Preventing occupational respiratory disease: a lesson from coal mining.
Attfield-MD; Petsonk-EL; Wagner-GR
Working Partnerships: Applying Research to Practice, NORA Symposium 2003, June 23-24, 2003, Arlington, Virginia. Washington, DC: National Institute for Occupational Safety and Health, 2003 Jun; :35
The fact that coal miners can develop lung disease from their work exposures has been known for nearly 200 years. However, focused action to reduce dust levels, and thus lower disease risk, in western countries has occurred only over the last 35 years. Recent surveillance data from the U.S. indicate that the dust standard has been instrumental in bringing about a substantial reduction in the burden of coal workers’ pneumoconiosis (CWP). Historically, CWP was regarded as the major disease of concern among coal miners. For this reason, the logical basis of preventive measures in the U.S. is founded on eliminating this disease. But careful epidemiological investigation in a number of countries has now conclusively demonstrated that chronic obstructive pulmonary disease (COPD) as well as CWP can arise from coal mine dust exposure. Current surveillance data show that coal mining has the highest proportionate mortality ratio (PMR) for COPD among all industries, and that mining machine operators have the fourth highest PMR for COPD among occupations. Because of the historical focus on CWP, current mandated medical monitoring in the U.S. for coal miners still relies exclusively on the chest x-ray. Although recommendations have been made, nothing has been done since 1969 to implement medical monitoring for diseases other than CWP. The mandated program provides no specific preventive interventions for miners who develop COPD but have normal chest x-ray readings. This contrasts with the right of miners with CWP on chest x-ray to work in a low dust job without a reduction in wages and have their dust exposures monitored frequently. The current approach, therefore, can identify and act on only part of the disease burden. NIOSH is developing, improving, and evaluating approaches for medical monitoring of workers exposed to respiratory hazards. For example, NIOSH is conducting a large study in partnership with industry and labor groups to develop optimum medical monitoring practices for asthma among isocyanate-exposed workers. With both asthma and COPD there are common issues with quality control for spirometric testing and with the potential for high false positive and false negative rates arising from variability in the data. Among other things, reliable methods to assess temporal decline in longitudinal data need to be developed, along with sensitive but specific ways to identify promptly the start of excess decline in occupationally exposed individuals. Empirical evidence that medical monitoring and individualized intervention can effectively prevent disabling COPD would also be extremely valuable. The challenge of workplace exposure, COPD, and disease prevention is not limited to coal miners. Given recent estimates that between 1.5 to 3.5 million persons in the U.S. have COPD attributable to occupation, there is an imperative need for research into causation and approaches to prevention of this disease.
Coal-miners; Coal-mining; Underground-mining; Underground-miners; Milling-industry; Lung-disease; Pneumoconiosis; Epidemiology; Chronic-degenerative-diseases; Pulmonary-system-disorders; Pulmonary-disorders; Chest-X-rays; Disease-prevention; Surveillance
Disease and Injury: Asthma and Chronic Obstructive Pulmonary Disease; Construction
Working Partnerships: Applying Research to Practice, NORA Symposium 2003, June 23-24, 2003, Arlington, Virginia