The importance of occupational health spirometry testing

While a large number of Chronic Obstructive Pulmonary Disease (COPD) diagnosis is correlated with smoking cigarettes and tobacco products, research also suggests a strong link between workplace exposures to hazardous substances and an increased risk of COPD.^{1, 2}

As a result, spirometry testing plays a vital role in workplace health. Especially in places where employees are exposed to substances, such as dusts, gases, vapours, or other airborne inhalants, which if not properly managed can cause both restrictive (Pulmonary Fibrosis, Pneumoconiosis, asbestosis etc.) and obstructive lung diseases (occupational asthma, emphysema etc.).

Occupational health spirometry tests

A spirometry test can highlight whether an employee is showing a specific pattern of respiratory impairment that requires further investigation.

Spirometry testing in occupational health programs can be highly effective in helping to identify respiratory problems such as asthma, COPD and other conditions that can affect breathing, and it can also highlight the effectiveness of any respiratory protective measures within the work environment.

Why employers should provide regular spirometry testing

Health surveillance in the workplace exists for several reasons and is valuable for both the employer and employee. For the employer it helps to keep the workforce healthy, reduces absenteeism and can result in increased productivity. For the employee, it shows that their wellbeing is supported, creates a positive working environment and helps to identify any potential health conditions.  

Regular spirometry testing should be considered in workplaces where respiratory risks exist, but they should not be used as a substitute for effective control. Where employees are exposed to hazardous substances to health, there’s a legal responsibility to control and monitor their exposure.  

Industries that have an impact on respiratory health

Many industries can pose a risk for the respiratory health of employees. These tend to be the ones that produce vapor, gases, fumes, dust, and other irritants that can progressively cause damage to the respiratory system through inhalation, ingestion and/or absorption.  

Identified respiratory sensitisers include Isocyanates, metal working fluids, cleaning agents, metals, Colophony, Formaldehyde, adhesives, latex, wood dusts and flour. The UK Health and Safety Executive has listed the following occupations as showing an increased risk of respiratory problems:

Agriculture

Agriculture workers can be exposed to many substances that could cause respiratory problems. These substances include (but aren’t limited to) fungus spores, bacteria, animal or plant proteins and chemicals. Alongside the nature of the substance, the equipment and processes used can also have an effect on an employee’s respiratory health.

The three most common respiratory problems associated with agriculture are:

• Farmer’s lung/Farmer’s Hypersensitivity Pneumonitis (FHP) – results from the inhalation of hay, straw or grain mould spores. These spores are so minute, that millions of spores can be inhaled within a few minutes, embedding deep in the lower part of the lungs. These spores can cause an acute or chronic allergic reaction.⁴
• Silo fillers disease/acute bronchiolitis fibrosis – is a form of alveolitis or pneumoconiosis caused by inhalation of nitrous oxides that can lead to permanent lesions and scarring within the lungs. Exposure to high levels of concentration can result in pulmonary oedema leading to long-term respiratory problems.
• Organic Dust Toxicity Syndrome (ODTS) – exposure to large amounts of organic materials may cause an acute reaction within the airways. Symptoms include breathlessness, fever, and cough, however, fortunately most people tend to recover quickly.

Many substances within agriculture can exacerbate previously diagnosed asthma or trigger the development of new asthma. Agricultural workers breathe in pesticides, medicines, feed additives, and fertilisers, which can also be a trigger. 

Brick making

Brick kilns produce large amounts of sulphur dioxide due to the fuels they burn. They are not only hazardous to the environment but also harmful to human health, potentially resulting in significant respiratory problems.

As well as the problems caused by burning sulphur dioxide, brick making also carries a risk of Silicosis caused through crystalline silica found in stone. Exposure to, and inhalation of crystalline silica can cause fibrosis of the lung tissue, as once inside the lungs it can cause inflammation, hardening and scarring. Silicosis usually develops years after being exposed, although in cases where people have experienced high levels of exposure, it can sometimes be quicker.⁴

Cadmium

Cadmium is an element found in air, water, soil, food and mineral fertilisers. It is also used to manufacture batteries, pigments, metal coatings and plastics. Repeated exposure to Cadmium can lead to an increased risk of lung cancer.

