Abstract

According to a 2000 estimate based on workforce data and the CAREX (Carcinogen Exposure) database there were 386,000 deaths worldwide due to non-cancer respiratory diseases (asthma: 38,000; chronic obstructive pulmonary disease (COPD): 318,000; pneumoconioses: 30,000) and nearly 6.6 million disability-adjusted life years (DALYs) (asthma: 1,621,000; COPD: 3,733,000; pneumoconioses: 1,288,000) attributable to occupational exposure to airborne particulates. The same figures for Europe were 52,700 deaths (asthma: 6,200; COPD: 39,300; pneumoconioses: 7,200) and 868,000 DALYs (asthma: 139,000; COPD: 468,000; pneumoconioses: 261,000). Respiratory diseases rank as the third most prevalent occupational disease category (after ergonomic and stress-related diseases) according to a survey of occupational diseases in the European Union (EU). The prevalence of respiratory diseases was 296 per 100,000 population, with the highest proportion found in the mining industry. This amounts to almost 600,000 persons in the former 15 member states. Many of these diseases, though induced while working, are chronic, thus explaining the highest prevalence among older workers (0.5% aged 55–64 yrs).

Traditional high-risk occupations, such as mining, farming, manufacturing and service work (e.g. hairdressers), are among the professions with a high prevalence of occupational lung diseases. However, high rates of occupational lung disease are also seen in newer professions, such as public administration, education and occupational cleaning; the latter could be a reflection of problems related to new cleaning procedures, as found by the European Community Respiratory Health Survey (ECRHS), or to problems with indoor air in public spaces.

The pneumoconioses induced by exposure to mineral and other dusts at high concentrations were the dominating occupational lung diseases in the early industrialisation era. Their prevalence has been decreasing during the past decades. At the same time the obstructive lung diseases have gained increased importance, first because these diseases are widespread in the population, hence even small occupational contributions are important for society, and secondly because smoking has become less common during the same period, thereby revealing the "true" burden of occupational exposures, especially on COPD.

Although mining and quarrying are decreasing in industrially advanced countries, new technologies have introduced known exposures to new groups of workers. One example of this is the recurrence of silicotic lesions in construction workers, shown to coincide with the new technique of hand-held high-speed tools now in common use on construction sites. These new tools are a challenge to us all, since they introduce a potential dangerous exposure to groups of workers unaware of the associated risk.

For malignant diseases we are facing an epidemic of malignant mesothelioma caused by the intensive use of asbestos up to the late 1980s. The number of annual cases is predicted to increase steadily until 2020 in the old member states, and perhaps even later in the new member states 5.

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