ADVANCEMENT OF THE SCIENCE
bated asthma (WEA) worsened by exposure to substances in the workplace (Járes et al., 2012; MacKinnon et al., 2020; OSHA, 2014b; Roio et al., 2021). Overall, 7% of the estimated 500,000 asthma mortalities worldwide were work- related (Roio et al., 2021). According to NIOSH (2024), more than 300 known or suspected substances are associated with OA. Examples of agents related to OA include ammonia, cement dust, chloride, cleaning products, diesel exhaust, tobacco smoke, iso- cyanates, fire smoke, sulfur dioxide, mixed agents in swine confinement facilities, and welding fumes—while exposure to dust, environmental tobacco smoke, air pollution, stressful activities, temperature variations, and physical exertion are associated with WEA (Roio et al., 2021). In the U.S., 7.7% of adults are asthmatic, and of these cases, 11% appear to be work- related (Laditka et al., 2020). Removing the workers from exposure is an eective preven- tive strategy for work-related asthma (Rui et al., 2022). History of work and exposure is useful in diagnosing OA and, depending on the triggering agent, the latency period can be weeks to years. The latency period for low-molecular-weight sensitizers typically is within 2 years and longer for most high- molecular-weight sensitizers (Járes et al., 2012). Specific inhalation challenge (SIC) is the gold standard for diagnosis of asthma (Járes et al., 2012; Tarlo et al., 2008), but if SIC is not available or not possible, other diagnostic tools such as serial peak expira- tory flow and FEV1 at work and away from work, bronchoprovocation testing, and immunological tests can be beneficial (Fish- wick et al., 2012; Járes et al., 2012; Quirce & Sastre, 2020). Regulations, Prevention, and Safe Work Environment Occupational lung diseases are preventable, which underscores the need for regulations and preventive strategies to minimize and eliminate occupational exposure. As with most airborne exposures, eliminating the hazard and using control measures to protect employees are important actions. Asbestos OSHA has standards for controlling asbestos exposure in the workplace. The permissible
exposure limit (PEL) for asbestos exposure is 0.1 fiber per cubic centimeter (f/cc) of air on an 8-hr, time-weighted average (TWA) (Table 1). In addition, asbestos has an excur- sion limit (EL) of 1.0 f/cc over a 30-min TWA (OSHA, 2014a). Silica OSHA has regulations for construction, general industry, and the maritime industry related to silica exposure. The action level is 25 µg/m 3 , and the PEL is 50 µg/m 3 for an 8-hr TWA (Table 1). In addition, the employer must establish and implement a written exposure control plan that identifies methods to control exposure. OSHA also requires that employees exposed at or above the action level for more than 30 days per year be oered medical surveillance (OSHA, 2017, 2018). Coal Dust The 2014 Respirable Dust Rule by MSHA (n.d.) is an eort by federal regulatory agen- cies to provide a safe environment for miners and protect against the potential development of CWP in the future (Mazurek et al., 2018). Due in part to the increase in cases and sever- ity of CWP, MSHA lowered the respirable coal dust concentration limits to 1.5 mg/m 3 in 2016 (Table 1), which are above the 1995 NIOSH recommendation of 1.0 mg/m 3 (Liu & Liu, 2020). Cotton Dust Byssinosis has long been recognized as an occupational health hazard. The PEL for cotton dust depends on the type of cot- ton dust and its operation; according to the OSHA standard for cotton dust, exposures are required to be measured using a vertical elutriator or equivalent instrument (Cotton Dust, 2024). Table 1 shows the action level and PEL for dierent categories of exposure to cotton dust. Prevention Preventing exposures in the workplace is one way to protect employees from occupational lung disease. In turn, this action will lessen the number of people who are diagnosed with lung disease, including older adults. OSHA has put into eect a respiratory pro- tection standard and numerous PELs to limit employee exposure in the workplace, which requires employers first to utilize eective
engineering controls to mitigate respiratory hazards in the workplace and prevent expo- sure (Respiratory Protection, 2024). When those control methods do not reduce expo- sure below the PEL for respiratory hazards, then respiratory protection is acceptable to protect employees. As part of a respiratory protection program, employers must have employees medically evaluated to ensure that each employee can wear a respirator, fit test employees to ensure that the respirator has an acceptable seal, pro- vide training to employees, and select the res- pirator that will protect against the hazard of concern at the concentration employees are exposed to in the workplace (Respiratory Pro- tection, 2024). Deviations from the standard or the written program can lead to employee exposure to hazards that can have detrimental eects later in life in the form of lung disease or other diseases from work exposures. Conclusion Most occupational lung diseases have long latency periods, with workers manifesting conditions long after exposure—and with devastating lung damage in most cases. The chemical and physical properties of the exposed particles or materials are essential in determining the severity, clinical out- come, and pathogenesis of occupational lung diseases. Diagnosing occupational lung disease can be challenging, and knowl- edge of exposure history, clinical signs and symptoms, consensus diagnostic tools, and criteria are essential for early detection and management. Prevention from exposure, along with disease surveillance programs, upholding industrial standards for expo- sure, and regulatory oversight, are all essen- tial to protecting workers from developing occupational lung diseases. Most occupa- tional lung diseases have limited therapeu- tic options, leaving prevention and early detection as crucial ways of reducing the disease burden. Lastly, continuing research to better understand the impact of these exposures will help provide a safer environ- ment for all workers. Corresponding Author: Alexander C. Ufelle, Associate Professor, Department of Public Health Sciences, Slippery Rock University, 1 Morrow Way, Slippery Rock, PA 16057. Email: alexander.ufelle@sru.edu
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Volume 87 • Number 4
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