Mining

Miners are at an increased risk of Pneumoconiosis due to exposure to fine dust particles. They also have an increased risk of developing lung cancer, COPD, chronic bronchiectasis, and emphysema.

Coal mining is obviously completely below ground, so workers spend hours in low ventilated areas. Not only does coal mining generate a tremendous amount of dust, debris, and toxins, but the equipment used by miners is primarily diesel-powered. These emissions in a non-ventilated area can be highly damaging to the respiratory system.

Construction

There are many respiratory hazards that can be found in the construction industry, so construction workers are at high risk of developing respiratory problems. Some processes emit dust, vapours and/or gases which have the potential to cause serious and irreversible harm.

Accurate statistics for the amount of construction workers who are affected by respiratory disease are difficult to obtain because of the long latency of most lung diseases and many cases go unreported for years.

Asbestosis is probably the most well-recognised lung-related health issue for construction workers. It has been mostly eliminated in new buildings, but still exists in many industrial or residential buildings that were built or refurbished prior to the year 2000.⁵ Asbestos can cause scarring of the lungs and stiffen lung tissue, making it difficult to breathe. Mesothelioma and lung cancer are also caused by exposure to asbestos.

Food manufacturing

There are several risks within food manufacturing that can cause respiratory problems including diacetyl, flour, coffee bean dust, crustacean, fish and egg proteins and soybean dust.

Workers can be exposed to diacetyl, a compound used for artificial flavourings. This can cause Bronchiolitis obliterans (sometimes colloquially referred to as “Popcorn Lung”) which presents as difficulties with breathing and reduced oxygen levels in the bloodstream.

Exposure to flour or coffee dust and soybean can cause irritation and lead to an allergic reaction, which in turn can trigger asthma. When inhaled, crustacean, fish and egg proteins can lead to adverse respiratory reactions such as nasal congestion, sneezing, coughing, and wheezing, and in very rare cases, anaphylaxis.

Hair & beauty

The focus on developing non-toxic chemical products for hairdressers and cosmetology has increased. While the industry is actively attempting to reduce its dependence on aerosol sprays, it is the lack of proper ventilation and repeated exposure to hair spray, nail products, glue, and disinfectants that poses the risk of occupational asthma.⁷

Petroleum

Petroleum workers are exposed to many substances that are hazardous to the respiratory system, including diesel particle matters, chemicals, hydrocarbon gases and vapours, hydrogen sulphide and Silica. Exposure to petroleum products can cause significant respiratory problems, including increased risk of lung cancer.

Pottery/ceramics

Pottery workers are exposed to ceramic dust containing silica, organic matter and other sulphur compounds like sand, talc, vermiculite, perlite, barium carbonate and metal oxides. These substances can lead to respiratory problems including silicosis, asbestosis, hypersensitivity pneumonia and even Kaolinosis; a type of silicatosis caused through the inhalation of kolin which is a clay mineral.

Rubber

Respiratory function can be adversely affected when working with rubber - both natural and synthetic. Rubber products are manufactured using mixing, heating and formation, which can result in the release of rubber dusts and/or rubber fumes. Long term exposure to rubber compounds can lead to chronic health issues including cancer and COPD.

Plastics

Working with plastics can be particularly hazardous to respiratory health because of the inhalation of toxic fumes, chemicals, dust particles and mould. Inhalation of these toxic substances can lead to pulmonary oedema, destruction of cilia and a build-up of mucus in the airways which can cause chronic bronchitis, or emphysema. Plastic production workers are also at increased risk of mesothelioma and lung cancer.

