INSTITUTE OF OCCUPATIONAL MEDICINE . Edinburgh . UK www.iom-world.org
COPD and low toxicity dust
John Cherrie
Summary…
• There has been a gradual realisation that
exposure to most dusts can harm the lung
• The unifying factor may be...
COPD
• Chronic Obstructive Pulmonary Disease is
characterised by progressive airflow
obstruction and destruction of lung
•...
Lung function assessments
• Symptoms of COPD include:
• Dyspnea (breathlessness)
• Chronic cough
• Chronic sputum producti...
HSE says…
• Work related COPD is a priority because of
the human costs in terms of suffering, its
effects on the quality o...
“Inert” or nuisance particulates
• Threshold Limit Values (TLVs) 1969
• Published by Department of Employment
as Technical...
Nuisance particulate
• By 1974 limit reduced
• TLV 10 mg/m3 or 30 mppcf, <1%
crystalline silica
• “… when inhaled in exces...
Dust, not otherwise specified
• 1984 HSE publish Guidance Note
EH40, Occupational Exposure Limits
• Recommended Limit of 1...
COSHH Regulations
• From 1988 the definition of a “substance
hazardous to health” included dust of any
kind…present at a c...
Low toxicity dusts
• Do NOT include: quartz, asbestos or
toxic metals
• Could include: amorphous silica,
silicon, silicon ...
How many people are exposed to
dusts?
• Estimated as 9,200,000
• Manufacturing - 29%
• Construction - 19%
• Hospitality - ...
Past exposure to dust
• In British coal mines in the 1940s dust
levels could be very high
Bedford and Warner (1943) Chroni...
Exposures decreased over time
Exposure decreases over time…
Creely KS et al. (2007) Trends in inhalation exposure--a review of the data in
the published...
Respirablevs Inhalable
• Which size fraction causes the adverse
health effects?
• How are these size fractions related?
• ...
Respirablevs Inhalable
Okamoto S, et al. Variation in the ratio of respirable particulates over inhalable
particulates by ...
PVC dust
• Study of 818 workers in a PVC
manufacturing plant
• Highest respirable dust levels about
2.5 mg/m3
• FEV1 was s...
Some people become seriously
disabled…
• The average reduction in lung function is
relatively modest when compared with th...
Surface area is an important
factor…
• Inflammatory response (neutrophils) in
bronchoalveolarlavage: TiO2, CB and latex
Do...
…unifies biological response to
dusts
TiO2 (rectangle and
diamond), BaSO4 at
two exposure
concentrations
(triangles) and d...
A No Observed Adverse Effect
Level
• We used a mathematical model based on
animal toxicity data to estimate the NOAEL
for ...
Our recommendation…
• The current British limit values for
respirable and inhalable dust (4 and 10
mg/m3, respectively) ar...
More information…
• Cherrie J, Brosseau LM,
Hay A, Donaldson K
(2013) A Commentary for
the Annals of
Occupational Hygiene:...
Questions…
www.SlideShare.net/JohnCherrie/
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Copd and dust

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A talk I gave to the local IOSH Branch in Edinburgh in September 2013.

Published in: Health & Medicine
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  • Thanks John Cherrie, Very helpful , I would like to know how the heavy dust from 911 can affect a smoker that now has Copd
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  • I was a smoker, but in 2001 i worked in New York, in construction as a superintendent i was caught up in the heavy dust when the Twin Towers fell . and i worked in the zone for a couple years after 911 what i need to know is could the dust make me develop my COPD even if i smoked in the past. I am very sick with my COPD and i need a answer to this if you could please Email me at donchristian4@gmail.com Thank you very much
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  • This is a bit of technicality – the Regs don’t actually specify a limit they have these criteria that set out when the requirements to control come into play.
  • The need to classifymany dust together as low toxicity is because it is difficult (impossible for mixtures) to have individual limits.
  • You may want to dispense with this one? My estimate of the number of people exposed to airborne dust based on employment stats and job title/industry.
  • This is from the book on the second slide,
  • These are data from NCB and the PFR (these are data from surface operations NOT underground)Not sure why the PFR is lower but it may be something to do with the location of the Samplers. TP data was converted to be roughly equivalent to the MRE using the appropriate MNI (Mass-Number Index)
  • In a review of published evidence for temporal trends that we published in 2007 we identified 38 cases where there was informative data for aerosols. We analyzed the temporal trends on the log-scale assuming an exponential decline in exposure level over time. 58% of these involving aerosols there was a significant reduction in exposure, typically between 5% and 10% per year. Only one dataset (3%) showed a significant increase.
