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Occupational lung disease
Executive Editor, InnovAiT
E-mail: chantal.simon{at}oxfordjournals.org
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Abstract |
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 TOP Abstract The GP curriculum and...Industrial lung diseasesBenefits availableCompensation for workers...References |
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Exposure to gases, vapours and dusts at work can lead to lung disease. If a patient develops an occupational lung disease, a doctor is obliged to notify the patient's employer in writing with the patient's consent. A list of notifiable respiratory diseases is included in Box 1. The doctor does not need to make a judgement about whether the disease is, in that particular case, caused by the occupation.
The work of family doctors is determined by the make-up of the community and therefore they must understand the character of the community in which they work in terms of socio-economic and health features. GPs must understand the health needs of communities through the epidemiological characteristics of their population and this includes the incidence of occupational lung disease. Curriculum statement 15.8: ‘Respiratory problems’ states that GPs must be able to assess the likelihood of occupational exposure as a cause of respiratory disease.
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Employers must then inform the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations (RIDDOR) incident contact centre (Tel: 0845 300 99 23, website: www.riddor.gov.uk). Self-employed patients must contact RIDDOR themselves. Patients who do not give consent for the doctor to notify their employer may allow the doctor to inform the employer's occupational health department or RIDDOR directly instead.
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Industrial lung diseases |
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TOPAbstractThe GP curriculum and...Industrial lung diseasesBenefits availableCompensation for workers...References |
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In all cases, if you suspect an industrial lung disease, refer to a respiratory physician for confirmation of diagnosis and advice on management. This is essential for the patient to claim appropriate benefits or if the patient is seeking compensation.
Coal worker's pneumoconiosis
Coal worker's pneumoconiosis accounts for around 90% of all compensated industrial lung disease in the UK. ‘Pneumoconiosis’ means accumulation of dust in the lungs and tissue reaction to its presence. Incidence is related to total dust exposure.
In simple pneumoconiosis, there is deposition of coal dust in the lung. Changes are graded on chest X-ray appearance. This grading determines whether disability benefit is payable in the UK. The effect of the X-ray changes on lung function is debated. Simple pneumoconiosis predisposes to progressive massive fibrosis.
In progressive massive fibrosis, round fibrotic masses several centimetres in diameter form in the upper lobes (Fig. 1). Progressive massive fibrosis presents with exertional dyspnoea, cough, black sputum and eventually respiratory failure. Symptoms progress, or may even start, after exposure to coal dust has ceased. Lung function tests show a mixed restrictive and obstructive picture with loss of lung volume, irreversible airflow limitation and reduced gas transfer.
Box 1. Notifiable industrial respiratory diseases
Note: For a complete list, see RIDDOR: Information for doctors available from website: www.hse.gov.uk.
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Asbestosis
Before legislation banning its use, exposure to asbestos was widespread in the UK and occurred particularly in naval shipyards and power stations. Effects of asbestos exposure are summarized in Table 1. Deaths from mesothelioma (Fig. 2) are increasing and are likely to peak in 2020. Remember to consider this diagnosis in relatives of asbestos workers who came into contact with asbestos indirectly, for example through washing asbestos workers' clothes. These people can claim compensation if affected in the same way as asbestos workers.
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Occupational asthma
Over 200 industrial materials cause occupational asthma. Important causes are recognized occupational diseases in the UK. Up to 15% of all adults with new onset or recurrence of asthma have occupational asthma. Patients may be eligible for statutory compensation if they apply within 10 years of leaving the occupation in which the asthma developed. Suspect occupational asthma if a patient has symptoms of asthma that improve on days away from work or when on holiday. Figure 5 summarizes the British Occupational Research Foundation guidelines for case finding and management in primary care
Hypersensitivity pneumonitis
Hypersensitivity pneumonitis was formerly known as extrinsic allergic alveolitis. It is also colloquially known as ‘farmer's’ or ‘bird fancier's’ lung. Inhaled particles, such as fungal spores or avian proteins, provoke an allergic reaction in the lungs of hypersensitive individuals. Hypersensitivity pneumonitis may count as an industrial disease if the exposure was as a result of the individual's work.
It presents in two ways that can occur together simultaneously:
- Acute reactions: These occur 2–4 hours after exposure to the allergen. The patient develops fever, malaise, dry cough and shortness of breath.
- Chronic reactions: Ongoing symptoms of malaise, weight loss and exertional dyspnoea. Examination reveals fine crepitations in both lung fields.
In general practice, investigate with a full blood count, erythrocyte sedimentation rate (ESR) and chest X-ray. In an acute reaction, the neutrophil count and ESR are both raised. Chest X-ray may be normal or have characteristic features of shadowing (Fig. 3), widespread small nodules or a ground glass appearance. Specialist confirmation of the diagnosis is based on high-resolution computerised tomography (CT) findings and the presence of serum precipitins to the provoking factor (found in more than 90% of patients).
