BREATHING EASY AT WORK

1
BREATHING EASY AT WORK

• OCCUPATIONAL LUNG HEALTH

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OUTLINE

• The Facts
• Your lungs
• Workplace exposures
• Lung health impact/ Occupational Health trends
• Research
• Acts Regulations
• Workplace Interventions
• The Lung Association

3
THE FACTS

• Every 20 minutes a Canadian dies from lung
  disease
• One in five Canadians (six million) have a
  breathing problem
• More than 2.8 million Canadians have asthma
• Asthma is the number one reason for work /school
  absenteeism
• More than 750,000 Canadians have chronic
  obstructive pulmonary disease (COPD) - estimated
  only half of these people have been diagnosed and
  treated.

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THE FACTS

• Lung disorders are the number one cause of short
  term disability
• 4th leading cause of death (2004)
• 13 of all hospitalizations
• Decreased quality of life for patients with COPD
• High health service resource use economic
  burden to society
•  

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THE RESPIRATORY SYSTEM

• No oxygen -live only minutes
• Every cell needs constant supply of oxygen
• Lungs link to supply of life-giving oxygen
• From American Lung Association Occupational Lung
  Diseases An Introduction. New York, NY.
  Macmillan. 1979 pp 10. (5).
•  
•  

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THE RESPIRATORY SYSTEM

• Susceptible to damage from inhaled toxic
  materials irritants surface area exposed to
  air is so large and bodys need for oxygen so
  great.great impact on body.leading to disease
  of other vital organs

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THE RESPIRATORY SYSTEM

• NATURAL MECHANISMS against airborne hazards
• Fine hairs in nose
• -front-line barrier
• -filter
• -exercise/hard work
• Cough reflex clears trachea main bronchi
• Special cells-destroy bacteria viruses

• Ciliary cells-few hrs to expect foreign material
• Innermost areas of lungs- much longer to clear
  out

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THE RESPIRATORY SYSTEM

• Lungs that receive prolonged /or repeated
  exposure to air contaminants eventually cannot
  keep up with the rate of deposition /or constant
  irritation. Result contaminants accumulate
  contributing to the development of Occupational
  Lung Diseases.

Diagram- black asbestos fibers- exposure
standards to be less than 1 fibre/cm3 for 8 hr
exposure
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THE RESPIRATORY SYSTEM

• PARTICLES

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OCCUPATIONAL LUNG HAZARDS

• TYPES OF LUNG HAZARDS (AIRBORNE)
• Occupational Pulmonary Contaminants
• come in many forms
• Seen, smelled, felt as irritants in nose or
  throat
• Only detected with special equipment
• Short tem exposure- immediate, acute damage
• Most take repeated or constant exposure over
  months or years to cause disease or permanent
  harm
• Influenced by air pollution, age, smoking
  history, nutritional status as well as genetics
  and stress

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OCCUPATIONAL LUNG HAZARDS

• Several contaminants -same time lead to additive
  or worse, synergistic consequences to health
• Essential to know what materials processes used
  so appropriate monitoring control of potential
  lung hazards can take place
• Exposures to airborne hazards can be greatly
  reduced or eliminated through engineering
  controls such as improving ventilation and good
  work practices such as the use of personal
  protective equipment (properly selected
  maintained respirators) Legislated Workplace
  Safety and Health Act, W210

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MINERAL DUSTS
Particles formed from inorganic dusts.
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AIRBORNE HAZARDS

• MINERAL DUSTS
• Dusts mineral fibres from stones, rocks, ores
• Sources Mining, quarrying, tunnelling, blasting,
  smelting, grinding, milling, processing,
  drilling, abrading
• Industries mines, quarries, foundries
• Lung effects pneumoconiosis (asbestosis,
  silicosis, black lung) chronic bronchitis,
  emphysema, fibrosis, cancer

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ORGANIC DUSTS
Particles formed from organic materials.
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AIRBORNE HAZARDS

• ORGANIC DUSTS
• Dusts formed from living materials-micro-organisms
  , plants, animals natural products like
  wood/leather.
• Sources Wood, cereal grains (planting,
  harvesting, storing, transporting, processing),
  animal husbandry (droppings, dander, feathers)
• Industries Agriculture, manufacturers
  (furniture/ drugs), millers, bakers, chemists
• Lung effects Hypersensitivity reactions-occupatio
  nal asthma or hypersensitivity pneumonitis-permane
  nt obstructive disease, diffuse lung fibrosis.
  Wood dusts -cancer

