Occupational respiratory diseases. Merchant JA, Bochlecke BA, Taylor G, eds. Morgantown, WV: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control, National Institute for Occupational Safety and Health, DHHS (NIOSH) Publication No. 86-102, 1986 Sep; :503-529
Occupationally related chronic bronchitis and emphysema are reviewed with respect to agents of causation, occupations and industries involved, worker populations at risk, epidemiology, clinical description and diagnostic criteria, pathology, methods of prevention, and research needs. Causative agents from occupational exposure include specific chemicals which produce changes in airways (ammonia (7664417), arsenic (7440382), chlorine (7782505), osmium- tetroxide (20816120), phosgene (75445), tungsten-carbide (12070121), vanadium (7440622), sulfur-dioxide (7446095), toluene-diisocyanate (26471625), and chlorinated hydrocarbons) and complex dusts that occur in industry (cotton and flax dust, coke oven emissions, cement dust, foundry dust, ceramic dust, quarry dust, tomb cutting and rock crushing operations, metal smelting, silica (7631869), asbestos (1332214) and potash (584087) exposures). Early detection of chronic bronchitis depends on symptoms of functional impairment and pulmonary function tests sensitive for early detection of hypersecretion and airways obstruction. There are no early physical or radiological signs. Diagnostic criteria for emphysema are anatomic and structural and have been shown to correlate with dyspnea, functional insufficiency, increased total lung volume, decreased diffusing capacity, increased compliance, and decreased or absent breath sounds. Prevention involves the reduction of inhalation exposure to particles. The author notes that mainline cigarette smoke represents the major exposure to be reduced. The author identifies a need for data on the prevalence of chronic bronchitis and emphysema in workers involved with ammonia fertilizers, petrochemicals, quarry work, rock crushing, and cement and brick manufacture.