  • Okamoto et al, (1998) obtained comparative data from simultaneous measurements made using Respirable and Inhalable dust samplers. They found a statistically significant association between the two measures (correlation coefficient = 0.78, on the log-transformed data) with the regression equation of the form log(R) = 0.59 xlog(I) - 0.57 ). These data showed that Inhalable dust levels were on average 2.6 times the Respirable dust levels with a range of Inhalable to Respirable ratios from 2 (welding) to 5.1 (foundry work), corresponding to 50% and 18% of the dust being Respirable, respectively. The ratio of Total dust to Respirable dust in British coalmines was reported in the IOM report by Cowie et al (1981), where the average ratio between total and Respirable dust levels was 5.5 (i.e. 18% Respirable) and the correlation between these two measures was 0.89.
  • Loss similar magnitude to the loss caused by smoking 20 cigarettes a day.
  • instilled rat lungs with small masses of a number of low toxicity, low solubility particles (TiO2, CB and latex) in different size ranges including uf, and assessed short-term inflammation
  • Copd and dust

    1. 1. INSTITUTE OF OCCUPATIONAL MEDICINE . Edinburgh . UK www.iom-world.org COPD and low toxicity dust John Cherrie
    2. 2. Summary… • There has been a gradual realisation that exposure to most dusts can harm the lung • The unifying factor may be the surface area and surface properties of the dust • Even relatively low exposure to low-toxicity dust may be harmful and current exposure limits are probably not protective • Exposures are lower than in the past and so current exposure limits are not helpful • Many people are probably still exposed
    3. 3. COPD • Chronic Obstructive Pulmonary Disease is characterised by progressive airflow obstruction and destruction of lung • It is caused by chronic exposure of genetically susceptible individuals to environmental factors • It is associated with an enhanced chronic inflammatory response • Smoking is an important cause, but about a quarter of COPD patients are non-smokers
    4. 4. Lung function assessments • Symptoms of COPD include: • Dyspnea (breathlessness) • Chronic cough • Chronic sputum production • Episodes of acute worsening of these symptoms (exacerbations) often occur • Spirometry used to make a clinical diagnosis • the presence of a post-bronchodilator FEV1/FVC < 0.70. • “Mild” if FEV1 ≥ 80% predicted • “Moderate” if 50% ≤ FEV1 < 80% predicted http://www.GoldCOPD.org/
    5. 5. HSE says… • Work related COPD is a priority because of the human costs in terms of suffering, its effects on the quality of life and the financial costs due to working days lost and medical treatment. • Around 15% of COPD may be caused or made worse by dusts, fumes and irritating gases • 4,000 COPD deaths every year may be related to work exposures • 40% of COPD patients are below retirement age • A quarter of those with COPD below retirement age are unable to work at all
    6. 6. “Inert” or nuisance particulates • Threshold Limit Values (TLVs) 1969 • Published by Department of Employment as Technical Data Note 2/69 • TLV = 15 mg/m3 or 50 mppcf of total dust <1% crystalline silica • “… a number of dusts or particulates that occur in the working environment ordinarily produce no specific effects upon prolonged inhalation.”
    7. 7. Nuisance particulate • By 1974 limit reduced • TLV 10 mg/m3 or 30 mppcf, <1% crystalline silica • “… when inhaled in excessive amounts, so called ‘nuisance’ dusts have a long history of little adverse effect on the lungs and do not produce significant organic disease or toxic effect when exposure is kept under reasonable control.” • By 1980 TLV was… • 30 mppcf or 10 mg/m3 of total dust <1% quartz or 5 mg/m3 of respirable dust
    8. 8. Dust, not otherwise specified • 1984 HSE publish Guidance Note EH40, Occupational Exposure Limits • Recommended Limit of 10 mg/m3 of total dust or 5 mg/m3 of respirable dust.
