Preparation of Advisory Report on Chronic Obstructive Pulmonary Disorder

This advisory report provides a comprehensive analysis of chronic obstructive pulmonary disorder (COPD), including its origin, development mechanism, industries vulnerable to COPD, and prevention strategies. It discusses the high exposure risk factors in specific occupations and provides strategies to control the disease burden and protect individuals in these industries.

Preparation of advisory report on
chronic obstructive pulmonary
disorder

EXECUTIVE SUMMARY
The chronic pulmonary disease is life threatening and rapidly growing disease. The
disease is more prevalent in smokers as well as among individuals who are exposed to specific
industrial conditions. The report has discussed various occupations which have high exposure
risk factors leading to increased vulnerability of COPD. It has also provided a brief discussion of
various exposure measurement and management strategies so that disease burden can be
controlled and individuals in specific industries can be protected from the COPD risk.

TABLE OF CONTENT
EXECUTIVE SUMMARY ............................................................................................................2
INTRODUCTION...........................................................................................................................1
CHRONIC OBSTRUCTIVE PULMONARY DISORDER (COPD).............................................1
Origin of COPD ..........................................................................................................................1
Mechanism for development of disease ......................................................................................2
Industries vulnerable to COPD....................................................................................................3
An overview of COPD in UK .....................................................................................................4
Limits of occupational exposure and assessment methods ........................................................6
Strategy for exposure measurement ............................................................................................7
Prevention and management strategy .........................................................................................8
CONCLUSION .............................................................................................................................10
REFERENCES..............................................................................................................................11

INTRODUCTION
Chronic obstructive pulmonary disease (COPD) is one of the most rapidly growing and
developing lung disease resulting in poor airflow and long term breathing issues. The disease is
progressive and worsen with time. The deteriorating breathing issues also make it hard for
individual to perform routine activities. With progression and worsening of symptoms it can also
prove to be life threatening (Lemière and Bernstein, 2018). Apart from tobacco smoking, air
pollution long term exposure to irritants such as cooking fires or poorly vented heating also
makes individuals more vulnerable to disease. There are some occupations which have higher
risk for development and progression of COPD.
The report will explain the origin and development mechanism of COPD and its cost in
UK context. It will also evaluate various assessment and limits of occupational exposure and
measurement of pulmonary disease. The study will also evaluate various management and
prevention strategies so that occupational risks can be reduced and progression of such diseases
can be prevented.
CHRONIC OBSTRUCTIVE PULMONARY DISORDER (COPD)
Origin of COPD
COPD can be of different types such as bronchitis or emphysema. Tobacco smoking is
main factor responsible for the origin or cause of this pulmonary disorder. However the prolong
exposure to irritants which cause inflammatory response also narrow the airways and can even
break lung tissues (Miravitlles and et.al., 2016). Air pollution from both indoor and outdoor
environment, tobacco smoking and occupational exposure are key reasons for causing COPD.
The genetic factors can also play a minor role in this context. The individuals who are regular
tobacco smokers are at highest risk of COPD development. However the individuals who do not
smoke but are in exposure of such second-hand smoke are also vulnerable groups (Vanfleteren
and et.al., 2015). The vulnerability of disease rises considerably as with the increase in total
smoke exposure. The polluted air such as inefficiently ventilated cooing fires fuelled by coal or
biomass causes indoor pollution. Another reason which contributes in the rapid progression of
COPD is known as occupational exposure (Gudmundsson and et.al., 2019). Prolong and intense
exposure to occupational irritants such as dust, fumes or chemicals enhances the COPD risk in
individuals irrespective of their smoking practices. The occupations which does not have any
safety and health regulations witness more severe and extended risks. There are number of
1

