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COPD - Background in the US

COPD - Background in the US. Chronic obstructive pulmonary disease (COPD) includes chronic bronchitis, emphysema, bronchiectasis, and chronic airway obstruction. Estimated prevalence of 8.5% in the U.S. In 1999 COPD was the fourth leading cause of death in US (> 124,000 deaths).

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COPD - Background in the US

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  1. COPD - Background in the US • Chronic obstructive pulmonary disease (COPD) includes chronic bronchitis, emphysema, bronchiectasis, and chronic airway obstruction. • Estimated prevalence of 8.5% in the U.S. • In 1999 COPD was the fourth leading cause of death in US (> 124,000 deaths)

  2. Occupational burden of COPD • American Thoracic Society statement (2003) estimated 15% of COPD is caused by occupational exposures • Specific agents studied to date: • silica, coal dust • grain dust, wood dust, cement dust • cadmium, welding fumes • possibly isocyanates

  3. COPD in construction workers • Glencross et al. [1997] found that sheet metal workers followed over a 10-year period sustained significantly accelerated loss of FEV1 if they were exposed to asbestos and smoked. • Using data from the NHANES III for 1988-1994, workers in construction trades have been shown to be at increased risk of COPD based on PFT data [Hnizdo et al., 2002].

  4. COPD in construction workers • Oliver (2006) found that tunnel construction workers exposed to respirable crystalline silica and cement dust are at increased risk for airway disease. Extent of risk varied by trade and work activity.

  5. Impact of total dust in constructionBakke 2002 Appl Occ Env Hyg • Longitudinal accelerated decline in lung function • Exposure to dust and gases from diesel exhaust, blasting, drilling and rock transport in tunnel work enhances the risk for accelerated decline in FEV1, respiratory symptoms, and COPD in tunnel workers compared with other heavy construction workers

  6. Exposures to total dust in constructionBakke 2002 Appl Occ Env Hyg Among construction workers performing tunneling operations: • shotcreting operators 6.8 mg/m3 • tunnel boring machine workers 6.2 mg/m3 • shaft drilling workers 6.1 mg/m3 • outdoor concrete workers 1.0 mg/m3 • electricians 1.4 mg/m3 • support workers 1.9 mg/m3

  7. Exposure assessment in US construction (Rappaport 2003) Median values for respirable dust and silica (mg/m3 ) • Painters 13.5 total / 1.28 silica • Laborers 2.46 total / 0.350 silica • Bricklayers 2.13 total / 3.20 silica • Operating engineers total 0.720 / 0.075 silica 151 personal measurements were analyzed from 80 workers on 36 construction sites

  8. Questions • Can we separate effects of different components of construction dust? • Is most of the COPD due to specific agents, such as silica, diesel exhaust and welding fume? Or is there a combined impact of other “nuisance” dusts? • Focus on epidemiology or controls?

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