The Risk of COPD is Increased for Workers in Certain Industries and Occupations and with Certain Occupational Exposures

November is National COPD Prevention Month.  COPD – chronic obstructive pulmonary disease – is characterized by airflow obstruction and breathing-related problems. The term COPD includes the conditions of emphysema and chronic bronchitis.  COPD is a major cause of illness in the United States.  It affects at least 15 million US adult men and women and is the 4^th leading cause of death.[1] There is no cure for COPD, and patients get worse over time.  Prevention is essential to control this disease.  Prevention efforts have emphasized limiting exposure to cigarette smoke, which is the leading preventable cause of COPD. However, up to 30% of people with COPD never smoked.  Occupational exposures are important causes of COPD, contributing to an estimated 14% of all cases and 31% of cases in never smokers.[2]  To fully eliminate COPD, it is necessary to minimize exposures to work-related COPD agents that can cause new cases and make existing cases worse.

The following two NIOSH studies highlight associations between working in certain settings and increased risk for COPD.

Researchers in one NIOSH study identified different industries and occupations associated with COPD.[3]  This study was based on a survey that followed people for 20 years into retirement, making it possible to investigate the effects of occupational exposures that occurred during working years.

The study found risks for COPD were significantly elevated for several industries:

• mining
• blast furnaces
• steelworks
• rolling and finishing mills
• groceries and related products
• automotive repair shops

Occupations with significantly elevated risk for COPD were:

• maids and housemen
• farmworkers
• vehicle/mobile equipment mechanics and repair workers
• material-moving equipment operators
• non-construction laborers

Certain exposures in several industries and occupations put workers at elevated risks for COPD:

• asbestos in the blast furnace/steelworks/rolling/finishing mills industries,
• aerosol paint in automotive repair shops,
• pesticide among farmworkers, and
• dust and ash in both material moving equipment operators and non-construction laborers.

Findings from another NIOSH study implicated different occupational exposures as risk factors for COPD.[4] The researchers analyzed data from a nationally representative study of the non-institutionalized civilian US population. The occupational exposures associated with airflow obstruction or COPD were:

• mineral dust
• combined organic and mineral dust
• exhaust fumes
• diesel exhaust
• vapor-gas
• sensitizers
• any vapor-gas, dust, or fumes

Findings from other studies suggest COPD can also be associated with metal/welding fumes, asphalt/tar fumes or vapors in road and roofing operations, and smoke from fires.

Identifying specific work settings and exposures associated with increased risk for COPD is important because it can inform efforts to prevent COPD among workers in those settings. If employers and workers are aware of work-related respiratory hazards, they can implement interventions from across the hierarchy of controls to reduce or even eliminate potentially harmful exposures. In some work settings where workers are exposed to COPD-causing agents, health screening is required to detect COPD in its early stages so workers can take action before the disease progresses and becomes disabling. Workers in other settings with exposure to COPD-causing agents should discuss this with their healthcare providers so testing for COPD can be provided when appropriate. Eliminating work-related COPD is an important and achievable goal.

Paul K. Henneberger, MPH, ScD, is the Senior Science Advisor in the NIOSH Respiratory Health Division.

References

[1] National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH). What Is COPD? Updated March 24, 2022; https://www.nhlbi.nih.gov/health/copd#Signs,-Symptoms,-and-Complications#:~:text=What%20Is.%20COPD%2C%20or%20chronic%20obstructive%20pulmonary%20disease%2C,shortness%20of%20breath%2C%20chest%20tightness%2C%20and%20other%20symptoms

[2] Blanc PD, Annesi-Maesano I, Balmes JR, et al. The occupational burden of nonmalignant respiratory diseases: An Official American Thoracic Society and European Respiratory Society Statement. Am J Respir Crit Care Med 2019;199:1312–1334.

[3] Silver SR, Alarcon WA, Li J. Incident chronic obstructive pulmonary disease associated with occupation, industry, and workplace exposures in the Health and Retirement Study. Am J Ind Med 2021;64:26–38.

[4] Doney D, Kurth L, Halldin C, Hale J, Frenk SM. Occupational exposure and airflow obstruction and self-reported COPD among ever-employed US adults using a COPD-job exposure matrix. Am J Ind Med 2019;62:393–403.