Title : COPD and workplace
Chronic obstructive pulmonary disease (COPD) is a major cause of disability and one of the leading causes of death throughout the world. Although the cigarette smoking is the major and the best studied causative factor of COPD, there is consistent evidence that a substantial proportion of COPD cases cannot be explained by smoking. Other noxious particles and gases, such as workplace dusts, gases, vapors or fumes, indoor air pollution from burning biomass fuels from cooking and heating and urban outdoor air pollution are important risk factors of COPD. Occupational COPD is defined as a form of COPD caused in whole or in a part by occupational exposures. According to the actual knowledge, 15-20% of COPD cases are like to be caused or made worse by work, around 4,000 COPD deaths every year are related to workplace exposures and 40% of COPD patients are below retirement age and a quarter of those below retirement age are unable to work at all. There are several ways by which the workplace exposures may influence the course of COPD, like causing COPD, modifying the effect of tobacco smoke in causing COPD, triggering COPD exacerbations, as well as accelerating the progression and severity of the disease in the subjects with established COPD. The development of COPD as a consequence of workplace exposure is a matter of growing interest and importance, and not a little controversy. There is no doubt that certain workplace exposures enhance the risk of COPD and may do so independently of or in concert with cigarette smoking. The evidence is most coherent for work that entails exposure to coal, silica, welding fume, cadmium fume, diesel exhaust, cotton dust, farming dusts, grain dust or wood dust. The research found consistent associations between workplace exposures and COPD, across a wide range of sectors, describing a nearly uniform pattern of exposure-response relationships. Based on the research, affected occupations include miners, construction workers, road workers, tunnel workers, welders, glass workers, metal workers, foundry workers, textile workers, farm laborers, wood workers, chemical workers, and rubber workers, i.e. a working population including millions and millions workers worldwide. Prevention, based on proper engineering controls, respiratory protective equipment and regular periodical medical examinations, must be the primary tool for decreasing morbidity, mortality and disability from COPD. In addition, the prevention of both smoking and workplace exposure is needed to prevent the development and progression of disease, i.e. the joint analysis of smoking and workplace exposures implies that elimination of one, but not the other, risk will not be fully effective for reducing the global burden of COPD.