Your work, and your lungs
New Straits Times, 14 May 2013
Some occupations are particularly risky for the lungs,an expert tells Syida Lizta Amirul Ihsan
HER cough wouldn’t go away, even after a month. Every time she went to the clinic, she was given a cough mixture that made her drowsy.
It wasn’t until Nadira Hamid (not her real name) threw up when she coughed that she was referred to a specialist. He put her on the nebuliser and admitted her to a hospital, where she remained for four days.
At 31, she was diagnosed with asthma, a condition she didn’t know she had. “I have never had asthma so the ordeal was taxing. I kept feeling semput (breathless) and I could not move much without feeling tired,” she related in a phone interview.
The reason for her condition, according to Tropicana Medical Centre consultant chest physician Dr Mohammed Fauzi Abdul Rani, is prolonged exposure to vehicle fumes.
For the past 12 years, Nadira, married with two young children, has worked as a toll collector and the exposure to the dusty highway triggered her condition.
“She is genetically predisposed to asthma and the exposure to vehicle fumes and other environmental chemicals accelerated the manifestation of the disease,” says Dr Mohammed Fauzi.
Currently, Nadira is on asthma medication and has applied to work in the office instead of the toll booth. But, she admits, she has developed a phobia about vehicle fumes, traffic and any situation where there is a lot of smoke.
“But I know that sooner or later, I have to go back to that work,” she says.
OCCUPATION AND ENVIRONMENT
Occupational disease caused by activities and environmental factors in the work place is still largely under-reported in the country and Dr Mohammed Fauzi says occupational lung disease is estimated to be from six to seven per cent of all reported cases.
“It’s not just those who are exposed to vehicle fumes who can develop asthma, or work-aggravated asthma, like Nadira. Those who work in certain manufacturing industries, electrical and metal industries and in sawmills are also at
risk of developing a condition called occupational asthma,” he says. “This condition can become irreversible if an individual is perpetually exposed to the substance causing it.”
He says some people are genetically predisposed to asthma, and exposure to dust and fumes can accelerate the manifestation of the disease or exacerbate the condition in patients already having it.
“These people will feel well during long holidays but once they return to work, their condition worsens. We detect these changes through peak flow reading taken during work days and when they are on leave or off work. For those with occupational asthma, their peak flow reading can be reduced by as much as 30 per cent when they come back to work,” he says.
A peak flow meter is a portable, handheld device used to measure how well air moves out of your lungs and is an important tool in managing asthma.
Other jobs and industries that pose risk to the lungs, Dr Mohammed Fauzi says, include working in mines and quarries. “Construction labourers, rock blasters and those in the foundry industry are at risk of contracting silicosis due to the sand particles deposited in their lungs.”
Those in the agriculture and forestry sectors are at risk if they work with pesticides. “Pesticides are irritants and can cause breathlessness. They can even cause an asthmatic attack,” he says.
Another high-risk industry is healthcare due to close proximity to patients.
“Many healthcare workers contract tuberculosis due to the nature of their work which often requires them to be in close proximity with patients with sputum positive pulmonary tuberculosis,” he says.
“Other lung conditions associated with occupation are pneumoconiosis (a condition often suffered by miners who inhale coal dust over long periods), extrinsic allergic alveolitis (an inflammation of the alveoli within the lung caused by hypersensitivity to inhaled organic dusts) and cancer.
“Cancer can develop due to prolonged exposure to asbestos, which is carcinogenic.”
WHAT WORKERS CAN DO
There are some things workers can do if they work in these industries. The first is to quit smoking since the habit can worsen any lung condition and aggravate occupation-related conditions.
“In a closed environment, they should improve indoor air quality by increasing fresh air flow into the building. An exhaust fan can expel indoor air,” he says.
Workers should also use adequate protection and well-fitted equipment. “A mask that doesn’t fit well, for instance, cannot filter fumes from reaching the lungs,” he says.
“I think most importantly, workers have to equip themselves with knowledge, and they must know what they face and what they should do. Safety procedures and personal hygiene cannot be taken lightly.”
Symptoms of occupational lung disease include coughing, shortness of breath, chest pain, chest tightness and abnormal breathing pattern.
Dr Mohammed Fauzi says the industry must be attentive to this issue and comply strictly to safety rules and regulations for the welfare of the employees.
“Periodic checks and monitoring should be done to make sure workers are protected and the work environment does not jeopardise workers’ health,” he adds.
UNDER-REPORTED
Like Nadira, many people don’t realise the link between their health problems and work environment. Dr Mohammed Fauzi says there is poor reporting of occupational lung disease in the country.
According to the Department of Occupational Safety and Health website (www.dosh.gov.my), in 2010, a total of 1,426 cases of occupational disease and poisoning have been reported.
Almost half the cases happened in Selangor, followed by Johor and Penang. Of all the cases, 43 were lung disease.
Dr Mohammed Fauzi says the reported number is very low.
“I think there are many reasons why this is so. Some doctors don’t link a patient’s condition to his or her working environment,” he says.
“Workers may also be afraid they will lose their jobs by associating the condition with their workplace. For employers, there is the fear of losing the worker or a visit by the authority which may result in stop work order,”he says.
“The number of occupational lung diseases that we have doesn’t cover legal foreign workers. We also don’t know what happens to illegal foreign workers, or people who work part-time or from home. There is limited coverage for occupational lung disease in general.”
WHAT THE LUNGS CAN TAKE
The lungs, Dr Mohammed Fauzi says, can be affected by any form of air pollution. “It is well-documented that any kind of pollution will increase the risk of developing lung diseases and I think employers and employees must take this seriously and be proactive in protecting the organ,” he says.
“In addition to training more medical experts in managing occupational lung disease, medical schools could also systematically expose medical students to this disease during undergraduate training to allow awareness to start earlier on in their careers.
“With increased allocation and budget, it is also hoped that the central agencies can be stricter in enforcing safety regulations to protect the health of the workforce.”
Nadira says her condition is under control now that she is working in the office, although there are instances when she needs to use medication.
“I have thought of changing jobs, but it’s not easy to find one and my employer provides medical coverage,” she says. “Not working is not an option for me. But I’m scared my condition will get worse.”
RISK TO THE LUNGS
Here are some occupations that are a risk to lung health, from cases notified to the Ministry Of Health from June 1997 to Nov 1998.
Source: Med J Malaysia, Vol 56, No. 1 Mar 2001
OCCUPATIONAL DISEASE
Occupational disease is a disease caused by or due to activities or environmental factors at the workplace.
TYPES OF OCCUPATIONAL DISEASE
Occupational lung disease
Occupational skin disease
Musculoskeletal disease
Cardiovascular system disease
Reproductive system disease
Central nervous system disease
Liver disease
Renal disease
Psychiatric disease/mental health disturbance
Occupational cancers
CAUSATIVE AGENTS
Gas
Metal
Solvents
Pesticide/herbicide/rodenticide/fungicide
Noise
Vibration
Temperature
Radiation
Pressure (hyperbaric and hyperbaric)
Infectious agent
Source: www.dosh.gov.my