industries such as mining and textile industries in which welding fume, isocyanates and cadmium
are used. The adverse impact of smoke and dust exposure is highly addictive and can increase
the severity of COPD (van der Molen and et.al.,2017). Though smoking and occupational
exposures are prime factors for the origin of COPD but genetic factor can also appear in certain
cases (Lemière and Bernstein, 2018). The genetic factor plays dominant role among COPD
patients who smoke. Genetic factor in the origin of disease is less likely to occur in case of non-
smokers. Another factor which contributes in COPD is life style. For instance the homeless or
poor people used to spend most of the time on roads. Thus they are more exposed to air
pollution, dust and malnutrition. Similarly patients with airway hyperactivity and asthma also
have higher probability of getting affected by the disease. These attributes can also act as source
of origin for COPD among individuals.
Mechanism for development of disease
The continuous and prolong exposure to the above discussed risk factors is fundamental
and triggering factor in the development of COPD. The symptoms of COPD appears very lately
than the prevalence. However there are several triggering factors which worsen the symptoms. It
is known as acute exacerbation and is triggered by environmental pollutants, personal and second
hand smoke exposure and pulmonary embolism (Quirce and Sastre, 2019). COPD is
characterised by air presence of air trapping and poor air flow. The poor airflow is caused due to
breakdown of emphysema (lung tissue) and is refereed as obstructive bronchiolitis. COPD is
developed as the result of chronic and significant response towards inhaled irritants.
The inflammatory state is also contributed by chronic bacterial infections. The
inflammatory cells include white blood cells like macrophages and neutrophil granulocytes. The
individuals who smoke are diagnosed with COPD also have involvement of Tc1 lymphocyte
and eosinophil. The free radicals in tobacco produces oxidative stress which is also responsible
for the lung damage. The destruction of lung tissue cause emphysema leading to poor airflow
and exchange of respiratory gases (Doney and et.al., 2017) . The development of COPD can
be observed in four different categories namely mild to very severe. The disease has different
impact on individuals. The four progressive stages of the disease are as follows:
Mild COPD: In this stage individuals may not observe or realise the symptoms. They may have
phlegm or cough but it does not have any critical impact on routine life of individuals.
2

Moderate COPD: With the progression of the disease or in second or moderate stage of the
disease mucus and cough production becomes visible and significant so that people begin to seek
for medical attention due to increased symptoms appearance or breathing issues. In this stage
prescription of bronchodilators can be helpful for improving breathing. The initiation of
pulmonary rehabilitation programs at this stage can also improves health outcomes to great
extent (Vanfleteren and et.al., 2015). These programs provides education, support, medications
as well as integration of physical exercises so that progression can be controlled or delayed.
(Source: Umstead, 2017)
Severe COPD: The third development phase of COPD is known as severe and individuals in this
phase experience huge impact on their life quality. With severe COPD the functionality of lungs
3

began to decline and breathing difficulties become more severe. Thus progressive symptoms
make it hard for individual to mange their routine tasks. It this phase difficulties in performing
exercise or common events of fatigue may also observed by the patients.
Very severe COPD: This is the fourth and last stage of the development of disease and in this
stage breathing issues and flare ups may take form of life threatening events. It is often
characterised by low oxygen level in blood and serious health conditions such as cyanosis and
hypoxemia (Fishwick and et.al., 2015). Thus for the management of this stage appropriate
therapies for ensuring adequate level of oxygen becomes mandatory for the individual.
Industries vulnerable to COPD
COPD is deteriorating respiratory situation with high morbidity and mortality. Smoking
is considered to be primary and main risk factor for the development of this disease. However
certain occupational risks or exposure to some industrial environments which have fumes, dust,
smoke and gases is also leading cause of COPD. The industries which have highest prevalences
of COPD includes information industry, transportation, construction, agriculture, hunting,
forestry and fishing industry (Peng and et.al., 2018). The air pollutants in internal and external
environment make these industries vulnerable. The industries such as remediation services or
waste management are also prone to the high risk factors for COPD development. In these
industries or occupations the individuals who does not smoke are also prone to the COPD risk.
Thus there is high need of continued surveillance and early identification so that risk
actors can be minimised. The factors such as biological , genetic, social differences and
occupational exposures to toxins and dust increases the COPD risk among non-smoking
individuals as well (Halpin, 2019). It is vital to control and manage the occupation specific
COPD risk. Different occupations may have different triggering factor for the identification and
management of disease. For instance employees in mining industry are continuously exposed to
repairable crystalline silica and coal mine dust.
Similarly administrative or office workers, workers in telecommunication, broadcasting
and publishing industry are exposed to irritant gases, paper dust, paints, glues, inorganic and
organic dust, fumes from photocopiers, oil based ink (Postolache and et.al., 2015). These
substances are called respiratory irritants which have strong association with COPD, bronchitis
and emphysema. These non-smoking and preventable causes of COPD must be analysed and
4

