Approach

All patients who present with respiratory symptoms should have a work and environmental history recorded. Because many pulmonary toxins have effect years after exposure has ended, a lifetime exposure history should be obtained. This is particularly true for patients with interstitial disease or chronic obstructive pulmonary disease (COPD). Characteristic x-ray changes in conjunction with a work history are commonly sufficient to make the diagnosis. Bronchoscopy with biopsy and lavage is performed when confirming beryllium-related disease, or when the presentation is unusual. Pulmonary function tests are useful to determine severity and pharmacological treatment.

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