Occupational diseases are often thought to be uniquely and specifically related to factors in the work environment; examples of such diseases are the pneumoconioses. However, in addition to other factors (usually related to lifestyle), occupational exposures also contribute to the development or worsening of common respiratory diseases, such as chronic obstructive pulmonary disease (COPD), asthma and lung cancer.
Information about the occurrence of occupational respiratory diseases and their contribution to morbidity and mortality in the general population is provided by different sources of varying quality. Some European countries do not register occupational diseases and in these countries, information about the burden of such diseases is completely absent. In others, registration is limited to cases where compensation is awarded, which have to fulfil specific administrative or legal criteria as well as strict medical criteria; this leads to biased information and underestimation of the real prevalence. Under-reporting of occupational disease is most likely to occur in older patients who are no longer at work but whose condition may well be due to their previous job. In addition, there may be no incentive to report occupational diseases, and insufficient awareness among physicians may also contribute.
In some countries, schemes have been developed for the voluntary reporting of occupational respiratory diseases by respiratory and occupational physicians. The best known of these schemes is the SWORD (Surveillance of Work Related and Occupational Respiratory Disease) system initiated in the UK in 1989. While such voluntary reporting schemes have drawbacks, they nevertheless enable us to estimate the contribution of work to the occurrence of respiratory disease and to identify priorities for prevention.
For diseases with multiple causes, such as asthma, COPD and lung cancer, reliable information on the contribution of occupational exposures is provided by well-designed epidemiological studies. One complication is that occupational asthma is not directly measured (diagnosed) in general population studies, and attributable risks have to be calculated using often quite crude information about exposure and the phenotype of asthma. Based on such epidemiological analyses, it has been shown that the population-attributable fraction of occupational factors in mortality and morbidity from respiratory diseases is far from negligible: for asthma and COPD, respectively, it varies between 2–15% and 15–20%, resulting in a considerable number of cases in the European Union (EU), even if this is often difficult to substantiate and document in individual subjects. A similarly high contribution is expected for lung cancer.
This chapter provides a brief overview of the major categories of respiratory diseases and, where possible, will indicate the role and contribution of occupational exposures to their occurrence. Little quantitative information will be presented, but this summary should identify the main areas in which efforts are required for the prevention, diagnosis, management and compensation of occupationally induced respiratory diseases in Europe. The chapter will also address management and prevention.