Occupational lung disease
Occupational, or work-related, lung conditions are conditions that have been caused or made worse by the materials a person is exposed to within the workplace.
The impact of these conditions is underestimated due to under-reporting. For example, occupational disease is more likely to occur in the elderly, who are no longer at work but whose condition is due to their previous occupation.
Asthma is the most common work-related lung disease. It is estimated that one in seven severe asthma exacerbations are linked to work-related exposures, and work-related exposures are thought to account for about 15% of all adulthood asthma.
There are a growing number of materials that have been linked with asthma:
- Proteins from animals, plants and seafood
- Man-made proteins used in fabrics, detergents and glue
- Metallic agents used in industrial factories
- Synthetic chemicals used in spray paints, foams and adhesives
Existing asthma symptoms can also be worsened by the work environment and this is termed ‘work-aggravated asthma’. Given the important role occupational factors can play in the development and worsening of asthma, the workplace is an important area to focus on for asthma prevention.
Acute inhalation injuries
This occurs from a single incident resulting in a sudden and large exposure to a material, such as a chemical spillage, fire, gas explosions or exposure to large amounts of dust. Complications with lung health are also a major cause of death in people who are admitted for burn injuries. These exposures can lead to asthma and other rare conditions, such as metal fume fever and organic dust syndrome.
Groups commonly at risk include agricultural workers, fire fighters and emergency personnel. Research from Sweden and Finland found that one in 10 farmers has experienced an acute inhalation injury resulting from exposure to dust.
These infections occur from exposure to bacteria. They include:
- Tuberculosis (TB): Healthcare workers who are treating the condition in other people are the most at-risk group
- Legionnaires disease: This commonly spreads through air conditioning systems and usually affects hotels and leisure centre workers, people working on cruise ships and other crowded and confined areas such as schools
- Q Fever: This is caused by bacteria infecting farm animals, rodents or cats and dogs, putting agricultural workers at risk
Chronic obstructive pulmonary disease (COPD)
Most COPD is caused by smoking, however research suggests that between 15 and 20% of COPD cases are at least partially triggered by a certain material or agent in the work environment.
This can be due to exposure to mineral dusts, irritant gases or vapours in the air. A build-up of these materials can lead to chronic cough, chronic bronchitis and COPD. Underground miners and agricultural workers are most at risk of developing the condition.
In Europe, over 39,000 deaths have been estimated for the year 2000 as a result of work-related exposures to dusts and fumes.
Interstitial lung disease
There are a number of rare interstitial lung diseases that are clearly linked with occupational exposures. These include:
Pneumoconiosis: This is caused by exposure to silica, asbestos or coal dust. Dust controls in workplaces and the illegalisation of asbestos in building work has meant there has been a decline in these conditions and they are usually found in people who suffered exposure to these substances many years ago. A total of 7,200 cases of pneumoconiosis related to exposures to asbestos, silica and coal dust has been estimated for the year 2000 in Europe.
Metal-related lung conditions: Lung disease can be caused by exposure to metals such as beryllium used in modern technology (e.g. aerospace engineering) or cobalt used in alloys and batteries. These conditions can often be confused with other diseases, such as sarcoidosis, and more work is needed to ensure they are recognised as occupational diseases.
Extrinsic allergic alveolitis: This is caused by an allergic reaction to an agent in the work environment that affects the alveoli (the small air sacs in the lungs). The causes are diverse and could be from organic dusts, wood processing, birds and bird feed or vegetable stores. Annual incidences have been estimated at 2-6 cases per 1,000 farmers in Sweden in 1980s.
Other interstitial lung diseases: Rare diseases can occur as a random outbreak linked to a work exposure. One example of this is an outbreak of a severe form of pneumonia in textile workers called Ardystil syndrome, caused by aerosolised paints. These rare outbreaks are a reminder that workers should not be exposed to aerosolised compounds unless they have been tested and are known to be safe.
