Common Health Conditions Associated with Occupational Exposure

Condition Selected exposures Selected occupations Letter sorting Assembly work Computer work Food processing Meatpacking Manufacturing Computer work Assembly work Musculoskeletal Carpal tunnel syndrome Repetition Vibration Awkward postures Cold temperature De Quervain's tendinitis Repetition High force Cervical strain Static posture Thoracic outlet Static posture, repetition syndrome Respiratory Interstitial fibrosis Asbestos Silica Coal

Asthma

Animal products Plant products Wood dust Isocyanates Metals (e.g., cobalt) Cutting oils Irritants (e.g., sulfur dioxide) Acids Smoke Nitrogen oxides Moldy hay Cutting oils Indoor air pollution (i.e., sick building syndrome) Organic solvents Organophosphate pesticides Lead

Mining, construction trades, building maintenance Mining, foundry work, sandblasting Mining Laboratory work Baking Furniture making Plastics manufacturing Hard metals manufacturing Machine operation Various occupations Plating Fire fighting Welding Farming Machine operation Office work Teaching Painting, automobile body repair Pesticide application Bridge work, painting, radiator repair, metal recycling Pesticide application Fabric coating Many occupations Health care work, prison work Health care work, prison work Health care work, animal care Forestry and other outdoor

Bronchitis

Hypersensitivity pneumonitis Upper airway irritation Neurologic Chronic encephalopathy

Peripheral polyneuropathy Hearing loss Infectious Bloodborne infections Airborne infections Infections transmitted fecally or orally Zoonoses

Organophosphate pesticides Methyl butyl ketone Noise HIV, hepatitis B Tuberculosis Hepatitis A Lyme disease

work Cancer Lung Asbestos Chromium Coal tar, pitch Vinyl chloride Benzidine Construction trades Welding, plating Steelworking Plastics manufacturing Plastics and chemical manufacturing Many occupations Hairdressing Health care work Sterilizing Pesticide manufacturing Radiographic technicians Bridge work, metal recycling Working with combustion products Machine-paced work Electrical equipment manufacturing and repair

Liver Bladder Skin Contact dermatitis

Organic solvents Nickel Latex Ethylene oxide Dibromochloropropane Ionizing radiation Lead

Reproductive Spontaneous abortion Sperm abnormalities Birth defects Developmental abnormalities Cardiovascular Coronary artery disease Gastrointestinal Hepatitis

Carbon monoxide Stress

Polychlorinated biphenyls

HIV=human immunodeficiency virus. Derived from references 2, 4, and 8 through 11. See reference 2 for a more extensive list of common occupationally related diagnoses.

Illustrative Case
A 38-year-old man reported several weeks of generalized headaches. A diagnosis of stresstension headache was made, and he was given an analgesic. Because he continued to have pain, computed tomographic (CT) scanning was performed. The CT scan was normal. The patient was referred to a neurologist and then to a specialty headache clinic. Various treatments were applied without effect. An occupational history revealed that he had been a spray painter for 11 months. While at work, he was routinely exposed to mixed organic solvents. When he was taken out of work for four weeks, his headaches cleared. Musculoskeletal Disorders Patients with musculoskeletal disorders involving the arm and neck frequently seek medical care. Work tasks contribute to symptoms in a significant proportion of these patients. More than 60 percent of reported occupational illnesses are work-related musculoskeletal disorders of various types. Specific diagnoses, such as localized nerve entrapment (e.g., carpal tunnel
14

syndrome), tendinitis (e.g., lateral epicondylitis, de Quervain's tendinitis), muscle strain and less well-defined regional pain syndromes, have been associated with jobs in all sectors of the economy. Repetition, force, awkward or static postures, vibration, work speed and restricted tasks are job factors that may contribute to the development of these ailments. Respiratory Diseases A variety of respiratory diseases are also commonly occupational in origin. Pneumoconiosis due to inhalation of asbestos, silica or other nonorganic dust should be considered in patients who report progressive dyspnea and dry cough. Airway diseases, including rhinosinusitis, bronchitis and asthma, have been increasingly recognized as work related. A widening array of exposures has been linked to occupational asthma related to possible exposure to allergens (e.g., grain dust), respiratory irritants (e.g., sulfur dioxide) or substances acting through other mechanisms (e.g., isocyanates). Less frequently, recurrent "flu" or
10,15 9

Airway disease, including rhinosinusitis, bronchitis and asthma, has been increasingly recognized as work related.

"pneumonia" may actually be symptoms of hypersensitivity pneumonitis from exposure to mold, other organic materials or certain chemicals. Neurologic Disorders The nervous system is a frequent target of toxins, including organic solvents (e.g., toluene and chlorinated hydrocarbons), metals (e.g., lead and manganese) and pesticides (e.g., organophosphates). Peripheral polyneuropathy may be caused by agents such as lead, methyl butyl ketone and organophosphate pesticides. More commonly, chronic organic solvent exposure is responsible for a syndrome that includes headaches, fatigue, light-headedness, cognitive difficulties and depression. Cancer and Heart Disease Work exposures also contribute to a notable percentage of cancers and have been increasingly recognized as factors in the development of coronary artery disease. Stress-Related Illnesses Stress has also emerged as an important hazard in the contemporary workplace. It has been associated with a range of emotional and physical ailments, including coronary artery disease and myocardial infarction. The risk of stress-related illness is increased in jobs with high emotional/psychologic demands and low potential for control by the worker. Work Conditions and Illness As the focus of business has shifted from manufacturing to service in most industrialized countries, traditional notions of hazardous work have, by necessity, been expanded. Occupational illnesses continue to occur in manufacturing, construction and agricultural
11 11,17 16

sectors, but they are also increasingly being recognized in the burgeoning service sector. For example, rapidly expanding computer use has been associated with musculoskeletal and eye problems in a growing number of office workers. Today a significant proportion of occupational illnesses are related to building conditions, such as inadequate fresh-air ventilation, low humidity and the presence of cigarette smoke, volatile organic compounds and fibers, molds or other microbiologic materials. Typically, workers with symptoms related to indoor air quality report upper airway and eye irritation, frequently accompanied by fatigue and difficulty concentrating. These symptoms generally occur in a group of workers in the same environment. Furthermore, the workers report rapid clearing of the symptoms when they leave the workplace. Other illnesses, including asthma, hypersensitivity pneumonitis and respiratory infections, have also been linked to specific building-related exposures. Index of Suspicion An occupational etiology should be considered if an illness fails to respond to standard treatment, does not fit the typical demographic profile (i.e., lung cancer in a 40-year-old nonsmoker) or is of unknown origin. Much is still unknown about the health effects of most workplace exposures. The introduction of new chemicals and other materials has far outpaced general knowledge of their potential toxicity. Consequently, family physicians continue to play a crucial role in recognizing unsuspected links between exposures and specific illnesses.
18