Occupational Lung Diseases â€“ General Principles and Approaches

Occupational Lung Occupational Lung Diseases Diseases –– General General

Principles and Principles and ApproachesApproaches

IntroductionIntroduction

Recent decades have seen a marked increase in concern Recent decades have seen a marked increase in concern about the adverse health effects of hazardous exposures about the adverse health effects of hazardous exposures in the workplace and elsewhere in the environment.in the workplace and elsewhere in the environment.

Endless array of hazardous substances in industrial and Endless array of hazardous substances in industrial and agriculture sectors.agriculture sectors.

The lung The lung –– with its extensive surface area, high blood with its extensive surface area, high blood flow and thin alveolar epithelium flow and thin alveolar epithelium –– is an important site is an important site of contact with these substances in the environmentof contact with these substances in the environment

DefinitionsDefinitions

Damage to the lungs caused by dusts or fumes or noxious Damage to the lungs caused by dusts or fumes or noxious substances inhaled by the workers in certain specific occupationsubstances inhaled by the workers in certain specific occupations s is known as is known as ““Occupational Lung DiseasesOccupational Lung Diseases””..

PneumoconiosisPneumoconiosis –– the accumulation of the dust in the lungs the accumulation of the dust in the lungs and the tissue reactions to its presence.and the tissue reactions to its presence.

DustDust –– an aerosol composed of solid inanimate particles.an aerosol composed of solid inanimate particles.

Importance of Occupational Lung DiseasesImportance of Occupational Lung Diseases

Knowledge of cause may affect patient management and Knowledge of cause may affect patient management and prognosis and may prevent further disease progression in the prognosis and may prevent further disease progression in the affected person.affected person.

Establishment of cause may have significant legal, financial andEstablishment of cause may have significant legal, financial andsocial implications for the patient.social implications for the patient.

The recognition of occupational and environmental risk factors The recognition of occupational and environmental risk factors can also have important public health and policy consequences.can also have important public health and policy consequences.

Occupational and environmental lung diseases can also serve as Occupational and environmental lung diseases can also serve as important disease models.important disease models.

Global burdenGlobal burden

Health burden: Health burden: 2 million work related death per year. 2 million work related death per year. ##

Fatalities Attributable to work:Fatalities Attributable to work:Circulatory diseasesCirculatory diseases

23%23%

Respiratory diseasesRespiratory diseases

7%7%CancerCancer

32%32%

Contagious diseasesContagious diseases

17%17%Accidents and violenceAccidents and violence

19%19%

Other causesOther causes

2%2%

Tip of the iceberg : Tip of the iceberg : 160 million nonfatal diseases.160 million nonfatal diseases.# ILO Statistics 2002# ILO Statistics 2002

WHO: World Health Report WHO: World Health Report -- Oct 2002Oct 2002

Occupational risk factors account for :Occupational risk factors account for :InjuriesInjuries

10%10%

Back painBack pain

37%37%Hearing lossHearing loss

16%16%

CancerCancerlunglung

10%10%

leukemialeukemia

2%2%Lung diseasesLung diseases

COPDCOPD

13%13%AsthmaAsthma

11%11%

Silicosis, Asbestosis, CWPSilicosis, Asbestosis, CWP

100%100%

ClassificationClassification

Occupational lung diseases can be classified according to Occupational lung diseases can be classified according to several schemes.several schemes.

Clinical presentationClinical presentation

Type of exposure to agent Type of exposure to agent Organic dustsOrganic dustsInorganic dustsInorganic dustsMetalsMetalsBiological factorsBiological factors

Types of industry potentially associated with Types of industry potentially associated with respiratory diseasesrespiratory diseases

International Labour organization, Geneva.International Labour organization, Geneva. List of occupational Diseases (2002)List of occupational Diseases (2002)

1.1. Diseases caused by agentsDiseases caused by agents

1.1 Chemical agents ( 32 items)1.1 Chemical agents ( 32 items)1.2 Physical agents ( 8 items )1.2 Physical agents ( 8 items )1.3 Biological agents ( infectious and parasitic diseases 1.3 Biological agents ( infectious and parasitic diseases

contracted in an occupation where there is a parcontracted in an occupation where there is a particular ticular risk of contamination )risk of contamination )