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CHEMICAL DUSTS
Dusts from synthetic materials.
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AIRBORNE HAZARDS

• CHEMICAL DUSTS
• Synthetic chemicals (powder form)-pesticides,
  pharmaceuticals, dyes, bleaching agents,
  detergents, paints
• Sources Any contact from making, packaging,
  applying, weathering
• Industries aircraft building, autobody, pulp
  mills, chemical, breweries, foundries,
  hairdressing, health care, labs, manufacturing
  (paints), paint sprayers
• Lung effects Depends on toxic properties of
  specific chemicals-irritants, allergens, lungs-
  cause cancer

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FUMES
Metals and polymers.
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AIRBORNE HAZARDS

• FUMES
• Very small solid particles formed when hot vapors
  cool rapidly condense
• Can give off hazardous gases
• Act like very fine mineral dust in lungs
• Sources High heat processes
• Industries Smelting, arc-welding, furnace work
• Lung effects Difficult to assess effects of
  separate materials since several hazards present
  at same time. Can lead to emphysema lung
  cancer.

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MISTS and SPRAYS
Liquid droplets and other propellant gas.
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AIRBORNE HAZARDS

• MISTS SPRAYS
• Liquid droplets suspended in air or other
  propellant gas.
• Sources Cleaning products, pesticides, paints,
  cosmetic products, rust removers, by-products
  from other processes (cutting oils in machine
  shops)
• Industries Cutting, grind, spraying and pickling
  operations, electroplating
• Lung effects The finer the spray the deeper
  into the lungs it goes. Effect depends on
  material, concentration and temperature.

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GASES
Natural or Manmade chemical reactions phosgene,
nitrogen oxides or methane ammonia, bromine,
sulfur dioxide, chlorine nitrogen, carbon
monoxide cyanide, or radioactive, vinyl
chloride gas, nickel carbonyl.
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AIRBORNE HAZARDS

• GASES
• Fluids that expand to fill the space containing
  them
• Can travel quickly, be highly flammable,
  explosive when mixed with air, chemically or
  physiologically reactive. Some colorless
  odorless.
• Sources Natural chemical reactions (fermenting
  silage), Manmade chemical reactions (high-heat
  processes-welding)
• Industries Agriculture, foundries, manufacturing
• Lung effects suffocation, interference with
  oxygen use, immediate irritation, airway
  constriction, existing lung disease aggravation,
  cancer (takes years)

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VAPORS
Ketones, aromatic hydrocarbons, alcohols,
acetates and mercury.
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AIRBORNE HAZARDS

• VAPORS
• Gaseous form of liquid always found over that
  liquid-more vapors form as liquid heats. Affect
  lungs similar to gases. Vapors hang out with
  parent liquids-gases dont always stick with
  liquid forms.
• Sources Inorganic-high boiling points, dont
  vaporize at room temp.-arent usually assoc. with
  lung disease Organic-many vaporize at room
  temp.-used as solvents (ketones, alcohols,
  acetates, aromatic hydrocarbons)
• Lung effects enter body through lungs- damage to
  other organs more so than lungs-pulmonary edema
  tracheobronchitis.

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RADIATION
Ionizing (electromagnetic waves) and non-ionizing
radiation.
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AIRBORNE HAZARDS

• RADIATION
• Non-ionizing radiation (electromagnetic
  waves-infrared, ultraviolet, microwave, laser,
  radar, radio frequency) Ionizing radiation
  (alpha, beta, gamma rays, neutron particles
  x-rays)
• Sources Mining radioactive ores
• Industry Medicine, power plants, equipment used
  in industry (high energy electrical equip.,
  lasers, microwaves, radar)
• Lung effects Electromagnetic waves can cause
  thermal burns. Ionizing radiation can cause
  cancer.

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BIOLOGICAL HAZARDS
Bacteria, viruses, fungi, ricketsia, Chlamydia
parasites.
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AIRBORNE HAZARDS

• BIOLOGICAL
• Bacteria, viruses, fungi, rickettsial, chlamydial
  parasitic agents
• Sources Health care child care facilities,
  poorly maintained ventilation systems, biological
  research labs, animal care processing
  facilities
• Lung effects Depends on type of hazard. Can be
  minor allergies resp. infections to cancer.
  Vaccinations for some.

