OBSTRUCTIVE, OCCUPATIONAL AND ENVIRONMENTAL DISEASES: Edited by Manish Joshi and Basil VarkeyOccupational lung diseases in the 21st century the changing landscape and future challengesFazen, Louis E.a; Linde, Briana; Redlich, Carrie A.a,bAuthor Information aYale Occupational and Environmental Medicine Program, Department of Medicine bSection of Pulmonary, Critical Care and Sleep Medicine, Yale School of Medicine, New Haven, Connecticut, USA Correspondence to Louis E. Fazen, MD, PhD, Yale Occupational and Environmental Medicine Program, 367 Cedar St, ESHA 2nd Floor, New Haven, CT 06510, USA. Tel: +1 203 785 6434; fax: +1 203 785 5713; e-mail: firstname.lastname@example.org Current Opinion in Pulmonary Medicine: March 2020 - Volume 26 - Issue 2 - p 142-148 doi: 10.1097/MCP.0000000000000658 Buy Metrics Abstract Purpose of review Occupational exposures remain an underrecognized and preventable cause of lung disease in high-income countries. The present review highlights the emergence of cleaning-related respiratory disease and the re-emergence of silicosis as examples of trends in occupational lung diseases in the 21st century. Recent findings Employment trends, such as the shift from large-scale manufacturing to a service economy, the growth of the healthcare sector, and changing consumer products have changed the spectrum of work-related lung diseases. Following decades of progress in reducing traditional hazards such as silica in U.S. workplaces, cases of advanced silicosis have recently re-emerged with the production of engineered stone countertops. With growth in the healthcare and service sectors in the United States, cleaning products have become an important cause of work-related asthma and have recently been associated with an increased risk of chronic obstructive pulmonary disease (COPD) in women. However, these occupational lung diseases largely go unrecognized by practicing clinicians. Summary The present article highlights how changes in the economy and work structure can lead to new patterns of inhalational workplace hazards and respiratory disease, including cleaning-related respiratory disease and silicosis. Pulmonary clinicians need to be able to recognize and diagnose these occupational lung diseases, which requires a high index of suspicion and a careful occupational history. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.