2. Diseases by target organ systems2. Diseases by target organ systems

2.1 Occupational respiratory diseases2.1 Occupational respiratory diseases2.2 Occupational skin diseases 2.2 Occupational skin diseases 2.3 Occupational musculoskeletal disorders2.3 Occupational musculoskeletal disorders

3. Occupational cancer ( 15 items )3. Occupational cancer ( 15 items )(Asbestos, (Asbestos, BenzidineBenzidine

and compounds, and compounds, BischloromethylBischloromethyl

ether, chromium ether, chromium and compounds, coal tar, betaand compounds, coal tar, beta--

naphthylaminenaphthylamine, Vinyl chloride, Benzene, , Vinyl chloride, Benzene, Toxic nitroToxic nitro--

and amino derivatives of benzene, Ionizing radiations, Tar, and amino derivatives of benzene, Ionizing radiations, Tar, pitch bitumen, mineral oil, and related compounds, cpitch bitumen, mineral oil, and related compounds, coke oven emission, oke oven emission, wood dust )wood dust )

4. Other diseases 4. Other diseases

4.1 Miner4.1 Miner’’s nystagmus s nystagmus

2.1 Occupational respiratory diseases2.1 Occupational respiratory diseases

2.1.1 Pneumoconioses caused by sclerogenic mineral dusts 2.1.1 Pneumoconioses caused by sclerogenic mineral dusts 2.1.2 2.1.2 BronchopulmonaryBronchopulmonary disease caused by harddisease caused by hard--metal dustmetal dust2.1.3 2.1.3 BronchopulmonaryBronchopulmonary disease caused by cotton, flax, hemp or disease caused by cotton, flax, hemp or

sisal dustsisal dust2.1.4 Occupational asthma2.1.4 Occupational asthma2.1.5 Extrinsic allergic 2.1.5 Extrinsic allergic alveolitisalveolitis2.1.5 2.1.5 SiderosisSiderosis2.1.6 Chronic obstructive pulmonary diseases2.1.6 Chronic obstructive pulmonary diseases2.1.7 Diseases caused by 2.1.7 Diseases caused by aluminiumaluminium2.1.9 Upper airways disorders2.1.9 Upper airways disorders2.1.10 Any other respiratory disease not mentioned in the 2.1.10 Any other respiratory disease not mentioned in the proceeding items caused by an agent where the casual proceeding items caused by an agent where the casual relationship is established.relationship is established.

Basic principles of occupational lung diseasesBasic principles of occupational lung diseases

Certain principles apply broadly to the full range of Certain principles apply broadly to the full range of occupational respiratory disordersoccupational respiratory disorders

While a few environmental and occupational lung diseases may While a few environmental and occupational lung diseases may present with present with pathognomonicpathognomonic features, most are difficult to features, most are difficult to distinguish from disorders of nonenvironmental origin.distinguish from disorders of nonenvironmental origin.

A given substance in the workplace or environment can cause A given substance in the workplace or environment can cause more than one clinical or pathologic entity.more than one clinical or pathologic entity.

The etiology of many lung diseases may be multifactorial and The etiology of many lung diseases may be multifactorial and occupational factors may interact with other factors.occupational factors may interact with other factors.

The dose of exposure is an important determinant of the The dose of exposure is an important determinant of the proportion of people affected or the severity of disease.proportion of people affected or the severity of disease.

Individual differences in susceptibility to exposures do exist.Individual differences in susceptibility to exposures do exist.

