title: Occupational chronic obstructive pulmonary disease: a standard of care.
abstract: BACKGROUND
  Consistent evidence from population studies report that 10-15% of the total burden of chronic obstructive pulmonary disease (COPD) is associated with workplace exposures. This proportion of COPD could be eliminated if harmful workplace exposures were controlled adequately.
  
  
  OBJECTIVE
  To produce a standard of care for clinicians, occupational health professionals, employers and employees on the identification and management of occupational COPD.
  
  
  METHODS
  A systematic literature review was used to identify published data on the prevention, identification and management of occupational COPD. Scottish Intercollegiate Guidance Network grading and the Royal College of General Practitioner three star grading system were used to grade the evidence.
  
  
  RESULTS
  There are a number of specific workplace exposures that are established causes of COPD. Taking an occupational history in patients or workers with possible or established COPD will identify these. Reduction in exposure to vapours, gases, dusts and fumes at work is likely to be the most effective method for reducing occupational COPD. Identification of workers with rapidly declining lung function, irrespective of their specific exposure, is important. Individuals can be identified at work by accurate annual measures of lung function.
  
  
  CONCLUSIONS
  Early identification of cases with COPD is important so that causality can be considered and action taken to reduce causative exposures thereby preventing further harm to the individual and other workers who may be similarly exposed. This can be achieved using a combination of a respiratory questionnaire, accurate lung function measurements and control of exposures in the workplace.
authors.affiliation: Centre for Workplace Health, Health and Safety Laboratory, Buxton, UK, d.fishwick@sheffield.ac.uk.
authors.forename: D
authors.initials: D
authors.lastname: Fishwick
authors.affiliation: Health and Safety Executive, Bootle, Merseyside, UK.
authors.forename: D
authors.initials: D
authors.lastname: Sen
authors.affiliation: Centre for Workplace Health, Health and Safety Laboratory, Buxton, UK.
authors.forename: C
authors.initials: C
authors.lastname: Barber
authors.affiliation: Centre for Workplace Health, Health and Safety Laboratory, Buxton, UK.
authors.forename: L
authors.initials: L
authors.lastname: Bradshaw
authors.affiliation: Centre for Workplace Health, Health and Safety Laboratory, Buxton, UK.
authors.forename: E
authors.initials: E
authors.lastname: Robinson
authors.affiliation: Centre for Workplace Health, Health and Safety Laboratory, Buxton, UK.
authors.forename: J
authors.initials: J
authors.lastname: Sumner
mesh_terms: D004391:Dust; D006801:Humans; D009784:Occupational Diseases / Q000628:therapy*; D000067393:Personal Protective Equipment; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy*; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D059039:Standard of Care; D011795:Surveys and Questionnaires
chemical_list: D004391:Dust
keywords: COPD; FEV1 decline; lung function; occupation; workplace.