Textiles

Textile workers can breathe in dust produced by hemp, flax, and cotton processing, which can lead to a condition known as Brown Lung Disease, also known as Byssinosis. This chronic condition can cause chest tightness and shortness of breath. 

Work-related asthma is another common condition for textile workers who breathe in certain dust, gases, fumes, and vapours and can lead to asthmatic symptoms such as chronic coughing or wheezing.

Welding

Welding can have a severe impact on the respiratory system, even, in rare cases, leading to death through asphyxiation. Welding fumes contain carbon monoxide, oxides of sulphur, manganese, tungsten and chromium, all compounds which can irritate the lungs.  

Airborne particles produced from welding, such as swarf particles, can also be an issue to welders. This is commonly referred to as welding plume and consists of metal oxide particles. These particles, along with the gases and vapours produced when welding, can lead to pneumoconiosis, COPD, chronic bronchitis, and lung cancer.

This study published in the European Respiratory Journal aimed to identify the most common industries associated with respiratory problems: The occupations at increased risk of chronic obstructive pulmonary disease (COPD).⁷

Spirometry solutions

Regular spirometry tests allows employers to take the necessary actions to protect their employee’s health before lung damage can happen. At Amplivox we are proud to offer PC-based, desktop and handheld spirometry solutions to help with the diagnosis and monitoring of lung disease.

Our industry-leading spirometers are compatible with many EMR systems, ensuring the requirements of occupational and respiratory health professionals are not only met, but exceeded.

With the inclusion of PC database applications, users can benefit from comprehensive data analysis, trending and transfer capabilities.

As well as spirometry devices, we also offer comprehensive occupational spirometry training courses, providing everything you need to know to be an expert in spirometry testing.

For more information on our spirometry products please visit our spirometers webpage, contact our customer support team on +44 (0)1865 880 846 or email.

References

¹Health and Safety Executive. COPD causes - occupations and substances. Accessed at:  https://www.hse.gov.uk/copd/causes.htm#:~:text=A%20wide%20variety%20of%20dust,Grain%20and%20flour%20dust 

²P D Blanc, C Iribarren, L Trupin, G Earnest, P P Katz, J Balmes, S Sidney, M D Eisner. BMJ Journals. Occupational exposures and the risk of COPD: dusty trades revisited. Accessed at: https://thorax.bmj.com/content/64/1/6 

³American Lung Association. Hypersensitivity Pneumonitis. Accessed at: https://www.lung.org/lung-health-diseases/lung-disease-lookup/hypersensitivity-pneumonitis 

⁴NHS. (July 2021). Silicosis. Accessed at: https://www.nhs.uk/conditions/silicosis/#:~:text=Silicosis%20is%20a%20long%2Dterm,that%20can%20be%20easily%20inhaled 

⁵Health and Safety Executive. Where can you find asbestos? Accessed at: https://www.hse.gov.uk/asbestos/building.htm 

⁶Mayo Clinic. (May 2022). Occupational Asthma. Accessed at: https://www.mayoclinic.org/diseases-conditions/occupational-asthma/symptoms-causes/syc-20375772 

⁷De Matteis S, Jarvis D, Darnton A, et al. European Respiratory Journal. The occupations at increased risk of chronic obstructive pulmonary disease (COPD): analysis of lifetime job-histories in the population-based UK Biobank Cohort. Eur Respir J 2019; in press (https://doi.org/10.1183/13993003.00186-2019). Accessed at: chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://erj.ersjournals.com/content/erj/early/2019/04/25/13993003.00186-2019.full.pdf

Additional reading

Health and Safety Executive. Exposure to diacetyl vapour in food and drink manufacture. Accessed at: https://www.hse.gov.uk/safetybulletins/diacetyl-vapour-exposure.htm?utm_source=govdelivery&utm_medium=email&utm_campaign=diacetyl-safety-alert&utm_term=safety-alert-1&utm_content=workers-health-2-feb-23