The Occupational Burden of Nonmalignant Respiratory Diseases. An Official American Thoracic Society and European Respiratory Society Statement

Abstract

Workplace inhalational hazards remain common worldwide, even though they are ameliorable. Previous American Thoracic Society documents have assessed the contribution of workplace exposures to asthma and chronic obstructive pulmonary disease on a population level, but not to other chronic respiratory diseases. The goal of this document is to report an in-depth literature review and data synthesis of the occupational contribution to the burden of the major nonmalignant respiratory diseases, including airway diseases; interstitial fibrosis; hypersensitivity pneumonitis; other noninfectious granulomatous lung diseases, including sarcoidosis; and selected respiratory infections. Methods: Relevant literature was identified for each respiratory condition. The occupational population attributable fraction (PAF) was estimated for those conditions for which there were sufficient population-based studies to allow pooled estimates. For the other conditions, the occupational burden of disease was estimated on the basis of attribution in case series, incidence rate ratios, or attributable fraction within an exposed group. Results: Workplace exposures contribute substantially to the burden of multiple chronic respiratory diseases, including asthma (PAF, 16%); chronic obstructive pulmonary disease (PAF, 14%); chronic bronchitis (PAF, 13%); idiopathic pulmonary fibrosis (PAF, 26%); hypersensitivity pneumonitis (occupational burden, 19%); other granulomatous diseases, including sarcoidosis (occupational burden, 30%); pulmonary alveolar proteinosis (occupational burden, 29%); tuberculosis (occupational burden, 2.3% in silica-exposed workers and 1% in healthcare workers); and community-acquired pneumonia in working-age adults (PAF, 10%). Conclusions: Workplace exposures contribute to the burden of disease across a range of nonmalignant lung conditions in adults (in addition to the 100% burden for the classic occupational pneumoconioses). This burden has important clinical, research, and policy implications. There is a pressing need to improve clinical recognition and public health awareness of the contribution of occupational factors across a range of nonmalignant respiratory diseases.

<p>Lifetime Occupational History, Respiratory Symptoms and Chronic Obstructive Pulmonary Disease: Results from a Population-Based Study</p>

“…Chronic obstructive pulmonary disease (COPD) is a progressing condition with accelerated lung function decline, which requires early recognition and treatment and is often associated with smoking, 1,2 air pollution, 3,4 and occupational exposure to noxious gases and particles in the workplace. 5 A recent comprehensive review on the occupational burden of respiratory disease concluded that every tenth COPD case may be attributed to hazardous occupations. 5 Occupational surveillance programs are therefore essential to detect accelerated lung function decline in those at risk, to offer smoking cessation and increase workers' awareness of the inhaled hazards.…”

“…5 A recent comprehensive review on the occupational burden of respiratory disease concluded that every tenth COPD case may be attributed to hazardous occupations. 5 Occupational surveillance programs are therefore essential to detect accelerated lung function decline in those at risk, to offer smoking cessation and increase workers' awareness of the inhaled hazards.…”

“…Most, if not all, epidemiological evidence on the occupational burden of COPD has emerged from the West, 5 whereas the industry transition to the East in recent decades will imply the greatest burden in the developing nations, where most current and future patients reside. The lack of high-quality studies in developing nations coupled with high smoking prevalence and poor workplace surveillance programs may leave most patients unattended, when some action can still be taken to prevent the disease or slow its progression.…”

Workplace indoor environmental quality and asthma‐related outcomes in healthcare workers

“…OA is defined as asthma that is caused by workplace exposures, while WEA is defined as a worsening of existing asthma due to the workplace environment. On the basis of the statements from the American Thoracic Society, 16% of incident asthma among adults is attributable to the workplace, while WEA has a 21.5% prevalence among adults with asthma 4,5 . WRA can be costly.…”

“…On the basis of the statements from the American Thoracic Society, 16% of incident asthma among adults is attributable to the workplace, while WEA has a 21.5% prevalence among adults with asthma. 4,5 WRA can be costly. Follow-up studies of OA cases reported prolonged unemployment rates of 14% to 69% and rates of lost income ranging from 44% to 72%, with similar results for WEA cases.…”