The effects of a given occupational or environmental lung The effects of a given occupational or environmental lung exposure occur after the exposure with a predictable latency exposure occur after the exposure with a predictable latency intervalinterval

PathogenesisPathogenesis

The effects of an inhaled agent depend on many The effects of an inhaled agent depend on many factors:factors:

its physical and chemical propertiesits physical and chemical properties

the susceptibility of the exposed personthe susceptibility of the exposed person

the site of deposition within the bronchial treethe site of deposition within the bronchial tree

Physical properties Physical properties

physical state physical state (solid particulates, mist, vapor and gases(solid particulates, mist, vapor and gases

))

solubilitysolubilitysize, shape and densitysize, shape and densityconcentrationconcentrationpenetrabilitypenetrabilityradioactivityradioactivity

Chemical propertiesChemical propertiesalkalinity and acidityalkalinity and acidityfibrogenicityfibrogenicityantigenicityantigenicity

Susceptibility of exposed personSusceptibility of exposed personIntegrity of local defense mechanismsIntegrity of local defense mechanismsImmunological status ( atopy, HLA type )Immunological status ( atopy, HLA type )Airway geometryAirway geometry

Site of depositionSite of depositionWhen airborne particles come in contact with the wall of thWhen airborne particles come in contact with the wall of the e conducting airway or a respiratory unit they do not become conducting airway or a respiratory unit they do not become airborne again.airborne again.

Governs the lung response substantiallyGoverns the lung response substantially

Mechanisms of dust deposition:Mechanisms of dust deposition:SedimentationSedimentation

InterceptionInterception

Inertial impaction Inertial impaction Electrostatic precipitationElectrostatic precipitationDiffusionDiffusion

Size of particleSize of particle

mechanism of depositionmechanism of deposition

site of depositionsite of deposition

Large particlesLarge particles

Sedimentation andSedimentation and

Nose, trachea and Nose, trachea and (6 (6 ––

25 um) inertial impaction25 um) inertial impaction

conducting airwaysconducting airways

Smaller particlesSmaller particles

diffusiondiffusion

gas exchanginggas exchanging(0.5 (0.5 ––

6um)6um)

portions of lungsportions of lungs

Particles of < 1 umParticles of < 1 um

diffusiondiffusion

most of them most of them exhaled out, exhaled out, <10% of them<10% of themdeposited in alveolideposited in alveoli

Diagnostic criteriaDiagnostic criteria

The clinical presentation and workup are consistent The clinical presentation and workup are consistent with the diagnosis.with the diagnosis.

A casual relationship between the exposure and the A casual relationship between the exposure and the diagnosed condition has been previously established diagnosed condition has been previously established or strongly suggested in the medical, epidemiologic or or strongly suggested in the medical, epidemiologic or toxicologic literature. toxicologic literature.

There is sufficient exposure to cause the disease.There is sufficient exposure to cause the disease.

The details of the particular case, such as the temporal The details of the particular case, such as the temporal relationship between exposure and disease, are relationship between exposure and disease, are consistent with known information about the exposureconsistent with known information about the exposure--disease association.disease association.

There is no other, more likely diagnosis.There is no other, more likely diagnosis.

Determination of casual relationshipDetermination of casual relationship

Three main types of information can be used to Three main types of information can be used to establish a casual relationship between an exposure and establish a casual relationship between an exposure and a respiratory condition: a respiratory condition:

Case series or reportsCase series or reportsEpidemiologic studiesEpidemiologic studiesToxicologic studiesToxicologic studies

Clinical approach to the patientClinical approach to the patient

There are two important phases in the workup of any patient There are two important phases in the workup of any patient with a potential occupational or environmental lung disease.with a potential occupational or environmental lung disease.

1. General approach: To define and characterize the nature and1. General approach: To define and characterize the nature andextent of the respiratory illness, regardless of the suspected extent of the respiratory illness, regardless of the suspected origin.origin.

A detailed history A detailed history Physical examinationPhysical examinationAppropriate diagnostic toolsAppropriate diagnostic tools

2. To determine the extent to which the disease or symptom 2. To determine the extent to which the disease or symptom complex is caused or exacerbated by an exposure at work or in complex is caused or exacerbated by an exposure at work or in the environment.the environment.

