End the trend: occupational lung disease

Across the world, the risk of occupational lung disease for workers in hazardous environments remains a real threat. An estimated 12,000 deaths in Great Britain annually are the result of lung diseases linked to exposures at work, according to the Health and Safety Executive (HSE). Fatalities aside, the HSE estimates that 20,000 new cases of lung or breathing problems reported are a result of (or worsened by) airborne hazards in work environments.

In the United States, the Occupational Safety and Health Administration (OSHA) estimates that over five million workers perform tasks where they are required to wear respirators. Yet, in 2018, OSHA reported that the fourth most violated OSHA standard in 2018 related to respiratory protection, meaning workers were not properly protected when they needed to be.

These numbers are staggering. Since occupational lung diseases can take a long time to manifest, these statistics may potentially rise even higher. Though some current cases may be a result of past work environments, the numbers are still not trending downwards as quickly as they should be. In the UK, the HSE reports that the number of self-reported work-related lung or breathing problems has remained mostly consistent over the last 10 years, with about 310 cases per 100,000 workers.

Why haven’t these numbers gone down? Technology has come a long way in 10 years, paving the way for more advanced respiratory protective equipment (RPE), and its use is more prevalent than ever before. These advances in technology and widespread use have allowed RPE to become more affordable and offer a wider range of features and capabilities to protect workers. On the surface, there shouldn’t be any reason why work-related lung or breathing problems wouldn’t decrease; why is it still happening so frequently and how can we stop it?

The unseen peril

To understand the solution, we need to first understand the threat. Airborne hazards are particularly dangerous because certain fumes, vapours and gases are often colourless, odourless and tasteless. Without gas detection monitoring systems and alerts, workers may not even realise when these substances are present or — even more worryingly — when they are breathing them in.

Asbestos, for example, can exist in microscopic fibres that one cannot see, smell or taste. Carbon monoxide is odourless and colourless. Certain airborne particulates — including silica dust — can be so fine that they are smaller than the diameter of a human hair.

Even when the hazard is visible — like dusts or sprays — workers may not understand the great health implications that can be caused by exposure and inhalation. Since many occupational lung diseases have long latencies, effects may not present themselves for years after initial exposure. In other words: they don’t know until it’s too late.

What workers are up against

According to a report by the Labor Force Survey done from 2009–2012, 50% of respondents who reported experiencing these lung issues shared a resounding answer — airborne hazards. They cited the causes as airborne materials from a range of applications and environments, including spray painting, welding, cutting/grinding metals and soldering. These airborne hazards take the form of dusts, fumes, gases, vapours, sprays, mists and smoke.

Below are just a few of the most common examples of toxic substances frequently found in trade environments:

Silica dust (crystalline silica)

A natural substance found in stone, bricks, concrete, rocks, gravel, clay and sand, crystalline silica is a result of cutting, grinding, drilling or chipping these materials. Inhalation can cause a form of cancer called silicosis, which is characterised by inflammation and scarring in the lungs. Silicosis is incurable and can often be fatal.

Asbestos

Asbestos is a natural mineral substance that can be pulled into long, thin fibres of a fluffy consistency. It is a known human carcinogen, and inhalation can lead to dangerous and fatal diseases including lung cancer and mesothelioma.

Beryllium

Beryllium is an industrial metal often used in welding materials and found in welding fume. It is extremely toxic to lung tissue and has been linked to chromosomal damage. Chronic beryllium disease results from prolonged exposure and causes symptoms such as difficulty breathing, weakness and fatigue, and heart disease.

Carbon monoxide

Carbon monoxide is a gas often found in welding fume, and exposure can cause carbon monoxide poisoning. Symptoms include dizziness, headaches, vomiting and confusion. Prolonged exposure and large quantities of the gas can be fatal.

Cadmium

Cadmium is a toxic heavy metal that is also present in welding fume. In dust form, inhalation can lead to respiratory and kidney issues that are often fatal. Cadmium’s permissible exposure limit (PEL) for humans is very low, meaning even a small amount of exposure can have adverse health effects.

The exact composition and medium of airborne hazards varies and is determined by the employee’s work and application itself. This is also a defining factor in the severity of the impact on human health. Uniform national standards, government agencies, and employer health and safety programs are set in place to provide safer working environments, with the goal of limiting exposure.

Why are workers still getting sick?

