One of the most serious illnesses today are respiratory diseases. In fact, they are considered the number one cause of medical admissions, sicknesses, and deaths globally. 

According to statistics: 

• Approximately 2 billion people worldwide are constantly surrounded by harmful smoke from burning biomass fuel
• Another 1 billion people are exposed to polluted air in industrialized cities
• 1 billion people inhale tobacco smoke from primary or secondhand sources on a regular basis

A majority of lung diseases can be prevented by simply improving the quality of air that we breathe. Individually, we can also take actions to improve our lung health through vaccinations and living a healthy lifestyle. We will discuss more these steps in the upcoming sections. 

The COVID-19 pandemic is another good reason why we should be mindful of lung health. As of this writing, the COVID-19 virus has affected more than 27 million people worldwide, with over 880,000 deaths. The most common cause of death in those with severe infections is, you guessed it – respiratory failure. 

In fact, according to autopsy findings, the lungs incur the greatest harm in patients with COVID-19 infections.  There are also specific lung diseases that can be obtained from the workplace. These types of lung diseases are known as Occupational Lung Diseases.

Lung Health & Issues at Work

Occupational Asthma

Asthma pertains to the tightening and inflammation of the airways in response to a particular exposure to an allergen or irritant. Its symptoms are similar to non-occupational asthma, which is characterized by breathing difficulty, wheezing, and chest tightness. Other symptoms include coughing at night and frequent production of sputum (a mixture of saliva and mucus).

Occupational asthma is a type of asthma that develops due to allergens or irritants present in the workplace (Cartier & Bernstein, 2019). People with occupational asthma typically find relief during vacations or days off. However, upon returning to their work environment, their symptoms usually return. (Lemière et al, 2019).

There are more than 300 possible irritants that can cause occupational asthma. In developed countries, the most common cause of occupational asthma is due to compounds that are present in paints, glues, and insulation. As well, fumes, gases, aerosols, and smoke are also possible triggers. (Cartier & Bernstein, 2019). 

The time from exposure to the development of symptoms varies from person to person. In most cases, a person requires continuous exposure to the allergen or irritant before symptoms begin to manifest. 

For those working in animal farms, common allergens include animal fur, urine, and dander. In the food processing industry, exposure to seafood allergens can also lead to the development of occupational asthma. For bakers, the protein that is present in wheat flour also poses a possible trigger.

Additionally, powdered latex gloves are a common cause of occupational asthma before their use was lessened. Healthcare workers exposed to sterilization compounds and orthopedic adhesives are also at risk for this disease. 

Other possible irritants that can cause occupational asthma include: 

• Wood dust from construction
• Acrylates and persulfate salts from salons 
• Metal salts from welding sites (Cartier & Bernstein, 2019).

Silicosis and other exposure pneumoconiosis

Silica is a mineral that can be found on the earth’s crust. Silica from silicone, silicon carbide, and glass is not harmful to our lungs. However, there exists another type of silica called crystalline silica, which IS harmful. This type of silica can be found in gravel, clay, granite, and other types of rocks (Department of Environmental and Occupational Health Sciences, 2014). 

The risks for silica exposure are associated with any work that involves disturbing the earth’s crust or minerals. People working in coal mining, tunneling, masonry, rolling mills, sandblasting, constructing, ceramics production and constructing are especially at risk for silicosis (Rose, 2020).

Silicosis is a lung disease caused by the inhalation of crystalline silica particles. There are two types of silicosis –  acute and chronic. 

Symptoms of acute silicosis typically manifest within a few weeks to a year after first being exposed to crystalline silica. These include having difficulty breathing, developing cough, chest pain, fever, fatigue and undergoing weight loss. Compared to chronic silicosis, acute silicosis is rare and requires a high volume of initial silica exposure. 

Chronic silicosis manifests 10 to 30 years after initial silica inhalation. It is often found in people who no longer work in their related occupation, but who develop symptoms such as cough and difficulty breathing. Additionally, some patients may not show any symptoms at all. In these situations, their illnesses are detected via abnormal chest x-rays. 

The treatment for silicosis is to avoid exposure to crystalline silica, as well as undergoing supportive care. Those who inhale large amounts of silica and develop acute silicosis should take extreme caution. These patients typically only continue living for a short period of time, and may not live longer than 4 years. As well, silicosis makes patients prone to other respiratory infections, which can cause further complications (Rose, 2020).

Each year, approximately 200,000 miners and 1.7 million non-mining workers are exposed to high doses of silica in the US. From the year 1987 and 1996, approximately 3000 people died from silicosis. Improvements in workplace protection have helped to significantly reduce the death rate for silicosis in the last few decades. 

Silicosis is just one type of pneumoconiosis – a group of occupational lung diseases that result from specific exposures. Other types of pneumoconiosis include coal worker’s pneumoconiosis, talcosis granulomatosis, asbestos-related thoracic diseases, and hypersensitivity pneumonitis. 

