30.","DOI":"10.1016\/j.chest.2021.02.021"},{"key":"88134","doi-asserted-by":"crossref","unstructured":"Robertshaw MJ, Gorman A, Glazer CS, Adams TN. Effect of antigen removal in hypersensitivity pneumonitis. BMC Pulm Med 2024;24:398.","DOI":"10.1186\/s12890-024-03098-3"},{"key":"88135","doi-asserted-by":"crossref","unstructured":"Fern\u00e1ndez P\u00e9rez ER, Swigris JJ, Forss\u00e9n AV, et al. Identifying an inciting antigen is associated with improved survival in patients with chronic hypersensitivity pneumonitis. Chest 2013;144:1644-51.","DOI":"10.1378\/chest.12-2685"},{"key":"88136","doi-asserted-by":"crossref","unstructured":"Barnes H, Chambers D, Grainge C, et al. Clinical utility of a standardized chronic hypersensitivity pneumonitis exposure questionnaire. Respirology 2023;28:366-72.","DOI":"10.1111\/resp.14404"},{"key":"88137","doi-asserted-by":"crossref","unstructured":"Barnes H, Morisset J, Molyneaux P, et al. A systematically derived exposure assessment instrument for chronic hypersensitivity pneumonitis. Chest 2020;157:1506-12.","DOI":"10.1016\/j.chest.2019.12.018"},{"key":"88138","unstructured":"Raghu G, Remy-Jardin M, Richeldi L, et al. Idiopathic pulmonary fibrosis (an update) and progressive pulmonary fibrosis in adults: an official ats\/ers\/jrs\/alat clinical practice guideline. Am J Respir Crit Care Med 2022;205:e18-47."},{"key":"88139","unstructured":"Raghu G, Remy-Jardin M, Ryerson CJ, et al. Diagnosis of hypersensitivity pneumonitis in adults. An official ats\/jrs\/alat clinical practice guideline. Am J Respir Crit Care Med 2020;202:e36-69."},{"key":"88140","unstructured":"hpLung. hpLung.com; c2019. Available from: https:\/\/www.hplung.com"},{"key":"88141","doi-asserted-by":"crossref","unstructured":"Lee CT, Gandhi SA, Elmrayed S, et al. Inhalational exposures associated with risk of interstitial lung disease: a systematic review and meta-analysis. Thorax 2025;80:918-26.","DOI":"10.1136\/thorax-2024-222306"},{"key":"88142","doi-asserted-by":"crossref","unstructured":"Huntley CC, Patel K, Mughal AZ, et al. Airborne occupational exposures associated with pulmonary sarcoidosis: a systematic review and meta-analysis. Occup Environ Med 2023;80:580-9.","DOI":"10.1136\/oemed-2022-108632"},{"key":"88143","unstructured":"World Health Organization. Household air pollution. 2025. Available from: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/household-air-pollution-and-health"},{"key":"88144","doi-asserted-by":"crossref","unstructured":"Cullinan P, Reid P. Pneumoconiosis. Prim Care Respir J 2013;22:249-52.","DOI":"10.4104\/pcrj.2013.00055"},{"key":"88145","doi-asserted-by":"crossref","unstructured":"Furuya S, Chimed-Ochir O, Takahashi K, et al. Global asbestos disaster. Int J Environ Res Public Health 2018;15:1000.","DOI":"10.3390\/ijerph15051000"},{"key":"88146","doi-asserted-by":"crossref","unstructured":"Blanc PD, Annesi-Maesano I, Balmes JR, et al. The occupational burden of nonmalignant respiratory diseases. An official american thoracic society and european respiratory society statement. Am J Respir Crit Care Med 2019;199:1312-34.","DOI":"10.1164\/rccm.201904-0717ST"},{"key":"88147","doi-asserted-by":"crossref","unstructured":"Hines SE, Dement J, Cloeren M, et al. Restrictive spirometry pattern among construction trade workers. Am J Ind Med 2023;66:484-99.","DOI":"10.1002\/ajim.23474"},{"key":"88148","doi-asserted-by":"crossref","unstructured":"Iversen IB, Vestergaard JM, Basinas I, et al. Risk of hypersensitivity