Another area of concern is the use of nano-materials for various new applications. Although no robust research has yet confirmed that lung conditions are caused by exposure to nano-materials, some studies in animals have raised concerns about the damaging effects they may have on humans.
There are a number of cancer-causing work place exposures, including asbestos fibres, nickel compounds, arsenic, diesel exhausts and radon gas. These agents can also react with cigarette smoke to cause harmful effects. Passive smoke from colleagues is also categorised as a workplace exposure. 15% of lung cancer cases in men and 5% in women are thought to be caused by occupational exposures. Occupational lung cancer is often underreported as many people with lung cancer are current or former smokers.
Pleural disease (including mesothelioma)
Pleural disease is almost exclusively linked to exposure to asbestos. Although asbestos-use is now illegal, people who were exposed to the condition at a young age are now living with the illness in old age.
Pleural diseases can be non-malignant, which means the tumour does not have the potential to spread. These occur more frequently in people with only light exposure to asbestos.
Malignant forms of the disease include mesothelioma, which usually occurs 30 or more years after asbestos exposure and is predicted to kill 250,000 people between 1995 and 2029. According to this prediction, one in 150 men born between 1945 and 2050 will die of this tumour, for which there is no effective cure.
In principle, occupational diseases should be easier to prevent than diseases that are caused by genetic factors, lifestyle factors or the general environment. It can be easier to change the situation to prevent exposure to the cause, and legal frameworks exist within Europe to help protect workers from any harmful effects of the work environment.
Additionally, the European Union has set exposure standards to define the safe level of pollutants at where no major health risks are expected. Not all these standards are up to date or health-based and some countries have their own standards, allowing for varying levels across Europe.
Some countries do not register the burden of occupational lung conditions and it is therefore difficult for experts to provide exact measurements of the burden in Europe. Instead, data is provided by estimations of the impact, calculated by voluntary reporting of occupational lung conditions to international databases.
- In Europe, over 39,000 deaths have been estimated for the year 2000 as a result of work-related exposures to dusts and fumes
- Up to 15% of all asthma cases are linked to occupational factors
- 15-20% of COPD cases are linked to factors in the workplace
- The costs of occupational asthma are high, but this usually falls on the state or individual, rather than the employer
- Thousands of coal miners across Europe have developed pneumoconiosis
- Work-related exposures are thought to account for 17% of all adult asthma cases
- Research from Sweden and Finland found that one in 10 farmers has experienced an acute inhalation injury resulting from exposure to dust
- 15% of lung cancer cases in men and 5% in women are thought to be caused by occupational exposures
Occupational asthma leads to considerable socioeconomic consequences even in countries that have adequate provisions for compensating workers with occupational conditions.
In some countries, schemes have been developed for the voluntary reporting of occupational lung diseases by healthcare professionals. The best known of these schemes is the SWORD (Surveillance of Work Related and Occupational Respiratory Disease) system initiated in the UK in 1989. This helps experts estimate the impact of the condition and identify priorities for prevention.
Mortality rate for mesothelioma. Data from the World Health Organization World and Europe Mortality Databases, November 2011 update
Current and Future Needs
- Efforts should be made to improve the recognition of conditions caused by a factor in the workplace
- Exposure standards should be uniform across Europe and updated to reduce the exposure of the working population
- Disaster plans should be in place to remove damaging effects of exposure accidents
- Workers who are at a high risk of developing infectious pneumonia should receive the pneumococcal vaccine
- Employers should be aware of potential costs of exposure to occupational asthma-causing agents to provide an incentive for preventative action
- Work and health authorities should aim for realistic targets to decrease incidence of lung conditions caused by silicosis and working in mines
- More efforts to recognise, register and prevent conditions caused by hard and soft metal materials
- Legislators must look at the use of nano-materials and how this is affecting health
- European efforts to detect and reduce occupational carcinogenic exposures need to be continued