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CONFINED SPACES
Oxygen deficient atmosphere.
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AIRBORNE HAZARDS

• CONFINED SPACES
• Oxygen deficient atmosphere-oxygen content below
  19.5 by volume.
• Sources Storage tanks, drums, sewers, septic
  tanks, manholes, pits, underground utility
  tunnels.
• Lung effects irritation to extreme ( immediate
  death)- dependant on material/activity in
  confined area- RESPIRATORS REQUIRED.

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LUNG HEALTH IMPACT

• OCCUPATIONAL HEALTH TRENDS
• Occupational respiratory (lung) diseases
• workplace exposure to irritating or toxic
  substances- may cause acute or chronic
  respiratory ailments.

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PNEUMONCONIOSES
Lung disease from inhaling inorganic dust in
mines other workplaces has declined over past
30 years.
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PNEUMOCONIOSES

• Pneumonconioses includes silicosis, black lung
  (coal miners), asbestosis (most common)

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MESOTHELIOMA

• Stats only available as of 2001 when the ICD
  codes were introduced and then only in all
  provinces in 2006 so national estimates are no
  available. Ca Care Ontario has stats that show a
  marked rise of mesothelioma associated with
  asbestos exposure decades earlier.

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CONDITIONS DUE TO INHALATION OF CHEMICALS, FUMES
OR GASES

• Hospital admissions for lung conditions due to
  inhalation of chemicals, fumes or gases remained
  steady from 1979 to 2004. 7 deaths 2000-2004.
  Specific causes not identified.

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OCCUPATIONAL ASTHMA

• Most common lung disease compensated for by
  workers compensation. National data not
  available on rates of confirmed occupational
  asthma.

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OCCUPATIONAL ASTHMA

• INDUSTRY/JOB at risk

• AGENT

• Printers/paper products
• Grain handlers
• Lumber/wood workers
• Leather workers
• Paint sprayers
• Plastics
• Rubber industry
• Bakers
• Veterinarians

• Vegetable gums, natural glues
• Grain dust
• Wood dust
• Formalin, chromium
• Diisocyanates, dimet ethanalamine
• Epoxy resin, polyurethane
• Ethylene diamine, diisocyanates
• Flour, insect, mite debris
• Animal dander

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OCCUPATIONAL ASTHMA

• INDUSTRY/JOB

• AGENT

• Laboratory workers
• Vegetable oil production
• Beauticians/cosmetologists
• Health care workers
• Pharmaceutical workers
• Solders, electronic fabricators

• Animal dander
• Flax seed, castor bean
• Diamines, potassium persulfate
• Formaldehyde, medication, latex
• Various drugs, enzymes
• Colophony resin, ethanalamine

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OTHER OCCUPATIONAL LUNG DISEASES

• ICD codes not available for other Occupational
  lung diseases include occupational lung cancer
  from agents such as asbestos, chromium, radon
  (photo), other occupational chronic obstructive
  lung disease. (15 to Occupational exposures).
  WCB numbers likely markedly underestimated.

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Occupational Lung Disease DeathsMB WCB-2005
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Occupational Disease Fatalities- MB
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Acute-Hazard Occupational Disease Deaths- MB
WCB
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SMOKING OCCUPATIONAL LUNG DISEASE

• Smoking contributes to lung disease
• Impairs lungs natural defense mechanisms
  irritates airways inhibits work of ciliary
  cells
• Smoking is leading cause of serious lung disease
  certain types of cancer
• Synergistic effect with other pulmonary
  carcinogens (asbestos, chromium/uranium
  compounds, arsenic)
• Increases lung cancer risk by 15 chronic
  asbestos exposure 4 60 risk NOT 29
• Smokers develop lung disease cancer more
  readily diseases progress more rapidly

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OCCUPATIONAL LUNG DISEASE

• Pulmonary Diseases
• Occupational Asthma
• Reactive Airways Dysfunction Syndrome (RADS)
• Emphysema
• Chronic Bronchitis (repeated infections and/or
  exposure to irritants such as fumes/dusts, oil
  aerosols, gases, smoke)
• Pneumoconioses (from particles less than 5
  microns in size)
• Hypersensitivity Pneumonitis (organic
  dusts-fungi, animal proteins, vegetable proteins)