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If possible, prevent further exposure to the allergen. Acute and chronic disease is treated with prednisolone. For acute attacks use 40 mg daily, reducing the dose and stopping the steroids as soon as the symptoms resolve. Refer for specialist advice on management of chronic reactions.
Silicosis
Silicosis is uncommon. It affects stonemasons, pottery workers, workers exposed to sandblasting and fettlers who remove sand from metal casts. It is caused by inhalation of silica. Silicosis is associated with an increased risk of lung cancer and tuberculosis.
Silicosis presents with exertional dyspnoea, sometimes accompanied by chronic cough. Lung function tests show a mixed restrictive and obstructive picture with loss of lung volume, irreversible airflow limitation and reduced gas transfer. Chest X-ray appearance is distinctive (Fig. 4).
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Berylliosis
Berylliosis is rare. It affects workers in the aerospace, nuclear power and electrical industries and their close relatives. Berylliosis can result from a single exposure to beryllium dust, but is more usually associated with prolonged exposure. The lungs become hypersensitive to beryllium causing the development of granulomas. Ultimately, this process leads to a chronic, restrictive lung disease.
Onset of symptoms may range from weeks to decades after exposure. Berylliosis presents similarly to sarcoidosis with respiratory symptoms, such as chest pain, cough and shortness of breath on exertion, and systemic symptoms, such as fever, weight loss and joint pains. Examination may reveal inspiratory crackles, lymphadenopathy and/or hepatosplenomegaly. Chest X-ray is normal in about half of all cases. Significant findings include hilar lymphadenopathy and increased lung markings. Specialist diagnosis is with high-resolution CT and the beryllium lymphocyte proliferation test.
If patients are asymptomatic and their lung function is stable, they are usually monitored. Treatment with steroids or methotrexate is used for patients with symptoms or progressive decline in lung function.
Byssinosis
Byssinosis affects cotton mill and yarn workers. The symptoms, tightness in the chest, cough and breathlessness, start on the first day back at work after a break. For this reason, it is colloquially known as ‘Monday sickness’. Symptoms improve as the week progresses. Chest X-ray is normal. Treatment is symptomatic with antihistamines and broncholdilators. Workers affected should be moved to work in a less contaminated area.
Iron (siderosis), barium (baritosis) and tin (stannosis) dust inhalation
Inhalation of iron, barium or tin particles results in dramatic dense nodular shadowing on chest X-ray but effects on lung function and symptoms are often minimal.
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Benefits available |
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TOPAbstractThe GP curriculum and...Industrial lung diseasesBenefits availableCompensation for workers...References |
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Prescribed industrial disease is disease for which benefit is paid if the applicant worked in a job for which that disease is ‘prescribed’ and it is likely that the employment caused the disease. For occupational respiratory diseases, claims may be made at any time with the exception of occupational asthma for which claims must be made within 10 years of leaving the employment causing the disease. The list of prescribed diseases is similar to but not the same as the list of notifiable diseases.
Disablement benefit
Disablement benefit is available to employed earners for injuries resulting from accidents, or certain prescribed illnesses arising as a result of employment, even if the employee was either part or wholly to blame. Industrial covers virtually all forms of work.
In all cases, benefits are only paid if the level of disability is assessed at 14% or more by a disability assessor. The exception to this is dust-related lung disease for which there is no minimum level of disability. For accidents, claims can be made at any time after the event but benefit is paid only if there are still effects of the injury after the 91st day. If a patient claims benefit for more than one industrial accident or disease, assessments may be added together and benefit awarded on the total.
Reduced earnings allowance
Reduced earnings allowance is payable if the accident occurred or the disease was contracted prior to the 1 October 1990, the patient is assessed as being at least 1% disabled and is
- unable to work;
- unable to perform his or her normal job or
- working less hours at his or her normal job as a result of the accident or disease.
Reduced earnings allowance becomes Retirement allowance at the age of 60 years for women or 65 years for men. It is paid at 25% of the rate of the reduced earnings allowance when the claimant stopped work.
Constant attendance allowance
Constant attendance allowance is for people so disabled that they need constant care and attention and who are getting disablement benefit for disability assessed at 100%. There are four rates of benefit.
Exceptionally severe disablement allowance
Exceptionally severe disablement allowance is for people who get constant attendance allowance at high rate and where need for attendance is likely to be permanent.
Making claims
Claims for benefits for industrial diseases or injuries can be made through local Jobcentre Plus or social security offices. A full list of prescribed industrial diseases is also available from these places. Some claims can be made online at website: www.jobcentreplus.gov.uk.