There are many other types of exposure-related lung diseases that can manifest depending on the chemical, allergen and irritant involved. One of these include Byssinosis, which is related to long-term inhalation of dusts in raw cotton, flax and hemp processing. 

Think of the possible harmful and noxious chemicals present in your workplace. Are your workers at risk for an exposure-related lung disease? Do you have a workplace protection policy in place? These questions will help you to take preventive measures and keep your lungs healthy.

Lung Cancer

In 80-90% of people that are diagnosed with lung cancer, the associated risk factor is tobacco exposure. However, around 10-20% of lung cancer cases occur in people who have never smoked. If you want to avoid developing lung cancer, you’ll need to take more preventive measures besides only adopting a “no smoking” policy (Spyratos et al., 2013). 

The following are potential carcinogens or agents in the workplace that can increase the risk for lung cancer:

• Asbestos use in the mining industry
• Arsenic use in the electronics industry, and jobs involving manufacturing or use of pesticides, herbicides and insecticides)
• Beryllium in aeronautics, radiation (like x-rays) and automotive related jobs
• Ether, chloromethyl ether, and cadmium use  in plastic manufacturing
• Paint exposure – either as a seller or consumer
• Chromium, silica, aluminum, and nickel exposure from occupations like mining, milling, refining, welding, electroplating, and smelting
• Dust and fume exposure from rubber production
• Diesel exhaust
• Exposure to radiation from the nuclear industry

Additionally, occupational exposure from second-hand smoking in places like bars, clubs, and restaurants, can also increase the risk of developing lung cancer later on in life (Spyratos et al., 2013).

Chronic Obstructive Pulmonary Disease (COPD)

Chronic Obstructive Pulmonary Disease or COPD, is a lung condition characterized by airflow limitation due to airway inflammation and abnormalities in lung tissues. COPD is caused by chronic inflammation of the airway and the destruction of small airways in the lungs. This includes chronic productive cough, difficulty in breathing, persistent wheezing, and recurrent respiratory infections (King Han M, Dransfield M & Martinez, 2020).

COPD has a higher prevalence in chronic smokers, but can also occur in non-smokers. Some occupational factors can trigger an attack in those who are already diagnosed with COPD. For these people, inhalation of such substances can increase their risk of developing COPD.

Possible airborne substances that can trigger COPD include mineral dusts, organic dusts, diesel exhaust fumes, and chemical vapors (Harber, Redlich & Henneberger, 2016). Earlier studies have also found that chronic occupational dust exposure is associated with the development of COPD (Korn et al., 1987).

Aside from exposure avoidance, COPD can be treated with drugs like formoterol and indacaterol, which dilate the airway and allow for proper airflow. It is often used in combination with steroids and muscarinic antagonists like ipratropium for maximum effect (Ferguson & Make, 2020). 

Respiratory Tract Infections | Lung Health

Workplaces are considered a potential source of infection even before COVID-19 became a worldwide pandemic. This is due to employees being in close proximity to one another and interacting on a consistent basis. If one worker develops a common cold or flu, there is a high risk that they will infect other people.

Additionally, commonplace objects at work can act as a source of infection. For example, an improperly cleaned air humidifier that houses viruses, fungi, and bacteria can contaminate the air and potentially cause people to become sick. Some of the usual pathogens associated with workplace respiratory infections include influenza, legionella, and tuberculosis (Harber, Redlich & Henneberger, 2016). 

The CDC (2020) has recently released reopening guidelines for buildings and offices that were affected by the lockdown. As mold can grow in empty buildings that are not adequately aerated or cleaned, precautions must be taken to prevent employees from becoming sick. Depending on the weather, this can range from weeks to months. 

Aside from mold, the bacteria Legionella is known to grow in stagnant and unclean water sources. It can be found inside of plumbing units like pipes, valves, and tanks, as well as air humidifiers and air conditioning units. 

If offices reopen and equipment is not properly cleaned, it can result in the spread of Legionella throughout the entire building. This could result in your employees developing Legionnaires’ disease – a respiratory infection that can range from mild or severe conditions. Almost half of the patients that contract this disease eventually develop moderate-severe pneumonia symptoms, with less than 20% requiring ICU admission (Murdoch, Chambers & Priest, 2020). 

Some of the measures enumerated include:

• The assessment of buildings for excess moisture
• Developing a water management program for any office device that uses water
• Ensuring adequate ventilation standards 
• Cleaning water-containing decorations such as fountains

Additionally, the CDC recommends employees with increased risk of severe pneumonia to work remotely. This includes those with diabetes, hypertension, or other chronic illnesses that may impair their immune system. If working remotely isn’t an option, personal protective equipment such as N95 masks should be provided.

Creating a Lung-Friendly Workplace

Health hazards in the workplace substantially increase the risk of developing specific diseases. Employees that are sick require additional days off and are less productive. This negatively impacts both the company and it’s employees. 

