Occupational Asthma Reference

HSE, Health surveillance for those exposed to respirable crystalline silica (RCS). Guidance for occupational health professionals., HSE Publications, 2019;:,http://www.hse.gov.uk/pubns/books/ healthsurveillance.htm

Keywords: silica, surveillance, FEV1

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Abstract

This supplement should be read and used within the context of the generalguidance on health surveillance for those exposed to RCS found in HSE’s COSHH essentials sheet G404 (www.hse.gov.uk/pubns/guidance/g404.pdf).

This supplement provides an example of a health surveillance programme for silicosis for occupational health providers and employers to consider. It provides advice on:
¦ who to include in a health surveillance programme; and
¦ who the ‘competent person’ should be for carrying out each stage of the health
surveillance programme.
Who should be included in the health surveillance programme?
Health surveillance for silicosis should be considered for workers who are involved
in high-risk occupations, including construction, foundry work, brick and tile work,
ceramics, slate, manufacturing, quarries and stonework. Where workers are regularly exposed to RCS dust and there is a reasonable likelihood that silicosis may develop, health surveillance must be provided.
Further examples of where health surveillance for silicosis may be appropriate include:
¦ where there have been previous cases of work-related ill-health in the workplace;
¦ where there is reliance on RPE as an exposure control measure for silica; or
¦ where there is evidence of work-related ill health in the industry.

Chronic obstructive pulmonary disease
The questionnaire and lung function testing elements of the health surveillance
should help in identifying chronic obstructive pulmonary disease (COPD) which is
also associated with exposure to RCS.

Tuberculosis
There is no current evidence to support the regular use of tuberculosis testing for
silica-exposed workers. Any worker suspected of having tuberculosis should be
referred by their GP to the local NHS TB service.

Use of chest X-rays
It is the responsibility of the employer to involve a health professional and discuss
the need for posterior anterior (PA) chest X-rays as part of a health surveillance
programme for silicosis. As chest X-rays carry risks associated with the use of ionising radiation, their use always needs to be justified on health grounds even though the actual dose of radiation required to carry out a single chest X-ray is very low. Periodic chest X-rays at the intervals described in the following section below are justified. Any X-rays need to be accessible for 40 years. These are likely now to be in a digital form.
Computerised tomography (CT) scanning can also be used, but this is currently normally reserved for those with an abnormal chest X-ray. There may be increased use of CT in the future for screening when the technology has improved. Some employers have found that it is feasible to contract a provider to carry out X-rays using mobile services brought on to site, although a certain amount of space is required to set up on site. X-rays should be of sufficiently good quality to interpret and should be read by a suitably experienced radiologist.

Baseline assessment for new entrants, before or shortly after first exposure to RCS,
would include:
¦ respiratory questionnaire (Example 1);
¦ lung function testing (spirometry) to measure forced expiratory volume (FEV1)
and forced vital capacity (FVC). FEV1 is measured to within current American
Thoracic Society (ATS)/European Respiratory Society (ERS) stipulated accuracy of 150 mls (or 100 mls if below 1 litre). The results should be recorded tomonitor how values change with time (see Example 1B); and
¦ consideration of a baseline chest X-ray for comparison with future chest X-rays.
After that, for both new-entrant and pre-existing employees, annual health
surveillance would include:
¦ respiratory questionnaire; and
¦ lung function testing.
After 15 years of exposure to RCS
For employees who have had 15 years of exposure to RCS while working for oneor more employer(s), the health surveillance for that year would include:
¦ respiratory questionnaire;
¦ lung function testing; and
¦ PA chest X-ray.
(This includes pre-existing employees with previous RCS exposure of 15 or moreyears at the time of introducing the health surveillance programme.)
Thereafter
Subsequent health surveillance (as detailed in Example 2) would be repeated annually (or earlier if indicated by the results of health surveillance or if a worker complained of symptoms in the intervening period). The employer may appoint a Health and Safety
Executive responsible person (supported by an appropriate health professional) so that
workers can report symptoms.

