COPD: a respiratory disease with a proven link to multiple occupational exposure sources
An underestimated link to work
COPD is currently the fourth leading cause of death worldwide. It takes the form of persistent and chronic respiratory symptoms that include progressive shortness of breath, coughing and repeated respiratory infections. The disease then develops, with a rapid decline in respiratory function and the onset of other concomitant conditions such as lung infections or heart problems.
Because of its insidious and slow progression, COPD is largely under-diagnosed. Patients often seek medical advice at a late stage, when their respiratory capacity is already significantly reduced.
Smoking – including passive smoking – is the main identified risk factor. However, there are other sources of exposure besides tobacco. For example, several scientific studies estimate that around 15% of COPD cases are work-related, and that certain agricultural and industrial sectors are associated with an increased risk of developing the disease.
A proven link with exposure to VGPF
ANSES assessed the link between COPD and VGPF, an overall indicator used in epidemiological studies to group together a wide variety of pollutants.
It identified multiple workplace studies showing that COPD can be caused by inhaling airborne pollutants such as mineral (silica, coal, etc.) or organic (plants, mould, and so on) particles, as well as gases, vapours and fumes. In combination with smoking, this exposure can also increase the risk of developing the disease or can aggravate symptoms in people who are already affected.
Based on its assessment of the available data, the Agency concluded that there is a proven causal relationship between occupational exposure to VGPF and the development of COPD. This finding is a scientific argument in favour of the creation of occupational disease tables.
Multiple sources of occupational exposure
These particles, vapours and fumes are produced by thermal or chemical reactions, mechanical action or the combustion of materials. The occupations exposed span a wide range of sectors, from mining and quarrying to construction and public works, foundries, steelmaking, coking plants, the textile and chemical industries, and agriculture. The long list of work environments involving exposure to VGPF, as established by ANSES, illustrates the extent of the multiple exposure sources and the various pollutants present in the workplace.
Towards a single table to facilitate the recognition process
At present, there are various tables of occupational diseases relating to COPD. Some are old and restrictive, while others are limited to specific occupations that sometimes no longer exist or involve particles that are too specific in the current state of scientific knowledge.
The proliferation of tables relating to the same disease complicates the recognition process for insured individuals and the doctors who treat them, due to the heterogeneity of the designations and the time limits for compensation mentioned in each one. The Agency had already made this observation in its expert appraisal on updating the existing tables. That is why ANSES recommends discussing the creation of a single table, incorporating the relevant information in the current tables for this disease and including the list of occupations exposing workers to VGPF as identified in its expert appraisal.
More broadly, on the eve of World COPD Day, the Agency recommends raising public awareness of this disease and rolling out screening for COPD during occupational health and general medical consultations in order to reduce under-diagnosis and treat the disease at an earlier stage to prevent it from worsening.