Employers should strive to create a healthy working space. The American Lung Association (2020) provides the following guidelines on how you can create a lung-friendly workplace: 

1. Provide Personal Protective Equipment

As mentioned earlier, the main cause of most occupational diseases are due to the inhalation of irritants, allergens, and infectious agents in the workplace. Inhaling harmful particles such as silica, asbestos, beryllium, dust, fumes, and coal may lead to the development of pneumoconiosis. Additionally, infectious agents like the COVID-19 virus and Legionella bacteria can cause severe pneumonia.

Industrial workplaces that have increased exposure for these agents should ensure employees are provided with personal protective equipment. The National Institute for Occupational Safety and Health recommends the use of N95 respirator masks. At higher concentrations of airborne silica (>50microg/m3), they recommend the use of powered respirators (Rose, 2020). 

The US government and the CDC have created a guideline for the re-opening of business establishments. Make sure you’re updated on the latest criteria and guidelines at www.whitehouse.gov/openingamerica/. 

To provide a brief summary of the guideline –  employers must have policies regarding proper social distancing and provision of protective equipment, temperature checkpoints, contact tracing, quarantine and sanitation/disinfection of the workplace. 

Prevention is always better than cure. By providing your employees with adequate protective equipment and investing in their health, your business will also benefit. 

2. Help Your Employees Stop Smoking

Smoking is the most important risk factor for developing COPD, lung cancer, and respiratory infections. Medications and hospital admissions that occur as a result of these diseases incur high medical expenses. 

The American Lung Association (2020) states that employers save at least $6,000 each year for every employee that stops smoking. Investing in smoking cessation programs can save you money as well as protecting your employees’ health.

According to a compilation of studies done in US and European countries, there is a substantial number of employees that are exposed to tobacco smoke in the workplace. 

In European countries, they estimate this to be 7.5 million workers while in the US it’s 24.6 million workers exposed to tobacco smoke. In addition, they pointed out that exposure to tobacco smoke is linked to incidence of COPD and stroke. The study concluded that there smoke-free legislations in the workplace are essential to improve not just the lung health of employees (Jaakkola & Jaakkola J, 2006). 

As an employer, you can establish smoking cessation programs. You can also implement a No Smoking policy in the workplace. This will not only help smokers reduce their use of tobacco but also minimize the exposure of the other nonsmoking employees.

For places where the use of tobacco might be a common activity like bars, clubs and restaurants there should be designated smoking areas. It can be in an open or a well-ventilated space where other employees won’t be exposed (Spyratos et al., 2013). 

3. Improve Indoor Air Quality

Aside from implementing a tobacco-free workplace, there are other aspects to consider for improving indoor air quality. Areas that are warm and humid provide a rich environment for mold and bacteria to grow in. Additionally, stagnant water and poor air circulation (American Lung Association, 2020).

The United States Environmental Protection Agency (2020) has a protocol for heating, ventilation, and air conditioning or HVAC systems. Depending on the type of building you have, you may need to hire engineers to assess the status of the HVAC system in your workplace. 

The USEPA recommends using windows for natural airflow. However, if your workplace is located in the middle of a city, external noise and air pollution may make this a less than ideal option. 

For ventilators, a central air handling unit is preferable over multiple separate unit ventilators or heat pumps. You can also incorporate air filters into your HVAC system to minimize employee exposure to pollen, dander, infectious agents, and other allergens (United States Environmental Protection Agency, 2020). 

When it comes to pest control, you’ll want to follow the proper protocols and hire reliable pest control services. As pest control services typically employ harmful chemicals in their work, you’ll want to ensure your workers are not exposed to them.

You can also implement a simple fragrance-free policy not just for your employees, but also for the visitors. Perfumes and colognes may contain allergens that can trigger an asthmatic or COPD flare in susceptible workers. By optimizing indoor air quality through these simple steps, you can create an asthma-friendly environment (American Lung Association, 2020).

4. Make health services more accessible

Besides encouraging employees to abstain from smoking, you can also recommend them to get regular exercise. Studies have shown that exercising on a regular basis can also improve lung health. Additionally, yearly flu vaccinations and pneumococcal vaccinations for susceptible individuals can lessen their risk of severe respiratory infections. 

If your employees have access to 24/7 health services, they can immediately relay their non-urgent medical concerns to health care providers. Medical concerns that are addressed earlier are less likely to worsen, as afflicted individuals can take immediate steps to prevent it from escalating. Diagnosing medical concerns early also decreases the overall number of emergency room visits.

Direct primary care (DPC) services can address these issues. Many employers are opting to add DPC to their existing benefits package.  The switching over from traditional healthcare plans to DPC, due to ease of access and cost-saving benefits is a win-win for employee and employer. If you’re interested in learning more about direct primary care and how you can provide it to your employees, visit us here and get in touch today!