Occupational and environmental historyOccupational and environmental history

––

single most helpful single most helpful

tool in the diagnostic workuptool in the diagnostic workup

Occupational and environmental historyOccupational and environmental history

Employment detailsEmployment detailsJob title Job title Type of industry and specific workType of industry and specific workName of employerName of employerYears employedYears employed

Exposure informationExposure informationGeneral description of job process and overall hygieneGeneral description of job process and overall hygieneMaterials wed by worker and othersMaterials wed by worker and othersSpecific workplace exposuresSpecific workplace exposuresVentilation / exhaust systemVentilation / exhaust systemUse of respiratory protectionUse of respiratory protectionIndustrial hygiene informations provided by the employer toIndustrial hygiene informations provided by the employer to

the employee.the employee.

Environmental nonoccupational factorsEnvironmental nonoccupational factorsSmokingSmokingDiet Diet HobbiesHobbiesPetsPets

Details about past employments in chronological orderDetails about past employments in chronological order

Other detailsOther detailsDoes the patient think symptoms / problem is related to anyDoes the patient think symptoms / problem is related to anything at work?thing at work?Are other workers affected?Are other workers affected?Work absenteeismWork absenteeismPrior pulmonary problems and medications usedPrior pulmonary problems and medications used

Physical examinationsPhysical examinations

Generally unrevealing about specific cause.Generally unrevealing about specific cause.

It is most helpful in ruling out nonoccupational causes It is most helpful in ruling out nonoccupational causes of respiratory symptoms or diseases (cardiac problems of respiratory symptoms or diseases (cardiac problems or connective tissue disorders).or connective tissue disorders).

DiagnosisDiagnosis

Chest radiographyChest radiography

It is the most important diagnostic test for occupational It is the most important diagnostic test for occupational lung disease.lung disease.

Under certain circumstances, the chest radiograph can Under certain circumstances, the chest radiograph can be unique or highly suggestive of an occupational be unique or highly suggestive of an occupational disorder and may be sufficient, along with an disorder and may be sufficient, along with an appropriate exposure history, to establish a diagnosis.appropriate exposure history, to establish a diagnosis.

SilicosisSilicosis

AsbestosisAsbestosis

Limitations:Limitations:The chest radiographic findings can be nonspecific.The chest radiographic findings can be nonspecific.

Conventional chest radiography is insensitive, missing Conventional chest radiography is insensitive, missing as many as 10 to 15 percent of cases with pathologically as many as 10 to 15 percent of cases with pathologically documented disease.documented disease.

Interpersonal variationsInterpersonal variations

ILO ILO –– International Classification of radiographs of International Classification of radiographs of pneumoconiosis 1971.pneumoconiosis 1971.

To evaluate chest radiographs for epidemiologic To evaluate chest radiographs for epidemiologic studies, clinical evaluation and screening.studies, clinical evaluation and screening.

The system require a PA radiograph and comparison to The system require a PA radiograph and comparison to a standard set of radiographsa standard set of radiographs


Film quality : Grades I to IVFilm quality : Grades I to IV

Small opacities:Small opacities:round opacities: round opacities: p (<1.5mm)p (<1.5mm)

q (1.5 q (1.5 ––

3mm)3mm)r (3r (3--10mm)10mm)

Irregular opacities: Irregular opacities: s (<1.5mm)s (<1.5mm)t (1.5 t (1.5 ––

3mm)3mm)

u (3 u (3 ––

10mm)10mm)


Profusion:Profusion:Category 0:Category 0:

small rounded opacities absent or less profuse than in small rounded opacities absent or less profuse than in

category 1.category 1.

Category 1:Category 1:

small rounded opacities definitely present but few in small rounded opacities definitely present but few in

number.number.


small rounded opacities numerous. The normal lung small rounded opacities numerous. The normal lung

markings are still visible.markings are still visible.


small rounded opacities very numerous. The lung small rounded opacities very numerous. The lung

markings are partially or totally obscured. markings are partially or totally obscured.


Large opacities:Large opacities:Category A :Category A :

one or more large opacities not exceeding a one or more large opacities not exceeding a

combined diameter of 5 cm combined diameter of 5 cm

Category B :Category B :

large opacities with combined diameter large opacities with combined diameter greater than 5 cm but does not exceed the equivalent of greater than 5 cm but does not exceed the equivalent of the right upper zone the right upper zone

Category C :Category C :

bigger than B bigger than B


Pleural Abnormalities:Pleural Abnormalities:LocationLocationwidthwidthextentextentdegree of calcificationdegree of calcification

Other abnormal features: Symbols as prescribed by Other abnormal features: Symbols as prescribed by ILO.ILO.

