BREATHING EASY AT WORK

OCCUPATIONAL LUNG HEALTH

OUTLINE

• The Facts• Your lungs • Workplace exposures• Lung health impact/ Occupational Health trends• Research• Acts & Regulations• Workplace Interventions• The Lung Association

THE FACTS:

• Every 20 minutes a Canadian dies from lung disease• One in five Canadians (six million) have a breathing

problem• More than 2.8 million Canadians have asthma• Asthma is the number one reason for work /school

absenteeism• More than 750,000 Canadians have chronic

obstructive pulmonary disease (COPD) - estimated only half of these people have been diagnosed and treated.

THE FACTS

• Lung disorders are the number one cause of short term disability

• 4th leading cause of death (2004)• 13% of all hospitalizations• Decreased quality of life for patients with COPD• High health service resource use & economic burden

to society

 

THE RESPIRATORY SYSTEM

•No oxygen -live only minutes •Every cell needs constant supply of oxygen•Lungs link to supply of life-giving oxygenFrom American Lung Association: Occupational Lung Diseases: An Introduction. New York, NY. Macmillan. 1979: pp 10. (5).

 

 

THE RESPIRATORY SYSTEM

• Susceptible to damage from inhaled toxic materials & irritants –surface area exposed to air is so large and body’s need for oxygen so great….great impact on body….leading to disease of other vital organs

Rest Breathe 6 liters air/minute

Heavy exercise Breathe over 75 liters /minute

8 hr day of moderate activity

Up to 8.5m³ (300 cubic ft)

Skin surface area 1.9m² (20 sq. ft)

Lungs surface area 28m² (300 sq. ft) rest → 93 m² (1000 sq. ft) deep breath

THE RESPIRATORY SYSTEM

NATURAL MECHANISMS against airborne hazards

• Fine hairs in nose

-front-line barrier

-filter

-exercise/hard work• Cough reflex –clears

trachea & main bronchi• Special cells-destroy

bacteria & viruses

•Ciliary cells-few hrs to expect foreign material•Innermost areas of lungs- much longer to clear out

THE RESPIRATORY SYSTEM

• Lungs that receive prolonged &/or repeated exposure to air contaminants eventually cannot keep up with the rate of deposition &/or constant irritation. Result: contaminants accumulate contributing to the development of Occupational Lung Diseases.

Diagram- black asbestos fibers- exposure standards to be less than 1 fibre/cm3 for 8 hr exposure

THE RESPIRATORY SYSTEMPARTICLES5 Fm or bigger Not airborne long

enough /trapped by nose

Heavier settle out quickly Easily removed if inhaled

Intermediate size (1-5 Fm)

Deposit in trachea & bronchi

Small size (0.01-1 Fm) Likely to reach bronchioles, alveolar ducts/alveoli

Fibrous/irregular shaped particles

Caught at bronchiole branching points

Some fibers/small particles

Travel to alveoli readily- aerodynamic properties

OCCUPATIONAL LUNG HAZARDS

TYPES OF LUNG HAZARDS (AIRBORNE)

Occupational Pulmonary Contaminants

come in many forms:• Seen, smelled, felt as irritants in nose or throat• Only detected with special equipment• Short tem exposure- immediate, acute damage• Most take repeated or constant exposure over

months or years to cause disease or permanent harm

• Influenced by air pollution, age, smoking history, nutritional status as well as genetics and stress

OCCUPATIONAL LUNG HAZARDS

• Several contaminants -same time –lead to additive or worse, synergistic consequences to health

• Essential to know what materials & processes used so appropriate monitoring & control of potential lung hazards can take place

• Exposures to airborne hazards can be greatly reduced or eliminated through engineering controls such as improving ventilation and good work practices such as the use of personal protective equipment (properly selected & maintained respirators) Legislated: Workplace Safety and Health Act, W210

MINERAL DUSTS

Particles formed from inorganic dusts.

AIRBORNE HAZARDS

MINERAL DUSTS • Dusts & mineral fibres from stones, rocks, ores• Sources: Mining, quarrying, tunnelling, blasting,

smelting, grinding, milling, processing, drilling, abrading

• Industries: mines, quarries, foundries• Lung effects: pneumoconiosis (asbestosis, silicosis,

black lung) chronic bronchitis, emphysema, fibrosis, cancer

ORGANIC DUSTS

Particles formed from organic materials.