Other benefits
People who suffer from industrial diseases or have suffered disability as a result of an industrial accident are also eligible to apply for benefits available for any disabled individual—such as Statutory Sick Pay, Incapacity Allowance, Working Tac Credit, Disability Living Allowance or Attendance Allowance, Carers Allowance and Income Support.
| Information and support for patients British Lung Foundation Tel: 08458 50 50 20, website: www.lunguk.org Occupational and Environmental Diseases Association website: www.oeda.demon.co.uk Trade unions Veterans UK Tel: 0800 169 22 77, website: www.veterans-uk.info Jobcentre Plus website: www.jobcentreplus.gov.uk Citizen's Advice Bureau website: www.adviceguide.org.uk The Tax Office website: www.hmrc.gov.uk (Tel: 0845 300 3900) Disability and carers service website: www.direct.gov.uk
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Compensation for workers disabled by lung disease |
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TOPAbstractThe GP curriculum and...Industrial lung diseasesBenefits availableCompensation for workers...References |
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Pneumoconiosis etc (Workers' Compensation) Act 1979
This Act is designed to provide compensation for sufferers of certain industrial diseases caused by dust, irrespective of industry. If the patient has died, a dependant may claim. Sufferers must be unable to claim damages from the employers who caused the disease because they have ceased trading. The sufferer or dependants must not have brought a court action or received compensation from an employer in respect of the disease.
Diseases covered include:
- Diffuse mesothelioma
- Pneumoconiosis (including silicosis, asbestosis and kaolinosis)—except former coal industry workers who are covered by a separate scheme (below).
- Diffuse pleural thickening
- Primary lung cancer if accompanied by asbestosis or diffuse pleural thickening
- Byssinosis
Sufferers should normally be in receipt of disablement benefit for the disease. Dependants can claim disablement benefit up to 6 months posthumously—if time-barred, dependants can still make a claim for compensation. Further information is available on—Tel: 0800 279 23 22 or website: www.jobcentreplus.gov.uk.
Coal miners
Former coal industry workers suffering from pneumoconiosis, chronic bronchitis and/or chronic obstructive pulmonary disease are covered by a separate scheme administered on behalf of the Department of Trade and Industry. Cases must be lodged via a trade union or legal representative.
Armed forces
Workers can claim under the War Disablement Pensions Scheme if occupational respiratory disease was as a result of work in the armed forces prior to 6 April 2005. If the occupational respiratory disease arose after that date, members of the armed forces can claim under the Armed Forces Compensation Scheme.
The courts
Claims brought through the courts are fraught with difficulty. Expert legal advice from a lawyer specializing in industrial disease compensation claims is essential. Victims must establish that their condition was caused by work and due to negligence on the part of their employers or someone else. Sufferers or their dependants can make claims against a previous employer, the company responsible for their exposure (e.g. exposure due to living near an asbestos factory or exposure of a spouse due to washing clothes, etc.) or the company's insurer. Usually, claims must be initiated within 3 years of diagnosis of an asbestos-related disease.
Key points
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References |
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TOPAbstractThe GP curriculum and...Industrial lung diseasesBenefits availableCompensation for workers...References |
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British Occupational Health Research Foundation. Occupational Asthma: a guide for general practitioners and practice nurses (2004) Available from: www.bohrf.org.uk/downloads/asthlgp.pdf.
Citizen's Advice Bureau. www.citizensadvice.org.uk/ [date last accessed 16.12.2007].
Department of Works and Pensions. www.dwp.gov.uk/ [date last accessed 16.12.2007].
Disability and carers service. www.direct.gov.uk/en/CaringForSomeone/index.htm and www.direct.gov.uk/en/DisabledPeople/index.htm [date last accessed 16.12.2007].
Health and Safety Executive. Tel: 0870 154 55 00. Available from: www.hse.gov.uk/ [date last accessed 16.12.2007].
Jobcentre plus. www.jobcentreplus.gov.uk/JCP/Customers/WorkingAgeBenefits/Dev_007969.xml.html [date last accessed 16.12.2007].
Lynch J, Simon C. Oxford General Practice Library respiratory problems (2007) Oxford University Press: Oxford.
Newman Taylor AJ, Nicholson PJ. Guidelines for the prevention, identification & management of occupational asthma: evidence review & recommendations (2004) London (UK): British Occupational Health Research Foundation.
RCGP GP Curriculum statement 15.8: Respiratory problems. Accessed via www.rcgp-curriculum.org.uk/PDF/curr_15_8_Respiratory_problems.pdf [date last accessed 11.11.2008].
RIDDOR Incident Contact Center. Tel: 0845 300 99 23. www.hse.gov.uk/riddor/ [date last accessed 16.12.2007].
The Pensions Service. www.thepensionservice.gov.uk/ [date last accessed 16.12.2007].
The Tax Office. www.hmrc.gov.uk/. Tel: 0845 300 3900. [date last accessed 16.12.2007].
Veterans UK. Tel: 0800 169 22 77. www.veterans-uk.info/ [date last accessed 16.12.2007].
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