Authors' objectives: The Evidence-based Practice Group (EBPG) was asked to conduct a systematic review investigating the (causal) association between firefighting and the development of sarcoidosis. Prior to conducting the systematic review, the EBPG was sent a pre-print article entitled ?Environmental Exposure to Respirable Particles and Estimated Risk of Sarcoidosis: A Systematic Review and Meta-Analysis? by Wambui et al. The systematic review by Wambui et al assessed whether exposure to respirable particles was associated with an increased risk of sarcoidosis. This systematic review, although just recently posted, searched relevant published studies dated from January 1998 to October 2019 only. Briefly, the objective of this pre-print systematic review and meta-analysis (level of evidence 1. Appendix 1) by Wambui et al was to critically appraise the literature related to environmental or occupational exposures of respirable particulate matter, including dust and the association with physician diagnosed sarcoidosis and presenting such association, if any, in a meta-analysis to assess the strength of measured effects. Given the availability of this systematic review, the EBPG was tasked to update this study.

Authors' results and conclusions: Six primary studies were included in our update. Of the six primary studies included in this systematic review update, three studies provided evidence for the potential increase in the risk of diagnosis of sarcoidosis associated with silica exposure. However, these results should be interpreted with caution since bias, confounding and potential for chance association cannot be excluded from the reported association. Further, these six primary studies demonstrated significant heterogeneity in the case definition as well as in the exposure being investigated. Perhaps, most relevantly, there was no data that showed the potential association of being firefighters and the development of sarcoidosis. The original systematic review/meta-analysis by Wambui et al concluded that there was potential evidence of an increased risk between exposure to respirable particles and the development of sarcoidosis. This evidence has to be interpreted with caution as the potential effect of bias, chance and confounding cannot be excluded from the observed outcomes. Further, Wambui et al did not identify firefighting as an occupation with increased risk of developing sarcoidosis. Our literature update on the Wambui et al paper cannot confirm the association between exposure to respirable particles and the development of sarcoidosis. This update also did not identify any study reporting on the (causal) association of being firefighters and the increased risk of developing sarcoidosis.

Authors' recommendations: Six primary studies were included in our update. Of the six primary studies included in this systematic review update, three studies provided evidence for the potential increase in the risk of diagnosis of sarcoidosis associated with silica exposure. However, these results should be interpreted with caution since bias, confounding and potential for chance association cannot be excluded from the reported association. Further, these six primary studies demonstrated significant heterogeneity in the case definition as well as in the exposure being investigated. Perhaps, most relevantly, there was no data that showed the potential association of being firefighters and the development of sarcoidosis. The original systematic review/meta-analysis by Wambui et al concluded that there was potential evidence of an increased risk between exposure to respirable particles and the development of sarcoidosis. This evidence has to be interpreted with caution as the potential effect of bias, chance and confounding cannot be excluded from the observed outcomes. Further, Wambui et al did not identify firefighting as an occupation with increased risk of developing sarcoidosis. Our literature update on the Wambui et al paper cannot confirm the association between exposure to respirable particles and the development of sarcoidosis. This update also did not identify any study reporting on the (causal) association of being firefighters and the increased risk of developing sarcoidosis.

Authors' methods: In order to update the systematic review of Wambui et al, the EBPG attempted to follow the authors? methods (especially their search method) as much as possible. A systematic literature search was done on commercial medical literature databases on August 16, 2022. This combination of keywords was employed in our search: (respirable particles) OR dust OR (particulate matter)) AND sarcoidosis. With the exception that the search was limited to studies published from 2019 to August 2022, no other limitations, such as on the language or country of publication, were implemented in this search. A manual search was also done on the references of the articles that were retrieved in full.

Project Status: Completed

URL for project: https://www.worksafebc.com/en/about-us/research-services/evidence-based-medicine-and-systematic-reviews

Year Published: 2022

URL for published report: https://www.worksafebc.com/en/resources/health-care-providers/guides/environmental-exposure-respirable-particles-estimated-risk?lang=en&origin=s&returnurl=https%3A%2F%2Fwww.worksafebc.com%2Fen%2Fforms-resources%23sort%3DRelevancy%26q%3DEnvironmental%2520Exposure%2520to%2520Respirable%2520Particles%2520and%2520Estimated%2520Risk%2520of%2520Sarcoidosis%26tags%3DGuide%7C2d7eb4b30f6a4a319e0d40565c9abbab%2CHealth%2520Care%2520Provider%7C13468b0b3f074f6bade3f57ac3cdfb8e%2CSystematic%2520Review%7Cf78c29d570c14ec3b5a394385905df70&highlight=Environmental%20Exposure%20to%20Respirable%20Particles%20and%20Estimated%20Risk%20of%20Sarcoidosis

English language abstract: An English language summary is available

Publication Type: Mini HTA

Country: Canada

Organisation Name: WorkSafeBC

Contact Address: 6591 Westminster Highway, Richmond, BC, V7C 1C6 Canada. Tel: 604-231-8417; Fax: 604-279-7698

Contact Name: ebpg@worksafebc.com

Contact Email: ebpg@worksafebc.com

Copyright: WorkSafe BC