Occupational COPD - PowerPoint PPT Presentation

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Occupational COPD. M. Amini (MD) Aminim@mums.ac.ir. Patient history. A 45 y/o man non-smoker with history of 15 years working at rubber industry Presented with dyspnea, cough and phlegm in recent few years Physical examination reveals nothing specific. Chest radiography showed here.

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Occupational COPD

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Occupational copd l.jpg

Occupational COPD

M. Amini (MD)


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Patient history

  • A 45 y/o man non-smoker

  • with history of 15 years working at rubber industry

  • Presented with dyspnea, cough and phlegm in recent few years

  • Physical examination reveals nothing specific

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  • Chest radiography showed here

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  • Spirometery showed these values:

    • FEV1= 44%with BD 3% 

    • FVC= 65%with BD 5% 

    • FEV1%= 50%

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Patient asks you

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  • What is the diagnosis?

  • Does it relate to my work history?

  • What about prognosis?

  • Is it treatable?

  • How much does it cost?

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What is the diagnosis?

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  • Chronic obstructive pulmonary disease (COPD) is a disease state

  • characterized by airflow limitation

  • that is not fully reversible

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  • Chronic bronchitis, or the presence of cough and sputum production for at least 3 months

  • in each of two consecutive years, remains a clinically and epidemiologically useful term.

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  • Emphysema, or destruction of the gas-exchanging surface of the lung (alveoli)

  • is a pathological term that is often (but incorrectly) used clinically

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  • cough and sputum may precede the development of airflow limitation

  • conversely, some patients develop airflow limitation without chronic cough and sputum production.

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Does it relate to my work history?

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  • Occupational COPD develops slowly

  • the airflow limitation is chronic

  • does not reverse when exposure is discontinued

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  • So, diagnosis by methods similar to occupational asthma, is not feasible

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  • Epidemiologically, the identification of occupational COPD is based on

  • observing excess occurrence of COPD among exposed workers

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What about prognosis?

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  • COPD is currently the fourth leading cause of death in the world

  • and further increases in its prevalence and mortality can be predicted in the coming decades

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  • Cigarette smoking is undoubtedly the main cause of COPD in the population

  • average decline in FEV1 in smokers is faster (60 ml/yr) than in non-smokers (30 ml/yr)

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  • As only 15 to 20% of smokers develop clinically significant COPD

  • 6% of persons with COPD in the United States are never smokers

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  • A sizeable proportion of the cases of COPD in a society (average 15%)

  • may be attributable to workplace exposures

  • dusts, noxious gases/vapours, and fumes (DGVFs)

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  • The industries with increased risk include

    • Rubber

    • Plastics

    • and leather manufacturing

    • building services

    • textile manufacturing

    • and construction.

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  • The fraction of cases in a population that arise because of certain exposures

  • is called population attributable risk (PAR)

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  • The American Thoracic Society (ATS) calculated that PAR for COPD was about 15%

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  • Smoking and occupational exposures had greater than additive effects

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  • A cohort of more than 317000 Swedish male

  • construction workers was followed from 1971 to 1999

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  • There was a statistically significant increase mortality

  • from COPD among those with any airborne exposure (relative risk 1.12)

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  • Thus, physicians must be aware of the potential occupational etiologies for

  • obstructive airway disease and should consider them in every patient with COPD

  • An occupational history should be the first step in the initial evaluation of the patient

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  • The length of time exposed to the agent

  • the use of personal protective equipment such as respirators,

  • and a description of the ventilation and

  • overall hygiene of the workplace

    • quantify exposure from the patient's history

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  • Visit to the workplace by experts in occupational hygiene

  • material safety data sheets for workplace chemicals

  • manufacturers of the workplace substance

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IS IT treatable?

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COPD Stage Spirometry (Postbronchodilator)

  • Mild

    • FEV1 ≥80% predicted, FEV1/FVC <0.7

  • Moderate

    • 50% ≤ FEV1 <80% predicted, FEV1/FVC <0.7

  • Severe

    • 30% ≤ FEV1 <50% predicted, FEV1/FVC <0.7

  • Very severe 

    • FEV1 <30% predicted, FEV1/FVC <0.7

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  • Directions about the management and prevention of work-related diseases

  • can be applied to COPD as well

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  • understanding the patient's occupational exposure

  • Removal of the respiratory irritants

  • substitution of non-toxic agents

    • are the best approach because they eliminate the work-related COPD hazard.

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  • If substitution is not possible

    • ongoing maintenance of engineering controls

    • and improving work area ventilation

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  • Administrative controls (e.g., transfer to another job or change in work practices)

  • and personal protective equipment (e.g., masks or respirators)

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  • workers with COPD

  • may continue to work in their usual jobs if

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  • their exposure to the inciting agent is diminished via

    • proper engineering controls

    • or respiratory protective equipment

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How much does it cost?

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  • The total annual cost to theNational Health Service for the treatment of COPD is

  • thoughtto be £491,652,000 in direct costs

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Thank you

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