Occupational COPD Kayvan Karamifar M D Occupational Medicine

Occupational COPD Kayvan Karamifar, M. D Occupational Medicine Specialist Department of Occupational Medicine Yazd University of Medical Sciences

Obstructive Pulmonary Disease • Chronic obstructive pulmonary disease (COPD) • Asthma • Bronchiectasis • Cystic fibrosis • Bronchiolitis obliterans • Alpha-1 -antitrypsin deficiency

Introduction • The commonest form of chronic lung disease in developed countries • Affecting 5 -10% of population • Associated with chronic bronchitis, emphysema, bronchiolitis and asthma any combination of these.

Definition of COPD • Chronic Obstructive Pulmonary Disease (COPD) is a preventable and treatable disease state characterised by airflow limitation that is not fully reversible. • The airflow limitation is usually progressive and associated with an abnormal inflammatory response of the lungs to noxious particles or gases, primarily caused by cigarette smoking.

COPD- Definitions • Emphysema – "an anatomical alteration of the lung characterized by an abnormal enlargement of the air-spaces distal to the non-respiratory bronchioles, accompanied by destructive changes of the alveolar walls. " • Chronic Bronchitis – " a clinical disorder characterized by excessive mucus secretion. . . chronic or recurrent productive cough. . . on most days for a minimum of three months in the year for not less than two successive years. "

Prevalence & Incidence

COPD: Risk Factors • Exposures – Smoking (generally ≥ 90%) – Passive smoking – Ambient air pollution – Occupational dust/chemicals – Childhood infections (severe respiratory, viral) – Socioeconomic status • Host factors – Alpha 1 -antitrypsin deficiency (<1%) – Hyperresponsive airways – Lung growth

Normal Chronic Bronchitis Emphysema

• Most reviewers now accept a causal occupational link and the conditions experienced by workers in several industries over recent decades are considered by many to be similar potency to cigarette smoking

Specific Occupational Causes • • • Coal dust Silica Asbestos Cadmium fumes Cotton dust • Grade 3 byssinosis • Grain dust • Wood dust • Agriculture • Metal fume – welding • Irritant gases • Combustion products – Firefighters

Diagnostic criteria for occupational COPD • Definite confirmation of diagnosis of COPD according to GOLD criteria or ATS criteria – Chronic bronchitis or emphysema or both • Confirmed exposure to one or more occupational etiologic agents – Sufficient exposure ( duration and intensity) – Minimum exposure duration required: • 20 years for coal dust • R/O of antitrypsin deficiency • Least role of cigarette smoking

Assess and Monitor Disease: Key Points • Diagnosis of COPD is based on a history of exposure to risk factors and the presence of airflow limitation that is not fully reversible, with or without the presence of symptoms.

Assess and Monitor Disease: Key Points • Patients who have chronic cough and sputum production with a history of exposure to risk factors should be tested for airflow limitation, even if they do not have dyspnea.

Diagnostic Criteria

Diagnosis of COPD EXPOSURE TO RISK FACTORS SYMPTOMS cough sputum dyspnea tobacco occupation indoor/outdoor pollution è SPIROMETRY

Emphysema- CXR

Emhpysema- HRCT Normal Emphysema

Normal Lung Centriacinar Emphysema Panacinar Emphysema

Emphysema- HRCT Centriacinar Emphysema Panacinar Emphysema

Chronic Bronchitis Cor Pulmonale - CXR

GOLD Guidelines for COPD Stage 0: At Risk Diagnosis Treatment • Chronic cough/sputum • PFTs within normal limits • No symptoms • Avoid risk factors (smoking cessation)

GOLD Guidelines for COPD Stage I: Mild Diagnosis Treatment • FEV 1 >80% predicted • FEV 1/FVC <70% • With/without symptoms • Avoid risk factors • Short-acting bronchodilator PRN

GOLD Guidelines for COPD Diagnosis Stage II: Moderate • 50% FEV 1 <80% predicted • FEV 1/FVC <70% • With/without symptoms Treatment • Avoid risk factors • Regular therapy with 1 bronchodilators • Inhaled corticosteroids if significant symptoms and lung function response • Rehabilitation

GOLD Guidelines for COPD Stage III: Severe Diagnosis Treatment • 30% FEV 1 < 50% predicted • FEV 1/FVC < 70% • With/without symptoms • Avoid risk factors • Regular therapy with 1 bronchodilators • Rehabilitation • Inhaled corticosteroids if significant symptoms and lung function response or if repeated exacerbations

GOLD Guidelines for COPD Stage IV: Very Severe Diagnosis • FEV 1 < 30% predicted • FEV 1/FVC < 70% • Respiratory failure • Right-side-of-the-heart failure Treatment • Avoid risk factors • Regular therapy with 1 bronchodilators • Inhaled corticosteroids if significant symptoms and lung function response or repeated exacerbations • Rehabilitation • Treatment of complications • Long-term O 2 therapy for hypoxic respiratory failure • Evaluate for surgical treatment

Impairment Rating

Medical Surveillance • Respiratory Questionnaire • Spirometry ( annually )