AIRBORNE HAZARDSORGANIC DUSTS• Dusts formed from living materials-micro-organisms,

plants, animals & natural products like wood/leather.• Sources: Wood, cereal grains (planting, harvesting,

storing, transporting, processing), animal husbandry (droppings, dander, feathers)

• Industries: Agriculture, manufacturers (furniture/ drugs), millers, bakers, chemists

• Lung effects: Hypersensitivity reactions-occupational asthma or hypersensitivity pneumonitis-permanent obstructive disease, diffuse lung fibrosis. Wood dusts -cancer

CHEMICAL DUSTS

Dusts from synthetic materials.

AIRBORNE HAZARDS

CHEMICAL DUSTS• Synthetic chemicals (powder form)-pesticides,

pharmaceuticals, dyes, bleaching agents, detergents, paints

• Sources: Any contact … from making, packaging, applying, weathering

• Industries: aircraft building, autobody, pulp mills, chemical, breweries, foundries, hairdressing, health care, labs, manufacturing (paints), paint sprayers

• Lung effects: Depends on toxic properties of specific chemicals-irritants, allergens, lungs- cause cancer

FUMES

Metals and polymers.

AIRBORNE HAZARDS

FUMES• Very small solid particles formed when hot vapors

cool rapidly & condense– Can give off hazardous gases– Act like very fine mineral dust in lungs

• Sources: High heat processes• Industries: Smelting, arc-welding, furnace work• Lung effects: Difficult to assess effects of separate

materials since several hazards present at same time. Can lead to emphysema & lung cancer.

MISTS and SPRAYS

Liquid droplets and other propellant gas.

AIRBORNE HAZARDS

MISTS & SPRAYS• Liquid droplets suspended in air or other propellant

gas.• Sources: Cleaning products, pesticides, paints,

cosmetic products, rust removers, by-products from other processes (cutting oils in machine shops)

• Industries: Cutting, grind, spraying and pickling operations, electroplating

• Lung effects: The finer the spray… the deeper into the lungs it goes. Effect depends on material, concentration and temperature.

GASES

Natural or Manmade chemical reactions: phosgene, nitrogen oxides or methane ammonia, bromine, sulfur dioxide, chlorine & nitrogen, carbon monoxide & cyanide, or radioactive, vinyl chloride gas, nickel carbonyl.

AIRBORNE HAZARDSGASES• Fluids that expand to fill the space containing them • Can travel quickly, be highly flammable, explosive

when mixed with air, chemically or physiologically reactive. Some colorless & odorless.

• Sources: Natural chemical reactions (fermenting silage), Manmade chemical reactions (high-heat processes-welding)

• Industries: Agriculture, foundries, manufacturing• Lung effects: suffocation, interference with oxygen

use, immediate irritation, airway constriction, existing lung disease aggravation, cancer (takes years)

VAPORS

Ketones, aromatic hydrocarbons, alcohols, acetates and mercury.

AIRBORNE HAZARDSVAPORS

• Gaseous form of liquid always found over that liquid-more vapors form as liquid heats. Affect lungs similar to gases. Vapors hang out with parent liquids-gases don’t always stick with liquid forms.

• Sources: Inorganic-high boiling points, don’t vaporize at room temp.-aren’t usually assoc. with lung disease Organic-many vaporize at room temp.-used as solvents (ketones, alcohols, acetates, aromatic hydrocarbons)

• Lung effects: enter body through lungs- damage to other organs more so than lungs-pulmonary edema &

tracheobronchitis.

RADIATION

Ionizing (electromagnetic waves) and non-ionizing radiation.

AIRBORNE HAZARDS

RADIATION• Non-ionizing radiation (electromagnetic waves-

infrared, ultraviolet, microwave, laser, radar, radio frequency) Ionizing radiation (alpha, beta, gamma rays, neutron particles & x-rays)

• Sources: Mining radioactive ores• Industry: Medicine, power plants, equipment used in

industry (high energy electrical equip., lasers, microwaves, radar)

• Lung effects: Electromagnetic waves can cause thermal burns. Ionizing radiation can cause cancer.

BIOLOGICAL HAZARDS

Bacteria, viruses, fungi, ricketsia, Chlamydia & parasites.

AIRBORNE HAZARDS

BIOLOGICAL• Bacteria, viruses, fungi, rickettsial, chlamydial &

parasitic agents• Sources: Health care & child care facilities, poorly

maintained ventilation systems, biological research labs, animal care & processing facilities

• Lung effects: Depends on type of hazard. Can be minor allergies & resp. infections to cancer. Vaccinations for some.

CONFINED SPACES

Oxygen deficient atmosphere.

AIRBORNE HAZARDS

CONFINED SPACES• Oxygen deficient atmosphere-oxygen content below

19.5% by volume. • Sources: Storage tanks, drums, sewers, septic

tanks, manholes, pits, underground utility tunnels.• Lung effects: irritation to extreme ( immediate

death)- dependant on material/activity in confined area- RESPIRATORS REQUIRED.