pneumonitis and other interstitial lung diseases following organic dust exposure. Thorax 2024;79:853-60.","DOI":"10.1136\/thorax-2023-221275"},{"key":"88149","doi-asserted-by":"crossref","unstructured":"Garg A, Bagri S, Choudhary P, et al. The adverse effects of solid biomass fuel exposure on lung functions in non-smoking female population. J Family Med Prim Care 2022;11:2499-502.","DOI":"10.4103\/jfmpc.jfmpc_883_21"},{"key":"88150","doi-asserted-by":"crossref","unstructured":"Sullivan A, Shrestha P, Lanham T, et al. Bird fancier\u2019s lung: an underdiagnosed etiology of dyspnea. Respir Med Case Rep 2020;31:101288.","DOI":"10.1016\/j.rmcr.2020.101288"},{"key":"88151","doi-asserted-by":"crossref","unstructured":"Cramer C, Schl\u00fcnssen V, Bendstrup E, et al. Risk of hypersensitivity pneumonitis and interstitial lung diseases among pigeon breeders. Eur Respir J 2016;48:818-25.","DOI":"10.1183\/13993003.00376-2016"},{"key":"88152","doi-asserted-by":"crossref","unstructured":"Abramson MJ, Murambadoro T, Alif SM, et al. Occupational and environmental risk factors for idiopathic pulmonary fibrosis in australia: case\u2013control study. Thorax 2020;75:864-9.","DOI":"10.1136\/thoraxjnl-2019-214478"},{"key":"88153","doi-asserted-by":"crossref","unstructured":"Kumar A, Cherian SV, Vassallo R, et al. Current concepts in pathogenesis, diagnosis, and management of smoking-related interstitial lung diseases. Chest 2018;154:394-408.","DOI":"10.1016\/j.chest.2017.11.023"},{"key":"88154","doi-asserted-by":"crossref","unstructured":"Blanc AL, Delhaes L, Copin MC, et al. Interstitial lung disease due to domestic moulds. Rev Mal Respir 2011;28:913-8. [Article in French].","DOI":"10.1016\/j.rmr.2011.01.013"},{"key":"88155","doi-asserted-by":"crossref","unstructured":"Clarke K, Manrique A, Sabo-Attwood T, Coker ES. A narrative review of occupational air pollution and respiratory health in farmworkers. Int J Environ Res Public Health 2021;18:4097.","DOI":"10.3390\/ijerph18084097"},{"key":"88156","doi-asserted-by":"crossref","unstructured":"Kalchiem-Dekel O, Galvin JR, Burke AP, et al. Interstitial lung disease and pulmonary fibrosis: a practical approach for general medicine physicians with focus on the medical history. J Clin Med 2018;7:476.","DOI":"10.3390\/jcm7120476"},{"key":"88157","unstructured":"The National Institute for Occupational Safety and Health. National Occupational Research Agenda for Respiratory Health. 2019. Available from: https:\/\/www.cdc.gov\/niosh\/docket\/review\/docket302\/pdfs\/302-Final-NORA-Agenda-for-Respiratory-Health-12-20-18.pdf"}],"container-title":["Monaldi Archives for Chest Disease"],"original-title":[],"link":[{"URL":"https:\/\/www.monaldi-archives.org\/macd\/article\/download\/4008\/2286","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.monaldi-archives.org\/macd\/article\/download\/4008\/2287","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.monaldi-archives.org\/macd\/article\/download\/4008\/2286","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T07:44:34Z","timestamp":1791359074000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.monaldi-archives.org\/macd\/article\/view\/4008"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,7]]},"references-count":34,"URL":"https:\/\/doi.org\/10.4081\/monaldi.2026.4008","relation":{},"ISSN":["2532-5264","1122-0643"],"issn-type":[{"value":"2532-5264","type":"electronic"},{"value":"1122-0643","type":"print"}],"subject":[],"published":{"date-parts":[[2026,10,7]]}}}