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OCCUPATIONAL LUNG DISEASE

• Granulomatous Disease (TB, toxins-Berylliosis
  best known occupational example)
• Pneumonias- toxic process or more commonly
  infections (health care, child care animal care
  workers)-fungi, bacteria, viruses, other
  microorganisms
• Occupational Lung Cancer- smoking,
  bis-chloromethyl ether, coal tar, pitch
  volatiles, mustard gas, arsenic, asbestos,
  radium, petroleum, chromates, uranium

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REGULATIONS ACTS

• Labour Immigration of Manitoba
• Workplace Safety Health Division
• Workplace Safety Health Act of Manitoba
  (C.C,S,M.c.W210) updated to April 8,2008
• Effective Feb.1, 2007 a new WSH regulation was
  consolidated into one The Workplace Safety and
  Health Regulation 217/2006
• Certain industries regulated- exposure to
  asbestos silica (Fibrogenic Dust Exposure
  Guideline-revised released Dec.2008)
• Other industries- Due diligence

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REGULATIONS ACTS

• DUE DILIGENCE
• In occupational health safety employers shall
  take all reasonable precautions under the
  particular circumstances, to prevent injuries or
  accidents in the workplace. Applies to situations
  that arent addressed elsewhere in the OHS
  legislation.
• Bill C-45- federal legislation that amends the
  Canadian Criminal Code- became law 2004-applies
  legal duty to workplace health and safety.

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RESPIRATORY SURVEILLANCE

• Employment settings where workers use or are
  potentially exposed to lung hazards
• Lung diseasemost significant due to severity
• Human economic toll
• Significant causes of morbidity, disability,
  early retirement death
• Entirely preventable once causes recognized
• HIGH PRIORITY -Recognition of Occupational Lung
  Disease hazards prevention of exposure

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RESPIRATORY SURVEILLANCE

• Reduce human suffering economic impact of
  occupational disease.
• Detect occupational non-occupational lung
  diseases in earliest stages when reduction of
  exposure is likely to be most effective.
• Identify working conditions that are hazardous so
  that improvements in industrial hygiene can be
  made.
• Establish baseline function for new employees
  to identify job applicants with pre-existing lung
  damage so that they can be placed in positions
  that do not jeopardize their health.

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WORKPLACE INTERVENTIONS

• Workplace Inspections
• Workplace Safety Health reps/committees
• Engineering controls
• Workplace design
• Equipment selection
• Modification of existing equipment/processes
• Ventilation system
• Work Practices Procedures
• Housekeeping
• Maintenance

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WORKPLACE INTERVENTIONS

• Personal Hygiene
• Air-monitoring
• Replace toxic products for safer/ less toxic
  products
• Medical surveillance examinations Act/Reg. 50
  (1)
• Education training
• Personal protective equipment
• Smoking cessation programs
• Workplace wellness programs

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THE LUNG ASSOCIATION

• OCCUPATIONAL LUNG HEALTH
• Perform occupational lung health screening
• Prevention early detection
• On-site or office appointments
• Questionnaires
• Lung function tests (spirometry)
• Chest x-rays
• Fitness to wear respirator testing
• Medical surveillance reports
• Lung health trending
• Retention of health records for 40 years
• Presentations/displays

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THE LUNG ASSOCIATION

• TOBACCO CESSATION PREVENTION
• Lungs are for Life (school program)
• N.O.T. on Tobacco (teens)
• Smoke Free Car Home Campaign
• World No Tobacco Day (May)
• National Non-Smoking Week (Jan)
• Workplace Smoking Cessation project MANTRA/HC
• Smoking Cessation Forums (universities- target)
• Presentations, Displays, Print /video resources

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THE LUNG ASSOCIATION

• ENVIRONMENT
• Bye Bye Beaters-vehicle scrappage program
• Partnership with Science, Technology, Energy
  Mines to promote clear air quality messaging
• Member of Crop Residue Burning
• Advisory Committee
• Air Quality issues

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THE LUNG ASSOCIATION

• THE SANATORIUM BOARD -1904
• THE LUNG ASSOCIATION, MANITOBA
• (Non-profit health charity -division of the
  Sanitorium Board of MB in 1975)
• MISSION
• To improve lung health of Manitobans

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• For more information contact
• PHONE
• Winnipeg [phone]
• Brandon [phone]
• Toll free1-888-566-5864
• info_at_mb.lung.ca
• www.mb.lung.ca