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Occupational COPD

Learn about the diagnosis, prognosis, and treatment of occupational COPD, emphasizing the impact of workplace exposures and management strategies. Cost implications included.

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Occupational COPD

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  1. Occupational COPD M. Amini (MD) Aminim@mums.ac.ir

  2. 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

  3. Chest radiography showed here

  4. Spirometery showed these values: • FEV1= 44% with BD 3%  • FVC= 65% with BD 5%  • FEV1%= 50%

  5. Patient asks you

  6. What is the diagnosis? • Does it relate to my work history? • What about prognosis? • Is it treatable? • How much does it cost?

  7. What is the diagnosis?

  8. Chronic obstructive pulmonary disease (COPD) is a disease state • characterized by airflow limitation • that is not fully reversible

  9. 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.

  10. Emphysema, or destruction of the gas-exchanging surface of the lung (alveoli) • is a pathological term that is often (but incorrectly) used clinically

  11. cough and sputum may precede the development of airflow limitation • conversely, some patients develop airflow limitation without chronic cough and sputum production.

  12. Does it relate to my work history?

  13. Occupational COPD develops slowly • the airflow limitation is chronic • does not reverse when exposure is discontinued

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

  15. Epidemiologically, the identification of occupational COPD is based on • observing excess occurrence of COPD among exposed workers

  16. What about prognosis?

  17. 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

  18. 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)

  19. As only 15 to 20% of smokers develop clinically significant COPD • 6% of persons with COPD in the United States are never smokers

  20. 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)

  21. The industries with increased risk include • Rubber • Plastics • and leather manufacturing • building services • textile manufacturing • and construction.

  22. The fraction of cases in a population that arise because of certain exposures • is called population attributable risk (PAR)

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

  24. Smoking and occupational exposures had greater than additive effects

  25. A cohort of more than 317000 Swedish male • construction workers was followed from 1971 to 1999

  26. There was a statistically significant increase mortality • from COPD among those with any airborne exposure (relative risk 1.12)

  27. 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

  28. 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

  29. Visit to the workplace by experts in occupational hygiene • material safety data sheets for workplace chemicals • manufacturers of the workplace substance

  30. IS IT treatable?

  31. 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

  32. Directions about the management and prevention of work-related diseases • can be applied to COPD as well

  33. 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.

  34. If substitution is not possible • ongoing maintenance of engineering controls • and improving work area ventilation

  35. Administrative controls (e.g., transfer to another job or change in work practices) • and personal protective equipment (e.g., masks or respirators)

  36. workers with COPD • may continue to work in their usual jobs if

  37. their exposure to the inciting agent is diminished via • proper engineering controls • or respiratory protective equipment

  38. How much does it cost?

  39. The total annual cost to theNational Health Service for the treatment of COPD is • thoughtto be £491,652,000 in direct costs

  40. Thank you

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