Year : 2019 | Volume
: 23 | Issue : 3 | Page : 101-
Dealing with occupational lung diseases – A few challenges
Occupational Health Services, Department of Community Health, St. John's Medical College, Bangalore, Karnataka, India
Dr. Bobby Joseph
Occupational Health Services, Department of Community Health, St. John's Medical College, Bangalore - 560 034, Karnataka
|How to cite this article:|
Joseph B. Dealing with occupational lung diseases – A few challenges.Indian J Occup Environ Med 2019;23:101-101
|How to cite this URL:|
Joseph B. Dealing with occupational lung diseases – A few challenges. Indian J Occup Environ Med [serial online] 2019 [cited 2020 Jan 23 ];23:101-101
Available from: http://www.ijoem.com/text.asp?2019/23/3/101/273037
Experiences of practitioners of occupational medicine will surely point to an underrecognition and subsequent underreporting of occupational lung diseases (OLDs). Although history will tell us that the father of occupational medicine, Bernardino Ramazzini, first reported hypersensitivity pneumonitis among wheat reapers exposed to overheated grains, medical practice has scarcely been able to keep pace with the understanding of exposure to newer molecules and their outcomes in specific occupational groups. On the other hand, traditionally, reference books on OLDs – while dealing with pneumoconiosis, hypersensitivity pneumonitis, occupational asthma, and pulmonary function tests – rarely consider infectious diseases as one among those that are probably occupational in origin.
This issue of the IJOEM hopes to bring these two issues – OLDs and infectious diseases of the lung that are of occupational origin – to the attention of the readers. The report on Gujjar lung is a case in point – though identified first in 1991 as a pneumoconiosis attributable to biomass combustion at home, larger studies quantifying its prevalence and listing its risk factors are rare. The consequence of which is alarming from a public health point of view, wherein the disease is misdiagnosed as pulmonary tuberculosis and unnecessarily treated for the same. This phenomenon, which is probably true of many unrecognized “pneumoconioses,” has serious implications in the fight against tuberculosis. This has been the case with silicosis, where the lack of the facilities and skills to rule out tuberculosis, fear of consequences of the labeling of a case as silicosis, and even the well-known constraints in the management of the disease often lead to a “trial” of anti-tuberculosis treatment.
The issue of tuberculosis as an occupational-acquired disease begs consideration. While specific pneumoconiosis can be directly linked to being occupationally involved in an industry where the specific causative agent is present, it is difficult to prove whether tuberculosis in health workers is community-acquired or occupationally acquired. The mere incidence or prevalence of the disease in larger numbers than in other occupations is not sufficient to warrant it being called an occupational lung disease. Advanced statistical methods and mathematical models make it possible to estimate the burden of occupationally acquired pulmonary tuberculosis. However, as occupational physicians, in dealing with individual employees, it is important that we identify tuberculosis and other infectious diseases in as effective and efficacious a manner as is possible. The article in this issue on QuantiFERON-TB Gold In-Tube Test versus Tuberculin Skin Test focuses on this problem – where there is the likelihood of individual establishments in different geographic locations having to take decisions depending on factors related to cost and feasibility.
This issue has two articles that deal with unique medical consequences of OLDs – skin thickening and spontaneous pneumothorax, while another article deals with the broader quality of life of an occupational group with poor lung function.
In the coming year, selected issues of this journal will focus on specific occupational health themes – occupational health of health workers, occupational health of workers in unorganized sectors, and health of working women. We encourage researchers to submit articles to these thematic issues of the journal.