LUNG HEALTH IMPACT

OCCUPATIONAL HEALTH TRENDS

Occupational respiratory (lung) diseases:• workplace exposure to irritating or toxic substances-

may cause acute or chronic respiratory ailments.

PNEUMONCONIOSES

Lung disease from inhaling inorganic dust in mines & other workplaces has declined over past 30 years.

PNEUMOCONIOSES

Pneumonconioses includes silicosis, black lung (coal miners), asbestosis (most common)

MESOTHELIOMA

Stats only available as of 2001 when the ICD codes were introduced and then only in all provinces in 2006 so national estimates are no available. Ca Care Ontario has stats that show a marked rise of mesothelioma associated with asbestos exposure decades earlier.

CONDITIONS DUE TO INHALATION OF CHEMICALS, FUMES OR GASES

Hospital admissions for lung conditions due to inhalation of chemicals, fumes or gases remained steady from 1979 to 2004. 7 deaths 2000-2004. Specific causes not identified.

OCCUPATIONAL ASTHMA

Most common lung disease compensated for by workers compensation. National data not available on rates of confirmed occupational asthma.

OCCUPATIONAL ASTHMAINDUSTRY/JOB at risk

Printers/paper products

Grain handlers

Lumber/wood workers

Leather workers

Paint sprayers

Plastics

Rubber industry

Bakers

Veterinarians

AGENT

Vegetable gums, natural glues

Grain dust

Wood dust

Formalin, chromium

Diisocyanates, dimet ethanalamine

Epoxy resin, polyurethane

Ethylene diamine, diisocyanates

Flour, insect, mite debris

Animal dander

OCCUPATIONAL ASTHMAINDUSTRY/JOB

Laboratory workers

Vegetable oil production

Beauticians/cosmetologists

Health care workers

Pharmaceutical workers

Solders, electronic fabricators

AGENT

Animal dander

Flax seed, castor bean

Diamines, potassium persulfate

Formaldehyde, medication, latex

Various drugs, enzymes

Colophony resin, ethanalamine

OTHER OCCUPATIONAL LUNG DISEASES

ICD codes not available for other Occupational lung diseases include occupational lung cancer from agents such as asbestos, chromium, radon (photo), & other occupational chronic obstructive lung disease. (15% to Occupational exposures). WCB numbers likely markedly underestimated.

Occupational Lung Disease Deaths:MB WCB-2005INDUSTRY CIRCUMSTANCES OCCUPATION

Mining Exposure to asbestos: pulmonary fibrosis

•Miner

ConstructionTradeTransportation, communication & storage

Exposure to asbestos: mesothelioma

•Carpenter•Boiler Maker•Pipe Fitter

Mining Inhaled dust: COPD •Labourer

Public Administration Exposure to smoke: other cancer

•Firefighters (2)

Other Service Industry Silicosis •Dental Technician

Other Service Industry Exposure to asbestos: mesothelioma

•Plumber-oil burner mechanic•Security Guard

Public Administration Exposure to asbestos: mesothelioma

•Carpenter

Occupational Disease Fatalities- MBDisease Conditions

2000 2001 2002 2003 2004 2005 2006 Total

Asbestosis 2 3 1 3 1 3 1 14

Mesothelioma 4 11 7 8 7 8 4 49

Other Cancers 2 1 1 7 0 4 6 21

Heart Injury 2 1 0 1 1 0 3 8

Other disease 2 1 0 0 0 4 1 8

TOTAL 12 17 9 19 9 19 15 100

Acute-Hazard & Occupational Disease Deaths- MB WCB

Cause of death

2000 2001 2002 2003 2004 2005 TOTAL

Acute hazard exposure deaths

25 28 18 16 17 18 122

Occupational disease deaths (WCB)

13 17 9 20 9 17 85

TOTAL 38 45 27 36 26 35 207

SMOKING & OCCUPATIONAL LUNG DISEASE

• Smoking contributes to lung disease– Impairs lungs’ natural defense mechanisms –

irritates airways & inhibits work of ciliary cells• Smoking is leading cause of serious lung disease &

certain types of cancer– Synergistic effect with other pulmonary carcinogens

(asbestos, chromium/uranium compounds, arsenic)– Increases lung cancer risk by 15% + chronic

asbestos exposure 4%= 60% risk NOT 29%• Smokers develop lung disease & cancer more readily

