Preventing Occupational Lung Disease

Reducing exposure to a wide range of harmful agents present in the workplace, in addition to an overall reduction in cigarette smoking, can potentially help prevent a major proportion of lung disease. To prevent occupational lung diseases, a comprehensive strategy is required, which will put together medical and environmental surveillance, reduction and removal of exposures, promotion of health and education, regulation, research and enforcement. None of the individual strategy components should be ignored if the effectiveness of prevention measures is to be maintained.

The main objective of a strategy devised for the prevention of occupational lung disease should be to protect workers from being exposed to dangerous levels of hazardous substances. To implement the strategy, changes in work practices and technological controls will be required. Comprehensive information and training programs, developed on the basis of sound educational principles, should be established in order to properly inform workers, engineers, managers and healthcare professionals about the dangers, control measures and the additional hazards posed by cigarette smoking. It is essential to plan careful emergency response.

Systematic studies are needed which can provide reliable data about occupations and industries that are at a risk for occupational lung disease. Also required are studies that can help measure the incidence and prevalence of ailments in all types of industries identified to have hazardous exposures. Accurately judging the enormity of the problem may not be possible based on existing knowledge.

An essential requirement is to establish stringent and medically-based regulation of exposure levels for all types of substances known to cause occupational lung disease. In situations where not much information is available about safe levels, it is necessary to expedite research in order to provide an appropriate platform for effective regulation. In areas where OSHA regulations fail to reflect existing medical knowledge (for instance, cases where levels recommended by NIOSH are more stringent), these must be changed to do so. Acceptable exposure levels must consider all potential disease manifestations in relation to a given substance. However, the single most crucial factor, especially when the objective is to prevent occupational lung disease, is to work on the federal commitment to monitor workplace hazards and enforce regulations. To prevent exposure to respiratory toxins in the workplace, there are specific steps with the following recommendations:

1. Substitution is the best way to prevent hazardous emissions (i.e. replacing hazardous substances with those that are less hazardous).
2. Imposition of rigorous engineering controls is the second best way to prevent airborne exposure. This would include ventilation and process exposure which do not allow release of gases and toxic particles into the air.
3. By far, use of protective gear and respirators has been the least satisfactory method of preventing occupational respiratory exposures.
4. All approaches used for reducing exposure to hazardous substances in the workplace should be supported by stringent enforcement of law and through periodic review of current legal standards that regulate occupational exposure.

This is followed by a review of practice and research strategies, as needed to effectively prevent occupational lung disease.

Pneumoconioses

Specific practice strategies comprise of the following components: supporting stringent, legally-mandated prevention of airborne exposure to gases and toxic dusts in the workplace; providing education on hazards and ways to reduce risk of exposures, meant for engineers and managers working in industries known to use dusty materials; educating workers in identifying hazards, in safe work procedures, and use of respirators in an emergency; educating workers about the relationship between occupational dusts and cigarette smoking; and providing for smoking-cessation programs meant for workers. Treatment of asbestosis.

Specific research strategies comprise of the following: toxicologic and epidemiologic research, particularly large-scale epidemiologic studies involving exposed populations, with the objective to better understand dose-response relationship, especially at low exposure levels; efforts to gather more information on environmental surveillance, with the objective to determine the most appropriate sampling methods; efforts to augment engineering approaches on dust control; policy research on specific questions such as whether economic incentives would help promote a safer workplace; and assessment of needs in order to direct implementation of educational programming.

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