Occupational COPD
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Occupational COPD







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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.
Occupational COPD

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Slide 1

Occupational COPD

M. Amini (MD)

Aminim@mums.ac.ir

Slide 3

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

Slide 4

  • Chest radiography showed here

Slide 6

  • Spirometery showed these values:

    • FEV1= 44% with BD 3% 

    • FVC= 65% with BD 5% 

    • FEV1%= 50%

Slide 8

Patient asks you

Slide 9

  • What is the diagnosis?

  • Does it relate to my work history?

  • What about prognosis?

  • Is it treatable?

  • How much does it cost?

Slide 10

What is the diagnosis?

Slide 11

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

  • characterized by airflow limitation

  • that is not fully reversible

Slide 13

  • 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.

Slide 14

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

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

Slide 15

  • cough and sputum may precede the development of airflow limitation

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

Slide 16

Does it relate to my work history?

Slide 17

  • Occupational COPD develops slowly

  • the airflow limitation is chronic

  • does not reverse when exposure is discontinued

Slide 18

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

Slide 19

  • Epidemiologically, the identification of occupational COPD is based on

  • observing excess occurrence of COPD among exposed workers

Slide 20

What about prognosis?

Slide 21

  • 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

Slide 22

  • 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)

Slide 23

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

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

Slide 24

  • 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)

Slide 25

  • The industries with increased risk include

    • Rubber

    • Plastics

    • and leather manufacturing

    • building services

    • textile manufacturing

    • and construction.

Slide 26

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

  • is called population attributable risk (PAR)

Slide 27

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

Slide 28

  • Smoking and occupational exposures had greater than additive effects

Slide 29

  • A cohort of more than 317000 Swedish male

  • construction workers was followed from 1971 to 1999

Slide 30

  • There was a statistically significant increase mortality

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

Slide 31

  • 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

Slide 32

  • 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

Slide 33

  • Visit to the workplace by experts in occupational hygiene

  • material safety data sheets for workplace chemicals

  • manufacturers of the workplace substance

Slide 34

IS IT treatable?

Slide 35

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

Slide 37

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

  • can be applied to COPD as well

Slide 38

  • 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.

Slide 39

  • If substitution is not possible

    • ongoing maintenance of engineering controls

    • and improving work area ventilation

Slide 40

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

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

Slide 41

  • workers with COPD

  • may continue to work in their usual jobs if

Slide 42

  • their exposure to the inciting agent is diminished via

    • proper engineering controls

    • or respiratory protective equipment

Slide 43

How much does it cost?

Slide 44

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

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

Slide 45

Thank you


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