Not every case is the same, and there are many reasons that a worker may become a victim of an occupational lung disease. There are several large factors worth looking at:

Shifting standards

Rules, regulations, laws and programs are necessary to provide a standard of safety across industries. They set benchmarks for health and provide knowledge and awareness for employers and employees alike. Yet research is continuously ongoing, and new data and information often reveals that standards and PELs previously deemed acceptable are, in fact, not permissible for good health.

One of the most recent examples of this is the International Agency for Research on Cancer’s reclassification of welding fume as a Group 1 carcinogen. Where previously classified as “possibly carcinogenic to humans”, the IARC’s reassessment found that it was based on “limited evidence in human beings” and “inadequate evidence” in animals.

In the United States, a 2017 new Occupational Safety and Health Administration (OSHA) ruling on beryllium exposure reduced the PEL and required employers to implement new or improved workplace controls as necessary. This changed a 40-year-old PEL that, according to OSHA’s new ruling, was “outdated and did not adequately protect worker’s health”.

These are just a few cases. As science continues to evolve and new research and data is gathered, changes like this are likely to continue. This means that those who worked in environments that met certain standards which have since been revised may actually have experienced unsafe exposures, and are at risk of illness.

Employers’ weak points

According to the HSE, “A recent in-depth investigation of a small sample of companies showed only around half were effective in protecting the wearer through their use of RPE as a control.” HSE found this was mainly due to a lack of understanding, knowledge and awareness. This includes things like wrongfully assuming that workers know to protect themselves, opting for cheap or quick controls, management that lacks RPE training, and lacking communication between employees and management.

In most cases, employers don’t do this intentionally, yet it still happens. For example, in August 2018 an adhesives manufacturer in the US was cited for 18 health and safety violations, including several respiratory citations. Among these violations, OSHA found that though the employer provided respirators, they were not appropriate for hazardous atmospheres. It may have been a willful violation, but it may also have been a matter of purchasing cheaper, yet unknowingly inadequate respirators, simply because they were not properly informed.

Cases like these illustrate that employers without full, proper knowledge of RPE and adequate employee training programs in place can often end up violating standards. This means that even if employees trusted the government standards and PELs set in place, their employer may not be meeting them, leaving them at risk of exposure to airborne hazards.

What’s the solution?

Ending cases of occupational lung disease won’t be easy, but it can be summed up in one word: choice.

Employers have their choice of what RPE and safety programs they will offer their employees. A wide range of advanced respiratory protection is available around the world and offers more features and capabilities than what was available in the past. Training programs can be made as comprehensive and hands-on as employers choose. There are companies available whose primary function is to help employers set up proper health and safety programs, and employers can choose to make use of them.

Perhaps the biggest choice lies in the hands of workers themselves. Workers can choose to be educated about the risks. They can choose to ensure they familiarise themselves with their work environments and the potential risks that come with them. Most importantly, whenever they are in potentially hazardous environments, they can choose to be better safe than sorry, and always protect themselves to the best of their ability.

Sources

_{1. “Work-Related Ill Health and Occupational Disease in Great Britain.” Health Services — Safe Use of Bed Rails, Health and Safety Laboratory, www.hse.gov.uk/statistics/causdis/.}

_{2. “Occupational Lung Disease in Great Britain, 2018.” Occupational Lung Disease in Great Britain, 2018, Health and Safety Executive, 31 Oct. 2018, www.hse.gov.uk/statistics/causdis/respiratory-diseases.pdf.}

_{3. “Technical Note - Workplace Injury and Work-Related Illness Survey Modules of the Labour Force Survey: Background and Methods.” Health Services — Safe Use of Bed Rails, Health and Safety Laboratory, www.hse.gov.uk/statistics/lfs/technicalnote.htm.}

_{4. “AIHA Protecting Worker Health.” Lab Safety Chemical Exposures Incidents, www.aiha.org/publications-and-resources/TheSynergist/Industry News/Pages/IARC-Welding-Fumes-UV-Radiation-from-Welding-Are-Carcinogenic.aspx.}

_{5. “UNITED STATES DEPARTMENT OF LABOR.” Occupational Safety and Health Administration, www.osha.gov/berylliumrule/index.html.}

_{6. “How Good Are You?” Health Services - Safe Use of Bed Rails, Health and Safety Laboratory, www.hse.gov.uk/respiratory-protective-equipment/how-good-are-you.htm.}

_{7. “Department of Labor UNITED STATES DEPARTMENT OF LABOR.” Occupational Safety and Health Administration, www.osha.gov/news/newsreleases/region5/08032018.}

*Megan McConville, Digital Lead and Content Specialist, RPB Safety LLC

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