Annual health surveillance would include:
¦ respiratory questionnaire;
¦ lung function testing; and
¦ every 3 years, a PA chest X-ray.

Plain text: This supplement should be read and used within the context of the generalguidance on health surveillance for those exposed to RCS found in HSE's COSHH essentials sheet G404 (www.hse.gov.uk/pubns/guidance/g404.pdf). This supplement provides an example of a health surveillance programme for silicosis for occupational health providers and employers to consider. It provides advice on: ¦ who to include in a health surveillance programme; and ¦ who the 'competent person' should be for carrying out each stage of the health surveillance programme. Who should be included in the health surveillance programme? Health surveillance for silicosis should be considered for workers who are involved in high-risk occupations, including construction, foundry work, brick and tile work, ceramics, slate, manufacturing, quarries and stonework. Where workers are regularly exposed to RCS dust and there is a reasonable likelihood that silicosis may develop, health surveillance must be provided. Further examples of where health surveillance for silicosis may be appropriate include: ¦ where there have been previous cases of work-related ill-health in the workplace; ¦ where there is reliance on RPE as an exposure control measure for silica; or ¦ where there is evidence of work-related ill health in the industry. Chronic obstructive pulmonary disease The questionnaire and lung function testing elements of the health surveillance should help in identifying chronic obstructive pulmonary disease (COPD) which is also associated with exposure to RCS. Tuberculosis There is no current evidence to support the regular use of tuberculosis testing for silica-exposed workers. Any worker suspected of having tuberculosis should be referred by their GP to the local NHS TB service. Use of chest X-rays It is the responsibility of the employer to involve a health professional and discuss the need for posterior anterior (PA) chest X-rays as part of a health surveillance programme for silicosis. As chest X-rays carry risks associated with the use of ionising radiation, their use always needs to be justified on health grounds even though the actual dose of radiation required to carry out a single chest X-ray is very low. Periodic chest X-rays at the intervals described in the following section below are justified. Any X-rays need to be accessible for 40 years. These are likely now to be in a digital form. Computerised tomography (CT) scanning can also be used, but this is currently normally reserved for those with an abnormal chest X-ray. There may be increased use of CT in the future for screening when the technology has improved. Some employers have found that it is feasible to contract a provider to carry out X-rays using mobile services brought on to site, although a certain amount of space is required to set up on site. X-rays should be of sufficiently good quality to interpret and should be read by a suitably experienced radiologist. Baseline assessment for new entrants, before or shortly after first exposure to RCS, would include: ¦ respiratory questionnaire (Example 1); ¦ lung function testing (spirometry) to measure forced expiratory volume (FEV1) and forced vital capacity (FVC). FEV1 is measured to within current American Thoracic Society (ATS)/European Respiratory Society (ERS) stipulated accuracy of 150 mls (or 100 mls if below 1 litre). The results should be recorded tomonitor how values change with time (see Example 1B); and ¦ consideration of a baseline chest X-ray for comparison with future chest X-rays. After that, for both new-entrant and pre-existing employees, annual health surveillance would include: ¦ respiratory questionnaire; and ¦ lung function testing. After 15 years of exposure to RCS For employees who have had 15 years of exposure to RCS while working for oneor more employer(s), the health surveillance for that year would include: ¦ respiratory questionnaire; ¦ lung function testing; and ¦ PA chest X-ray. (This includes pre-existing employees with previous RCS exposure of 15 or moreyears at the time of introducing the health surveillance programme.) Thereafter Subsequent health surveillance (as detailed in Example 2) would be repeated annually (or earlier if indicated by the results of health surveillance or if a worker complained of symptoms in the intervening period). The employer may appoint a Health and Safety Executive responsible person (supported by an appropriate health professional) so that workers can report symptoms. Annual health surveillance would include: ¦ respiratory questionnaire; ¦ lung function testing; and ¦ every 3 years, a PA chest X-ray.

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