Computed tomographyComputed tomography

Conventional and HRCT scanning are highly sensitive Conventional and HRCT scanning are highly sensitive for diagnosis of pleural diseases and useful for for diagnosis of pleural diseases and useful for improved visualization of parenchymal abnormalities.improved visualization of parenchymal abnormalities.

HRCT findings are usually non specific, but HRCT findings are usually non specific, but occasionally certain features and distribution pattern occasionally certain features and distribution pattern may suggest a specific cause and may help narrow the may suggest a specific cause and may help narrow the differential diagnosis.differential diagnosis.


Chronic beryllium diseaseChronic beryllium disease

Hypersensitivity pneumonitis (FarmerHypersensitivity pneumonitis (Farmer’’s Lung)s Lung)

Physiological methodsPhysiological methods

The most important tool to assess functional The most important tool to assess functional respiratory status in patients with occupational lung respiratory status in patients with occupational lung disease.disease.

Generally not specific but useful in Generally not specific but useful in Evaluating dyspnoea of various causes.Evaluating dyspnoea of various causes.Differentiating obstructive from restrictive defects.Differentiating obstructive from restrictive defects.Assessing the degree of pulmonary impairment.Assessing the degree of pulmonary impairment.

Methods Methods

SpirometrySpirometryLung volumesLung volumesDiffusing capacityDiffusing capacityMethocholine challenge testMethocholine challenge testPreshift and postshift FEV1 measurementsPreshift and postshift FEV1 measurementsSerial measurements of peak expiratory flow ratesSerial measurements of peak expiratory flow ratesSpecific inhalation challenge testsSpecific inhalation challenge tests

Cardiopulmonary exercise testingCardiopulmonary exercise testing

Used to assess functional impairment and disease Used to assess functional impairment and disease progression progression

Can help distinguish among cardiac, pulmonary and Can help distinguish among cardiac, pulmonary and deconditioning causes of dyspnoea.deconditioning causes of dyspnoea.

Not helpful in determining the specific origin of the Not helpful in determining the specific origin of the lung diseases.lung diseases.

Pathologic examinationPathologic examination

Methods used to obtain specimens for Methods used to obtain specimens for pathologic examinationpathologic examination

BronchoscopyBronchoscopyThoracoscopyThoracoscopyOpen lung biopsyOpen lung biopsy

Bronchoalveolar lavageBronchoalveolar lavageA predominance of lymphocytes suggests certain diagnoses such A predominance of lymphocytes suggests certain diagnoses such as sarcoidosis, hypersensitivity pneumonitis or beryllium diseasas sarcoidosis, hypersensitivity pneumonitis or beryllium disease e (but is not by itself diagnostic).(but is not by itself diagnostic).

The diagnosis of beryllium disease can be established with the The diagnosis of beryllium disease can be established with the finding of a positive lymphocyte transformation in the BAL cellsfinding of a positive lymphocyte transformation in the BAL cellsof exposed patients.of exposed patients.

Characteristic multinucleated giant cells may be seen in the BALCharacteristic multinucleated giant cells may be seen in the BALfluid of patients with hardfluid of patients with hard--metal lung disease.metal lung disease.

Transbronchial lung biopsiesTransbronchial lung biopsiesTBLB yield only small tissue samples that may be adequate to TBLB yield only small tissue samples that may be adequate to diagnose disorders such as interstitial fibrosis, but are often diagnose disorders such as interstitial fibrosis, but are often unable to shed light on the reason for the pathology that is unable to shed light on the reason for the pathology that is noted.noted.

They are most helpful in diagnosing granulomatous interstitial They are most helpful in diagnosing granulomatous interstitial diseases such as sarcoidosis, beryllium disease and diseases such as sarcoidosis, beryllium disease and hypersensitivity pneumonitis and diffuse malignant processes.hypersensitivity pneumonitis and diffuse malignant processes.