    9. 9. COSHH Regulations • From 1988 the definition of a “substance hazardous to health” included dust of any kind…present at a concentration in air greater than • 10 mg/m3, as a time-weighted average over an 8- hours, of total inhalable dust, • 5 mg/m3, as a time-weighted average over an 8-hours, of respirabledust • From 1997 revised sampling criteria for respirable dust and the “limit” was reduced from 5 mg/m3 to 4 mg/m3
    10. 10. Low toxicity dusts • Do NOT include: quartz, asbestos or toxic metals • Could include: amorphous silica, silicon, silicon carbide, pulverised fuel ash, limestone, gypsum, graphite, aluminium oxide, titanium dioxide, coal dust, other mineral dusts with low crystalline silica content, etc
    11. 11. How many people are exposed to dusts? • Estimated as 9,200,000 • Manufacturing - 29% • Construction - 19% • Hospitality - 11% • Professional etc. - 9% • Wholesale/retail - 8% • Agriculture - 6% • Utility - 5% 4% 11% 9% 5% 9% 8% 9% 24% 9% 9%
    12. 12. Past exposure to dust • In British coal mines in the 1940s dust levels could be very high Bedford and Warner (1943) Chronic pulmonary disease in South Wales coalminers – II Environmental studies. London: HMSO. Total (mg/m3) Respirable (mg/m3) Longwall stalls 394 14 Narrow places 215 20
    13. 13. Exposures decreased over time
    14. 14. Exposure decreases over time… Creely KS et al. (2007) Trends in inhalation exposure--a review of the data in the published scientific literature. Ann OccupHyg.; 51(8): 665-678.
    15. 15. Respirablevs Inhalable • Which size fraction causes the adverse health effects? • How are these size fractions related? • Implicitly one might expect inhalable dust to be about twice respirable dust levels (based on the limits) • In typical situations inhalable dust is probably between about 2 and 5 times respirable dust concentrations
    16. 16. Respirablevs Inhalable Okamoto S, et al. Variation in the ratio of respirable particulates over inhalable particulates by type of dust workplace. Int Arch Occ Environ Health 1998; 71: 111–116. Log10(RESPIRABLE particulate concentration (mg/m3)) Log10(INHALABLEconcentration(mg/m3))
    17. 17. PVC dust • Study of 818 workers in a PVC manufacturing plant • Highest respirable dust levels about 2.5 mg/m3 • FEV1 was statistically significantly lower among men with higher PVC dust exposure • This is equivalent to a loss of 52 ml of FEV1 for the mean cumulative respirable dust exposure, equivalent to 0.7 mg/m3 for 20 years Soutar et al. (1979) An epidemiological study of respiratory disease in workers exposed to polyvinylchloride dust. IOM TM 79/02.
    18. 18. Some people become seriously disabled… • The average reduction in lung function is relatively modest when compared with the effects of aging or cigarette smoking • However, 12% of those exposed at the limit for 40 years would be twice as likely as controls to report breathlessness • 7% would report „walking slower than other people on the same level because of my chest‟
    19. 19. Surface area is an important factor… • Inflammatory response (neutrophils) in bronchoalveolarlavage: TiO2, CB and latex Donaldson K, Brown D, Clouter A, et al. The pulmonary toxicology of ultrafine particles. J Aerosol Med 2002;15:213–220.
    20. 20. …unifies biological response to dusts TiO2 (rectangle and diamond), BaSO4 at two exposure concentrations (triangles) and data from Oberdörster for TiO2 (fine and ultrafine, stars) Faux et al (2003) In vitro determinants of particulate toxicity: The dose-metric for poorly soluble dusts. HSE report RR 154.
    21. 21. A No Observed Adverse Effect Level • We used a mathematical model based on animal toxicity data to estimate the NOAEL for low toxicity dust – TiO2 • Based on avoiding „overload‟, i.e. the impairment of clearance and recruitment of inflammatory cells into the lung • Inflammation judged as beginning when neutrophils (PMN) constituted 2% of the total cells in the lung • Analysis estimated human NOAEL as 1.3 mg/m3 Tran et al. (2003) Risk assessment of inhaled particles using a physiologically based mechanistic model. HSE report RR 141.
    22. 22. Our recommendation… • The current British limit values for respirable and inhalable dust (4 and 10 mg/m3, respectively) are unsafe and it would be prudent to reduce exposures as far below these limits as is reasonably practicable • We suggest that, until safe limits are put in place, employers should aim to keep exposure to respirable dust below 1 mg/m3
    23. 23. More information… • Cherrie J, Brosseau LM, Hay A, Donaldson K (2013) A Commentary for the Annals of Occupational Hygiene: Low-Toxicity Dusts: Current Exposure Guidelines Are Not Sufficiently Protective. Annals of Occupational Hygiene. http://annhyg.oxfordjournals.org/content/ea rly/2013/07/07/annhyg.met038.full
    24. 24. Questions… www.SlideShare.net/JohnCherrie/

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