controlled so that such kind of chronic exposure can be regulated and workplace can be made
more secure.
COPD symptoms are not specific and its early symptoms are similar to other respiratory
diseases (Wedzicha and et.al., 2017). Thus it is necessary that respiratory symptoms of
employees must be measured so that their lung functioning can be screened. Though smoking is
believed to be predominant factor and reason for COPD but its interaction with occupational risk
factors can increase the severity of disease. The individuals who work in an environment with
significant concentration of repairable material are prone to airflow obstruction (Uzaslan and
et.al., 2016). The coal mine dust, welding fumes, silica are known to be pro-inflammatory. Their
repeated inhalation can cause airway epithelial damage. Similar effects are also observed among
workers in agriculture, textile industry and in the exposure of domestic biomass fuels.
An overview of COPD in UK
Likewise the other parts of the world, COPD is also one of the primary cause of mortality
in the world. Between 2014-2015 there were more than one million people who were diagnosed
with COPD (Snell and et.al., 2016). The number is growing fast and as a result admissions to
emergency COPD services is increasing in UK. However despite increase in the emergency
admissions the treatment are not effective enough to lower the time spent by patients in hospital
settings. One of the most effective treatment approach for the COPD in UK is known to be
pulmonary rehabilitation. In this treatment approach along with medications exercise regimen,
self care education are also included in the care plan. It helps COPD patients to improve their
quality of life, exercise tolerance and dyspnoea. Despite effective outcomes from this treatment
approach the statistics of 2014 shows unsatisfactory findings. In UK only 60% of patients were
refereed to these programs and out of them 38% people did not completed their treatment.
Though hospitals have facilities to provide these services but patients are required to wait for
more than a month to access it. Every year COPD costs an estimated amount of £1·9 billion
which is a major burden on health care services. As compare to 2014, at present only 54%
hospitals have smoking cessation services which was 63% in 2014 (Snell and et.al., 2016). The
smoking cessation lowers the decline rate of lung function and can play a great role in reducing
mortality particularly among those with smoking as well as occupational risk factors.
5

(Work-related Chronic Obstructive Pulmonary Disease (COPD) statistics in Great Britain, 2019)
Access to these treatment approaches and interacting services is helpful for improving
quality of patient's health and also provides a relieve from increasing financial burden on
emergency services in UK (Ramos and et.al., 2018). Lung diseases in UK cost to huge amount of
£ 11 billion every year. Lung diseases are considered as the fourth most costly disease in terms
of expenditure burden. Among these COPD and asthma are considered as most costly and
severely growing pubic health issues. Every year around 585, 000 patients are diagnosed with the
respiratory disease. Among these patients more than half of the individuals in UK are due to
COPD and asthma (UK COPD treatment: failing to progress, 2018).
Globally also UK is listed in top 20 countries for COPD related deaths. With such an
increasing burden of deaths, management and treatment cost there is high need that NHS, health
care service providers and professionals, government and professionals must work in
collaboration to manage the situation. The prevalence of COPD is also increasing and in the last
decade the number of people diagnosed with disease has increased by 27%. The statistic indicate
that there are higher possibilities of undiagnosed cases which need to be assessed particularly in
vulnerable occupations or industries.
6
Illustration 1: Annual deaths due to COPD

