Air Pollution Awareness

May 13, 2014

Air pollution reached high levels in parts of Britain due to a combination of dust from the Sahara desert as well as local and European emissions in April 2014.¹

This highlighted that Employers need to be aware of the health and comfort of outdoor and indoor employees.  Employers must control workplace exposure levels and emissions to the Environment. Employees should also be encouraged to stop smoking.

This article² considers the trends that emerge between air pollution, smoking, occupational health and lung disease.

The European Respiratory Society (ERS) published the European Lung White Book using data from the World Health Organization (WHO) and the European Centre for Disease Prevention and Control (ECDC). This report re-emphasises the problems with Lung Disease. It highlights key facts, figures, and factors resulting in lung disease and suggests recommendations.

• Lung diseases are responsible for 86% of deaths in Europe. There is a large financial strain associated with the disease.
• Smoking is a key factor in most cases of lung disease.
• There is limited awareness and understanding, including absence of surveillance data.
• Air pollution is considered to be a serious respiratory health issue. Many European air quality standards are far lower than WHO recommended levels.

Economic impact

The report reflects on the associated financial burden respiratory disease costs the EU. It is estimated that more than €380 billion a year is spent directly and indirectly. Direct costs associated with medical care include hospitalisation, rehabilitation, medication, tests, doctors and medical staff costs. Indirect costs are caused by time off work and premature death. Within Europe, approximately 66,155 working days per 100,000 of the population are lost per annum due to diseases of the respiratory tract.

Smoking

Smoking-related diseases are considered within the report, predicting that lung cancer and chronic obstructive pulmonary disease (COPD) will rise over the next 20 years because of past smoking rates. The report states that 90% of chronic obstructive pulmonary disease and 80–85% of lung cancer are directly linked to tobacco smoking. Many other factors can also cause lung disease such as genetic influences, nutritional, environmental and poverty-related factors. The human respiratory tract is also vulnerable to infectious agents.

Air pollution

Outdoor air pollution causes adverse respiratory effects. An increase in the concentration of particulate matter (PM), black smoke and sulphur dioxide are all known to increase the risk of death from a respiratory disease. Indoor air pollution has also been highlighted as a serious issue. Many deaths in the EU are due to inhalation of air pollutants caused by PM, nitrogen dioxide (NO2) and ozone (O3). Inhalation of PM causes irritation and damage to the lungs; ozone causes respiratory problems and is known to trigger asthma, while nitrogen dioxide causes reduced lung function.

Occupational health

Changes in workplace legislation have contributed towards the advance of workplace conditions to help prevent inhalation of pollutants. However, many air quality standards need to be improved. Cases of silica and asbestos exposure are still being seen. This is due to the latency period. In addition, exposure to di-isocyanates and beryllium is still increasing and hence an increase in cases of asthma and berylliosis.

Occupational agents are known to cause 15% of respiratory cancers in men and 5% in women, 17% of all adult asthma cases, 15–20% of chronic obstructive pulmonary disease (COPD) cases and 10% of interstitial lung disease cases.

The key points of the report with regards to occupational health include the following.

• A detailed history is key when assessing a worker’s occupational exposure risk and establishing a diagnosis. The latency of occupational respiratory diseases can range from a few hours to 50 years.
• National and international bodies set maximum allowable workplace concentrations for a wide range of substances. However, these limits are not usually set at a level designed to avoid sensitisation.
• The effects of workplace respiratory exposures can be life-changing, ranging from acute inhalation injuries to lung cancer, and running the full spectrum of pleural, interstitial and inflammatory respiratory disease.

Exposure history and assessment

Detailed history is identified as being key. The components of a thorough occupational exposure history are detailed in the report and are stated as follows.

• Job type and activities: employer, products the company produces, job title, years worked, description of job tasks or activities, description of all equipment and materials the patient used, description of process changes and dates they occurred, any temporal association between symptoms and days worked.
• Exposure estimate: visible dust or mist in the air and estimated visibility, dust on surfaces, visible dust in sputum (or nasal discharge) at end of work shift, hours worked per day and days per week, open or closed work process system, presence and description of engineering controls on work processes (for instance, wet process, local exhaust ventilation), personal protective equipment used (type, training, testing for fit and comfort and storage locations), sick co-workers.
• Bystander exposures at work: job activities and materials used at surrounding work stations, timing of worksite cleaning (during or after shift), individual performing clean-up and process used (wet versus dry).
• Bystander exposure at home: spouse’s job, whether spouse wears work clothes at home and who cleans them, surrounding industries.
• Other: hobbies, pets, problems with home heating or air-conditioning, humidifier and hot tub use, water damage in the home.

Discussion

Industry has taken some positive steps towards reducing exposure. There is clearly room for improvement. Employers need to record occupational exposure and introduce more controls to ensure that air quality standards are met.

The information in the report is harsh and to the point, suggesting that smoking and pollutant inhalation are primary causes of death with exposure levels recommended significantly lower than some prescribed UK thresholds.

More information

The European Lung White Book can be found on the ERS website.

The European Lung Foundation (ELF) works closely with the European Respiratory Society (ERS) and has jointly produced a brochure which summarises the key facts and information from the European White Book. This can be downloaded from the ELF website.

Scientific Committee on Occupational Exposure Limits is available from the EC website.

References

1 Air pollution warning continues for England and Wales; The Guardian; (accessed online on 14/04/2014)

2 Taken from Feature Article by Caroline Raine; Air pollution awareness highlighted by the World Health Organization (WHO); last update 25/09/2013 (accessed online at Croner-i Hazardous Substances on 14/04/2014)