SilicosisSilicosis


Chronic Beryllium DiseaseChronic Beryllium Disease

HardHard--metal diseasemetal disease

Hypersensitivity pneumonitisHypersensitivity pneumonitis

Methods used to analyze dust content of lung tissueMethods used to analyze dust content of lung tissue

Light microscopic evaluation with polarizationLight microscopic evaluation with polarization

Radiographic fluorescence scanning electron microscopyRadiographic fluorescence scanning electron microscopy

Energy dispersion radiographic spectroscopyEnergy dispersion radiographic spectroscopy

Asbestos Asbestos fibrefibre seen under polarized light microscopeseen under polarized light microscope

LimitationsLimitationsOnly particulates that are insoluble and retained in tissue at Only particulates that are insoluble and retained in tissue at sufficient concentration will be detected.sufficient concentration will be detected.

These methods can be tedious and there can be significant These methods can be tedious and there can be significant differences in results from different laboratories.differences in results from different laboratories.

Most importantly, a positive finding documents biologically Most importantly, a positive finding documents biologically detectable exposure but does not demonstrate disease or detectable exposure but does not demonstrate disease or establish a casual relationshipestablish a casual relationship..

Impact of diagnosisImpact of diagnosis

For the clinician: For the clinician: important social, economic, legal important social, economic, legal and public health considerations.and public health considerations.

For the patient: For the patient: a profound impact on the work, a profound impact on the work, income and social situation.income and social situation.

PreventionPrevention

Prevention Prevention –– central to the practice of occupational and central to the practice of occupational and environmental medicine. environmental medicine.

Two main strategies:Two main strategies:Primary preventionPrimary prevention

––

removal or modification of removal or modification of

hazardous risk or exposure before disease has occurred.hazardous risk or exposure before disease has occurred.

Secondary preventionSecondary prevention

––

early detection and prompt early detection and prompt treatment of adverse effects of the exposure.treatment of adverse effects of the exposure.

The various measures for the prevention of The various measures for the prevention of occupational diseases may be grouped as:occupational diseases may be grouped as:

Medical measures Medical measures Engineering measures.Engineering measures.

Medical measuresMedical measures

PrePre--placement examinationplacement examinationPeriodical examinationPeriodical examinationMedical and health care servicesMedical and health care servicesNotificationNotificationSupervision of working environmentSupervision of working environmentMaintenance and analysis of recordsMaintenance and analysis of recordsHealth education and counsellingHealth education and counselling

Engineering measuresEngineering measures

Design of buildingDesign of buildingGood housekeepingGood housekeepingVentilation and exhaust systemsVentilation and exhaust systemsMechanization Mechanization Substitution Substitution Dust controlDust controlEnclosure / isolationEnclosure / isolationProtective devicesProtective devicesEnvironmental monitoringEnvironmental monitoringStatistical monitoringStatistical monitoringResearchResearch

RespiratorsRespirators

Mask respiratorMask respirator Canister and cartridge RespiratorsCanister and cartridge Respirators

RespiratorsRespirators

Powered air purifying respiratorsPowered air purifying respirators Self contained breathing apparatusSelf contained breathing apparatus

http://tricon-env.com/3M_breathe_easy_10.htm

http://tricon-env.com/north_scba.htm

Ventilation and exhaust systemsVentilation and exhaust systems

Electrostatic filtration systemElectrostatic filtration system Fume extractor systemFume extractor system

Impairment Impairment assessmentassessment

Recommended by OHSC, Mumbai. Recommended by OHSC, Mumbai.

Indian scenarioIndian scenario

Occupational health in IndiaOccupational health in India

Past two decades have seen a rapid growth in the industrial and Past two decades have seen a rapid growth in the industrial and agricultural sector.agricultural sector.

However, new economic policies and globalization of world However, new economic policies and globalization of world trade have resulted in certain downfalls especially in industriatrade have resulted in certain downfalls especially in industrial l sectorsector

Shutdown of major industries Shutdown of major industries Emerging small illegal production unitsEmerging small illegal production units

The diagnosis and followThe diagnosis and follow--up of occupational diseases are to be up of occupational diseases are to be looked at in this background where survival is at stake and looked at in this background where survival is at stake and workersworkers’’ morale for struggle is lowmorale for struggle is low

Major hurdles Major hurdles ##

Poor training in OEH.Poor training in OEH.