(Work-related Chronic Obstructive Pulmonary Disease (COPD) statistics in Great Britain, 2019)
From various studies and analysis of cases it has been analysed that around 15% COPD
cases in UK are attributed to occupation or industry (Tee, 2017). Every year UK witness nearly
4000 deaths due to occupational COPD (UK COPD treatment: failing to progress, 2018).
Though in every individual type and level of COPD and accumulation of smoking factor plays
important role but the occupation is considered as critical aspect.
Limits of occupational exposure and assessment methods
Limits:
There have been very limited studies which describes the threshold or the optimum limits
of the exposures. However attributes such as geometric mean, and standard deviation are
adopted by organisations to measure the exposure limits. For instance the geometric mean of
0.58 mg per meter cube dust concentration at casting work place is also considered to be
vulnerable for COPD disease. Similarly the geometric mean and geometric standard deviation
for quartz sample measured by fluorescence spectrometer must be 4.41 micro gram per meter
cube and 14.88 micro gram per meter respectively (Yoon, 2017). The increasing concentration
of polycyclic aromatic hydrocarbons is also associated with the increased mortality related to
COPD. The
Assessment methods:
7
Illustration 2: Annual new cases of COPD among former coal miners
assessed for IIDB in UK

In various occupations specific job titles which are exposed to COPD risks are must be
subjected to temporal changes (Lemière and Bernstein, 2018). For this purpose causative agents
are located and identified so that targeted interventions can be applied to existing as well as
future practices. Thus organisations must conduct analyse and review the job exposure matrix
(JEM) for the assessment of occupational risks. Occupational pollutants such as fumes (welding,
cadmium and rubber) and dust (wood, coal, silica, grain and cotton) play significant role in the
development of COPD. The analysis of these pollutants is helpful in identification of workplace
interventions and adjustments for individuals so that occupational COPD risk can be eliminated
or minimised to a great extent. The assessment methods requires collection of personal exposure
data which is limited to only few industries (Sama and et.al., 2017). In the absence of measured
data self reported exposures are used. Thus organisations are widely using JEM to estimate these
occupational exposures. These are easy to use and economically feasible. Most of the JEM are
developed on the basis of general population, industrial knowledge, exposures to job
classification and work environment. Some advanced JEM can also be used by the industries in
which actual measured data from specific work site of their interest is used. JEM allow
organisations to assign exposure to particular substance along with the complete range of
pollutant form.
Strategy for exposure measurement
The management and health care organisations can use various strategies for the
measurement of the exposures. The exposure levels can be measured by using two methods. The
first is detailed and self reported measurement (Andujar and Dalphin, 2016). In this approach
each job is assigned a exposure level by job task data and self reported evaluation of the industry.
It also consider the disease status of the individuals or employees. The organisations must also
assure that routine reports must be produced every week to describe the on job exposure of
particles such as chemicals, dust, diesels gas and fumes. Another measurement strategy includes
categorisation of exposure level on the basis of severity into categories called minimal, moderate
and high for reach irritant particle. In this detailed evaluation the overall exposure such as
likelihood and duration of the exposure is also taken into consideration (Jenkins and et.al.,
2017). The job exposure matrix must consider all factors which can influence the exposure limits
of the particles as well as impact of these paraticles on any individual. It will also depends upon
8

the job role, existing health condition of the patient and the duration for which employee is
exposed to the risk factors.
Prevention and management strategy
For preventing the work force from the ill outcomes or exposure of COPD risk factor it is
necessary that organisations must incorporate appropriate strategy for the management and
prevention of disease. The goal of this management and prevention program is to first minimise
the exposure risk and then to prevent the progression of disease and to relieve symptoms (Bepko
and Mansalis, 2016). The plan will also aim to prevent and treat complications and exacerbations
so that COPD mortality can be reduced. The COPD patients in which co-morbidities are present
shows more challenging aspects in treatment procedure. Thus the first priority of the
organisations must be to lower the exposure risk so that patients can be protected. However the
improvement in deteriorating lung functions require both pharmacological and non-
pharmacological attempts to improve the condition. Thus an effective management plan must
include following stages:
(Source: COPD diagnosis, management and prevention 2019 strategy, 2019)
Assessment and monitoring: The occupations or the industries which have shown higher risk
factors for the development of COPD must emphasis greatly on this stage. There must be regular
monitoring of the exposure limits and factors by the means of job exposure matrix
(Jayachandran, 2019). Organisations must try to emphasis upon the regular monitoring and
analysis of the exposure factors so that their exposure can be reduced and employees can be
9

