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DR GOGILLAN SEVARATNAM
MBBS(B’LORE), MPH(UM), CMIA(NIOSH), LFOM,MFOM(IRELAND) FIAMS (INDIA)

OCCUPATIONAL PHYSICIAN
 Occupational Lung Disease- Case Study I
• 52 year old male , presents with a 4-year history of slowly
progressive respiratory complaints which include chest tightness,
wheeze, cough productive of minimal white phlegm, and dyspnea
• Over the last 4 months, the patient has awakened from sleep twice
weekly
• Given MDI. His use of metered dose inhaler has
gradually increased to a current level of 10-12 puffs
• Medical history is insignificant, with no
history of childhood asthma. Not smoker
• Referred to a physician
• Was diagnosed as Bronchial Asthma
• Notified as Occupational Asthma
Occupational history:
• Laboratory technician in
Histopathology Lab for more 6 years
• Exposes to formaldehyde and xylene
• No PPE
Formaldehyde Induced Bronchial Asthma
Advised for Compensation by SOCSO
 SWORD (Surveillance of Work Related and Occupational Respiratory Disease) system initiated in the UK in 1989
A scheme has been developed for the voluntary reporting of occupational respiratory diseases by Respiratory and Occupational Physicians
Jobs Involving The Usage Of Isocyanates

Surface coating Foam-blowing

Under carpet padding

 Occupational Lung Disease- Case Study II
• Between 1993-2000, eight employees of were reported to have
severe bronchiolitis obliterans They were former employees for a
microwave-popcorn plant
• On investigation at the workplace: Diacetyl (flavoring agent)
found to be the cause.
• Newer term: Flavorings-Related Lung Disease(Popcorn Lung)
Occupational Lung Disease- Case Study III
• 55 years old male complained of dyspnoea on effort for the past
one year. He had no cough, phlegm or chest pain.
• There was no history of bronchial asthma
• On examination, he had no cyanosis, clubbing or edema.
• Reduced breath sounds at the right apex with bilateral
crepitation heard over both lower zones.
• Abnormal changes in lung function tests
• He worked as a production worker in a factory manufacturing
asbestos cement pipes and building materials since 1965
• The job descriptions given by the workers and factory
management sources, there appeared to be considerable
occupational exposure to asbestos dust before 1984
Crocidolite was used until 1975
Amosite was used until 1983
A B C
Black Lung – Coal Worker
 What Causes Occupational Lung Disorders?

Dust Wood, cotton, coal, asbestos, silica, talc , cereal grains, coffee
particles
Fumes from Welding, smelting, furnace work, pottery making, plastics
metals manufacturing, rubber operations

Smoke from Firefighters

burning materials
Gases Laboratory, welding, brazing, smelting, oven drying, furnace
work

Mists or sprays Hair spray, pesticides, cleaning products, acids, oils, solvents
 Asbestos Related Disease
SWORD (Surveillance of Work Related and Occupational Respiratory Disease)

467- Asbestosis deaths in 2015

2,542-mesothelioma deaths in 2015
 Types of Asbestos
Types Uses

CHRYSOTILE (white Roofs, ceilings, walls

asbestos) Automobile brake linings, gaskets and boiler seals

AMOSITE (brown Tiles

asbestos)
very rare in Malaysia

CROCIDOLITE (blue Was commonly used to insulate steam engines,

asbestos) and it was also used in some spray-on coatings,
pipe insulation, plastics and cement products.

Factories & Machinery (Asbestos) Regulations 1986

 Occupational Lung Disorders – ILO
• Pneumoconioses caused by fibrogenic mineral dust (silicosis, anthraco-
silicosis, asbestosis)
• Silicotuberculosis
• Pneumoconioses caused by non-fibrogenic mineral dust
• Siderosis
• Bronchopulmonary diseases caused by hard-metal dust
• Bronchopulmonary diseases caused by dust of cotton (byssinosis), flax,
hemp, sisal or sugar cane (bagassosis)
• Asthma caused by recognized sensitizing agents or irritants inherent to
the work process
• Extrinsic allergic alveolitis caused by the inhalation of organic dusts or
microbially contaminated aerosols, arising from work activities
• Chronic obstructive pulmonary diseases caused by inhalation of coal
dust, dust from stone quarries, wood dust, dust from cereals and
agricultural work, dust in animal stables, dust from textiles, and paper
dust, arising from work activities
• Diseases of the lung caused by aluminium
 12,000- Lung disease deaths each 18,000-Estimated annual new
year estimated to be linked to past cases of self-reported work-
exposures at work related breathing or lung
problems

SWORD
(Surveillance of Work
Related and Occupational
Respiratory Disease)
Occupational Lung Disorders – DOSH

Year Reported Confirmed

2016 98
2018 123 76
2019 101 61
2020 134 63
2021 10
 Occupational and Environmental History
• Employment details
Job title
Type of industry and specific work
Years employed
• Exposure information Bernandino Ramazzini

General description of job process and overall hygiene

Materials used by worker and others
Specific workplace exposures
Ventilation / exhaust system
Use of respiratory protection
• Details about past employments in chronological order
• Other details
Does the patient think symptoms / problem is related to
anything at work?
Are other workers affected?
Work absenteeism
Part time job/ hobbies
 Prevention
The core of occupational medicine

• Primary prevention – removal or modification of hazardous risk or

exposure before disease has occurred

• Secondary prevention – early detection and prompt treatment of

adverse effects of the exposure
 Medical Measures
• Preplacement examination
• Medical Surveillance – USECHH Regulations
2000
• Medical and health care services
• Notification – JKKP/DOSH
• Supervision of working environment
• Maintenance and analysis of records
• Health education and counselling
 Engineering Measures
• Design of building
• Good housekeeping
• Ventilation and exhaust systems
• Substitution
• Dust control
• Enclosure / isolation
 Respirators

Self Contained
Cartridge Respirator Breathing Apparatus

Mask

Powered Air
Purified Respirator
 Way Forward
• Complete occupational history
• Notification – NADOPOD Regulation 2004
• Dialogue session
• Training on ILO Classification Of Radiographs For
Pneumoconiosis
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