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Occupational COPD. M. Amini (MD) [email protected] 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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patient history
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
Spirometery showed these values:
    • FEV1= 44% with BD 3% 
    • FVC= 65% with BD 5% 
    • FEV1%= 50%
What is the diagnosis?
  • Does it relate to my work history?
  • What about prognosis?
  • Is it treatable?
  • How much does it cost?
Chronic obstructive pulmonary disease (COPD) is a disease state
  • characterized by airflow limitation
  • that is not fully reversible
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.
Emphysema, or destruction of the gas-exchanging surface of the lung (alveoli)
  • is a pathological term that is often (but incorrectly) used clinically
cough and sputum may precede the development of airflow limitation
  • conversely, some patients develop airflow limitation without chronic cough and sputum production.
Occupational COPD develops slowly
  • the airflow limitation is chronic
  • does not reverse when exposure is discontinued
Epidemiologically, the identification of occupational COPD is based on
  • observing excess occurrence of COPD among exposed workers
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
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)
As only 15 to 20% of smokers develop clinically significant COPD
  • 6% of persons with COPD in the United States are never smokers
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)
The industries with increased risk include
    • Rubber
    • Plastics
    • and leather manufacturing
    • building services
    • textile manufacturing
    • and construction.
The fraction of cases in a population that arise because of certain exposures
  • is called population attributable risk (PAR)
A cohort of more than 317000 Swedish male
  • construction workers was followed from 1971 to 1999
There was a statistically significant increase mortality
  • from COPD among those with any airborne exposure (relative risk 1.12)
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
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
Visit to the workplace by experts in occupational hygiene
  • material safety data sheets for workplace chemicals
  • manufacturers of the workplace substance
copd stage spirometry postbronchodilator
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
Directions about the management and prevention of work-related diseases
  • can be applied to COPD as well
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.
If substitution is not possible
    • ongoing maintenance of engineering controls
    • and improving work area ventilation
Administrative controls (e.g., transfer to another job or change in work practices)
  • and personal protective equipment (e.g., masks or respirators)
workers with COPD
  • may continue to work in their usual jobs if
their exposure to the inciting agent is diminished via
    • proper engineering controls
    • or respiratory protective equipment
The total annual cost to theNational Health Service for the treatment of COPD is
  • thoughtto be £491,652,000 in direct costs