Bias of the professional class against the workersBias of the professional class against the workers

Studies done on workers not available to anyone except to the Studies done on workers not available to anyone except to the select few who are conducting the study.select few who are conducting the study.

Medical certification not given to workers easily.Medical certification not given to workers easily.

Disability certification, which is required for compensation, noDisability certification, which is required for compensation, not t understood by doctors and hence not given to workers.understood by doctors and hence not given to workers.

##

Murlidhar.VMurlidhar.V, Demystifying occupational and environmental health: experience, Demystifying occupational and environmental health: experience

in India, PRIAin India, PRIA

publication.publication.

Difficult access to the Internet due to shortage of resources.Difficult access to the Internet due to shortage of resources.

All information being in English (some Latin and Greek), there All information being in English (some Latin and Greek), there is a serious difficulty in understanding the language.is a serious difficulty in understanding the language.

Under funded workers insurance system (the ESI), and Under funded workers insurance system (the ESI), and understaffed and poorly trained personnel and also general understaffed and poorly trained personnel and also general apathy among the staff of ESI scheme.apathy among the staff of ESI scheme.

Lawyers ( proLawyers ( pro--worker ) having poor knowledge of many worker ) having poor knowledge of many progressive legislations in OEH.progressive legislations in OEH.

LegislationsLegislations

The Factories Act, 1948The Factories Act, 1948

The EmployeesThe Employees’’ State Insurance Act 1948State Insurance Act 1948

The Mines ActThe Mines Act

The Plantation ActThe Plantation Act

The Minimum Wages Act The Minimum Wages Act

The Maternity Benefit Act The Maternity Benefit Act

The Factories Act, 1948The Factories Act, 1948The First ScheduleThe First Schedule –– List of industries involving List of industries involving hazardous processeshazardous processes

The Second ScheduleThe Second Schedule –– Permissible levels of certain Permissible levels of certain chemical substances in work environmentchemical substances in work environment

The third scheduleThe third schedule –– List of notifiable diseasesList of notifiable diseases

Notifiable occupational lung Diseases, The Factories Notifiable occupational lung Diseases, The Factories Act 1948.Act 1948.

SilicosisSilicosisAsbestosisAsbestosisCoal minerCoal miner’’s pneumoconiosiss pneumoconiosisByssinosisByssinosisBerylliosisBerylliosisVarious radiation induced diseasesVarious radiation induced diseasesOccupational cancersOccupational cancersChrome ulcerations and sequalaeChrome ulcerations and sequalaeCarbon monoxide poisoningCarbon monoxide poisoningIsocyanates poisoningIsocyanates poisoning

Organizations involved in occupational HealthOrganizations involved in occupational Health

Directorate General, Factory Inspection and Advisory Directorate General, Factory Inspection and Advisory Services, Ministry of Labour, Govt. of IndiaServices, Ministry of Labour, Govt. of India

Central Labour institute, MumbaiCentral Labour institute, Mumbai

Regional Labour Institutes at Kanpur, Kolkata and Regional Labour Institutes at Kanpur, Kolkata and Chennai.Chennai.

Research InstitutesResearch Institutes

The Central Mining and Research Station, The Central Mining and Research Station, DhanbadDhanbad ( CSIR )( CSIR )

Industrial Toxicology Research Centre, Industrial Toxicology Research Centre, LucknowLucknow ( CSIR )( CSIR )

Occupational Health Research Institute, Occupational Health Research Institute, AhmedabadAhmedabad ( ICMR )( ICMR )

National Environmental Engineering Research Institute, National Environmental Engineering Research Institute, NagpurNagpur

All India Institute of Hygiene and Public Health, KolkataAll India Institute of Hygiene and Public Health, Kolkata

All the best..All the best..

Occupational Lung Diseases â€“ General Principles and Approaches

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