Occupational lung disease in the UK – a continuing challenge

Last week I was up in Glasgow for the annual BOHS Conference. As usual, there were lots of good interesting Keynotes, workshops and technical sessions. And there were plenty of opportunities for networking – and some fun too.

One of the highlights for me was the very first session, the Warner lecture, which this year was given by Professor Sir Anthony Newman Taylor, the renowned and respected expert in respiratory disease. Sir Anthony is the President’s Envoy for Health at Imperial College London and also chairs the new Workplace Health Expert Committee recently set up by the Health and Safety Executive. The theme of his lecture was The continuing challenge of UK Lung disease.

The Health and Safety Executive estimate that there are about 13,000 deaths every year in Great Britain due to respiratory disease caused by exposures to hazardous substances at work. The main agent of concern is asbestos, followed by respirable crystaline silica. Due to the long latency period associated with these diseases (i.e. the time taken for the disease to develop) most of these deaths have ben caused by historical exposures. So some people might argue that the numbers will reduce in the future as the substances causing the disease have either been banned (i.e. asbestos) or are becoming better controlled, and that these diseases are a problem of the past. However, for Sir Anthony this is not the case.

He pointed out that although silicosis is sometimes considered to be a disease of the 19th and 20th Centuries, there are still a significant number of cases in the UK, particularly in the construction industry where at least 50% of workers are exposed to silica. Internationally, examples of where silica exposure occurs include sandbalsting of oil platforms in Mexico and the use of sand to produce faded denim jeans. In both these cases the serious risk of silicosis and cancer can be prevented by substituting alternative processes or materials.

Although the use of asbestos has been prohibited in the UK, it is still present in many buildings, and there is still a risk of exposure for maintenance workers, electricians, plumbers etc. and also for building occupants where the material degrades. Even low exposures to asbestos, particularly the amphiboles (which include “blue” and “brown” asbestos) can lead to the development of mesothelioma, a serious cancer of the tissue surrounding the lungs. So it is likely that workers will continue to develop asbestos related disease for many years to come.

Other respiratory diseases also continue to be a problem, including asthma in bakers, paint sprayers and other workers and hypersensitivity pneumonitis associated with exposure to metalworking fluids.

New technology also presents risks to health, including respiratory disease. One example Sir Anthony highlighted was carbon nanotubes, which potentially have many uses. These very fine, fibre like particles have many similarities with asbestos in that they are small enough to reach the deep lung and are resiliant, so aren't easily absorbed by the body. Given these properties, perhaps it isn't surprising that there is evidence that they may present the same health hazards as asbestos, particularly mesothelioma.

There have been major changes in employment in the UK, with many of the “traditional” heavy industries exported overseas to the “developing” economies in Eastern Europe and the Far East where labour is cheap. Measures to control exposure in these countries are often less stringent and effective meaning that the historical industrial diseases are likely to re-emerge. Some might argue that the othe side of this coin is that these diseases will decline and even disappear in the UK. However, this is too simplistic an analysis. Sir Anthony demonstrated that there are still exposures occuring which are likely to mean that these diseases will continue to be a problem for many years to come. Yet most of the problems Sir Anthony highlighted could be prevented or, at least, reduce by applying good occupational hygiene practice. Unfortunately, many employers don't recognise this. So there is still much work for BOHS to raise awareness of the problems and the solutions and continue to argue for more emphasis to be placed on controlling health risks in the workplace.

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