& diseases progress more rapidly

OCCUPATIONAL LUNG DISEASE

Pulmonary Diseases• Occupational Asthma• Reactive Airways Dysfunction Syndrome (RADS)• Emphysema• Chronic Bronchitis (repeated infections and/or

exposure to irritants such as fumes/dusts, oil aerosols, gases, smoke)

• Pneumoconioses (from particles less than 5 microns in size)

• Hypersensitivity Pneumonitis (organic dusts-fungi, animal proteins, vegetable proteins)

OCCUPATIONAL LUNG DISEASE

• Granulomatous Disease (TB, toxins-Berylliosis best known occupational example)

• Pneumonias- toxic process or more commonly infections (health care, child care & animal care workers)-fungi, bacteria, viruses, other microorganisms

• Occupational Lung Cancer- smoking, bis-chloromethyl ether, coal tar, pitch volatiles, mustard gas, arsenic, asbestos, radium, petroleum, chromates, uranium

REGULATIONS & ACTS

• Labour & Immigration of Manitoba• Workplace Safety & Health Division:• Workplace Safety & Health Act of Manitoba

(C.C,S,M.c.W210) updated to April 8,2008• Effective Feb.1, 2007 a new WS&H regulation was

consolidated into one : The Workplace Safety and Health Regulation 217/2006 – Certain industries –regulated- exposure to

asbestos & silica (Fibrogenic Dust Exposure Guideline-revised & released Dec.2008)

– Other industries- Due diligence

REGULATIONS & ACTS

DUE DILIGENCE:

In occupational health & safety: employers shall take all reasonable precautions under the particular circumstances, to prevent injuries or accidents in the workplace. Applies to situations that aren’t addressed elsewhere in the OHS legislation.

Bill C-45- federal legislation that amends the Canadian Criminal Code- became law 2004-applies legal duty to workplace health and safety.

RESPIRATORY SURVEILLANCE

• Employment settings where workers use or are potentially exposed to lung hazards

• Lung disease—most significant due to severity• Human & economic toll • Significant causes of morbidity, disability, early

retirement & death• Entirely preventable once causes recognized• HIGH PRIORITY -Recognition of Occupational Lung

Disease hazards & prevention of exposure

RESPIRATORY SURVEILLANCE 1. Reduce human suffering & economic impact of

occupational disease.

2. Detect occupational & non-occupational lung diseases in earliest stages when reduction of exposure is likely to be most effective.

3. Identify working conditions that are hazardous so that improvements in industrial hygiene can be made.

4. Establish baseline function for new employees & to identify job applicants with pre-existing lung damage so that they can be placed in positions that do not jeopardize their health.

WORKPLACE INTERVENTIONS

• Workplace Inspections• Workplace Safety & Health reps/committees• Engineering controls

– Workplace design– Equipment selection– Modification of existing equipment/processes– Ventilation system

• Work Practices & Procedures• Housekeeping• Maintenance

WORKPLACE INTERVENTIONS

• Personal Hygiene• Air-monitoring• Replace toxic products for safer/ less toxic products• Medical surveillance & examinations: Act/Reg. 50 (1)• Education & training• Personal protective equipment• Smoking cessation programs• Workplace wellness programs

THE LUNG ASSOCIATION

OCCUPATIONAL LUNG HEALTH • Perform occupational lung health screening

• Prevention & early detection• On-site or office appointments• Questionnaires• Lung function tests (spirometry)• Chest x-rays• Fitness to wear respirator testing• Medical surveillance & reports• Lung health trending• Retention of health records for 40 years

• Presentations/displays

THE LUNG ASSOCIATION

TOBACCO CESSATION & PREVENTION• Lungs are for Life (school program)• N.O.T. on Tobacco (teens)• Smoke Free Car & Home Campaign• World No Tobacco Day (May)• National Non-Smoking Week (Jan)• Workplace Smoking Cessation project –MANTRA/HC• Smoking Cessation Forums (universities- target)• Presentations, Displays, Print /video resources

THE LUNG ASSOCIATION

ENVIRONMENT• Bye Bye Beaters-vehicle scrappage program• Partnership with Science, Technology, Energy &

Mines to promote clear air quality messaging• Member of Crop Residue Burning

Advisory Committee• Air Quality issues

THE LUNG ASSOCIATION

THE SANATORIUM BOARD -1904

THE LUNG ASSOCIATION, MANITOBA

(Non-profit health charity -division of the Sanitorium Board of MB in 1975)

MISSION:

To improve lung health of Manitobans

For more information contact:

PHONE:

Winnipeg: (204) 774-5501

Brandon: (204) 725-4230

Toll free:1-888-566-5864

info@mb.lung.ca

www.mb.lung.ca