provided with safe environment. The exposure to risk factors is one of the most dominant
indication of the disease prevalence. Thus it is recommended that such individuals must undergo
into diagnosis or regular basis. The airflow limitation test must be conducted to identify and
assess the patients who have chronic sputum and cough production. The spirometry results
provide most accurate and standard outcomes for the assessment of disease. Thus industries such
as mining and textile must have health regulatory teams and small equipments so that regular
check up of employees can be performed. The measurement of arterial blood pressure must also
be recommended for patients by the health care workers who can collaborate with the vulnerable
industries.
Risk reduction factors: Another significant stage in the management of the disease is to
minimise the risk factors. For instance occupational dust, smoke, outdoor and indoor air
pollutants must be used by appropriate technologies and management strategies. It will result in
effective outcomes in progression and onset of the disease (Würtz and et.al., 2015). Most of the
individuals or workers in vulnerable occupations are not able to access the smoking cessation.
The lack of knowledge and limited access to resources is the dominant factor. Thus health care
service providers and industries must assure that individuals particularly smokers are provided
complete knowledge and facility to access such services. For this purpose practical counselling,
treatment support and social support must be given to the patients (Quirce and Sastre, 2019).
Health care professionals must also assure that all necessary pharmacotherapy are available to
individuals without any contraindications. In the treatment of this long term disease regular
treatment is one of the necessary intervention to reduce the progression or risk factors. For this
purpose the statutory compensations must be provided to the workers of such occupations who
are at risk of COPD.
Managing stable COPD: The effective approach for the management of stable COPD must also
include the gradual progression of the treatment method as per necessity and severity of the
disease. Health education can play great role in this aspect (Vanfleteren and et.al., 2015). Thus
along with the health organisations, vulnerable industries must provide knowledge and training
to their employees so that they can use appropriate safety techniques and measures to stabilise
their COPD. The pharmacological aspects are used to only decline the symptom progression.
Thus it is recommended that patients must be provided with regular and easy access to health
care services, guidance, health and nutritional foods (Cooper and Barjaktarevic, 2015). The
10

regular exercise programs and oxygen administration among server ill patients can assist in
increasing quality of life of the patients. Thus organisations and health care service providers
must assure that they create a safe environment with minimum exposure of irritants.
Management of exacerbations: When individuals are diagnosed with the COPD then for quality
life and symptom management it is required that exacerbations of the symptoms must be
regulated by using necessary nursing and occupational interventions. The infections and
exposure to air pollutants can worsen the symptoms. Thus patients are recommended to avoid
exposure of such particles. For this purpose antibiotic treatments, inhaled bronchodilators and
minimum exposure to risk factor must be recommended to patients (Andujar and Dalphin, 2016).
Employees in such vulnerable industries must try to use variety of safety requirements and
procedures to avoid triggering of such infection risk and exacerbations.
CONCLUSION
From the study it can be concluded that COPD is among life threatening and progressive
chronic disease. Apart from the general risk factors the occupational risks and environment also
act as the major factor for the development of disease. It has been analysed that certain industries
are more vulnerable to COPD and thus additional measures and strategies must be taken into
practice so that employee health and safety can be improved. It can also be concluded that
organisations or industries must assess the exposure risk so that suitable management and
prevention strategies can be incorporated by them.
The increased awareness and management strategies at work place will act as effective
measure to control the increasing population and risk of COPD. It has been also analysed that
along with the awareness at individual level, organisational support and measurements are also
mandatory for the improving health outcomes at occupational as well as public health level.
11

REFERENCES
Books and Journals
Andujar, P. and Dalphin, J.C., 2016. Occupational chronic obstructive pulmonary diseases.
Legal aspects and practical management. Revue des maladies respiratoires. 33(2). pp.91-
101.
Bepko, J. and Mansalis, K., 2016. Common Occupational Disorders: Asthma, COPD,
Dermatitis, and Musculoskeletal Disorders. American family physician. 93(12).
Cooper, C.B. and Barjaktarevic, I., 2015. A new algorithm for the management of COPD. The
Lancet Respiratory Medicine. 3(4). pp.266-268.
Doney, B.C. and et.al., 2017. Occupational exposure to vapor-gas, dust, and fumes in a cohort of
rural adults in Iowa compared with a cohort of urban adults. MMWR Surveillance
Summaries. 66(21). p.1.
Fishwick, D. and et.al.,, 2015. Occupational chronic obstructive pulmonary disease: a standard
of care. Occupational Medicine. 65(4). pp.270-282.
Gudmundsson, G. and et.al., 2019. COPD patients’ experiences, self-reported needs, and needs-
driven strategies to cope with self-management.
Halpin, D., 2019. COPD and Work–Is It Time to Stop?. American Journal of Respiratory and
Critical Care Medicine, (ja).
Jayachandran, P., 2019. TEACHING AN OCCUPATIONAL HAZARD FOR RESPIRATORY
INSULT CONTRIBUTING TO BURDEN OF RESPIRATORY DISEASES IN THE
SOCIETY. Chest. 155(4). p.19A.
Jenkins, C.R. and et.al., 2017. Improving the management of COPD in women. Chest. 151(3).
pp.686-696.
Lemière, C. and Bernstein, D.I., 2018. Occupational asthma: management, prognosis, and
prevention. UpToDate, Waltham. Accessed on, 6.
Miravitlles, M. and et.al., 2016. A review of national guidelines for management of COPD in
Europe. European Respiratory Journal. 47(2). pp.625-637.
Peng, Y. and et.al., 2018. Prevalence and characteristics of COPD among pneumoconiosis
patients at an occupational disease prevention institute: a cross-sectional study. BMC
pulmonary medicine. 18(1). p.22.
Postolache, P. and et.al., 2015. The role of pulmonary rehabilitation in occupational
COPD. Journal of Environmental Protection and Ecology. 16(2). pp.521-527.
Quirce, S. and Sastre, J., 2019. Occupational asthma: clinical phenotypes, biomarkers, and
management. Current opinion in pulmonary medicine. 25(1). pp.59-63.
Ramos, M. and et.al., 2018. The cost-effectiveness of physical activity in the management of
COPD patients in the UK.
Sama, S. and et.al., 2017. 0133 Environmental and occupational triggers of copd symptoms: a
case crossover study.
Snell, N. and et.al., 2016. Burden of lung disease in the UK; findings from the British Lung
Foundation's' respiratory health of the nation'project.
Tee, A., 2017. Chronic Obstructive Pulmonary Disease (COPD): Not a cigarette only pulmonary
disease. Ann Acad Med. 46(11). pp.415-416.
Uzaslan, E. and et.al., 2016. Management of virtual COPD cases by pulmonary physicians.
12

van der Molen, T. and et.al.,2017. Optimizing identification and management of COPD patients–
reviewing the role of the community pharmacist. British journal of clinical
pharmacology. 83(1). pp.192-201.
Vanfleteren, L.E. and et.al., 2015. COPD management: need for more consensus. The Lancet
Respiratory Medicine. 3(7). pp.e21-e22.
Wedzicha, J.A. and et.al., 2017. Management of COPD exacerbations: A European respiratory
society/American thoracic society guideline. European Respiratory Journal. 49(3).
p.1600791.
Würtz, E.T. and et.al., 2015. Occupational COPD among Danish never-smokers: a population-
based study. Occup Environ Med. 72(6). pp.456-459.
Yoon, H., 2017. Prevention of COPD. In COPD (pp. 211-217). Springer, Berlin, Heidelberg.
Online
COPD diagnosis, management and prevention 2019 strategy. 2019. [Online]. Accessed through
<https://www.guidelines.co.uk/respiratory/gold-copd-2019-strategy/454454.article>
UK COPD treatment: failing to progress. 2018. [Online]. Accessed through
<https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)30904-8/fulltext>
Umstead, C., 2017. Understanding the four stages of COPD. [Online]. Accessed through
<https://www.1stclassmed.com/blog/understanding-the-4-stages-of-copd>
Work-related Chronic Obstructive Pulmonary Disease (COPD) statistics in Great Britain, 2019.
[Online]. Accessed through <http://www.hse.gov.uk/statistics/causdis/copd.pdf>
13

14

15

16

17