Original Articles

By Dr. Umesh C Ojha , Dr. Rajiv Gupta , Dr. S Raju
Corresponding Author Dr. Umesh C Ojha
Department of Pulmonary Medicine,ESIC Hospital basaidarapur, Institute of Occupational health &Environment Research.ESIC Hospital,Basaidarapur, New Delhi - India 110015
Submitting Author Dr. Umesh C Ojha
Other Authors Dr. Rajiv Gupta
ODC,ESIC Basaidarapur Hospital, Department of Pulmonary Medicine, - India

Dr. S Raju
ESIC S uperspeciality Hospital Kollam .KERALA, - India


COPD,Occupational COPD. CAT Score , Spirometery, Occupational exposure,Dust

Ojha UC, Gupta R, Raju S. Occupational lung health- A Pilot field study. WebmedCentral PULMONARY MEDICINE 2013;4(11):WMC004447
doi: 10.9754/journal.wmc.2013.004447

This is an open-access article distributed under the terms of the Creative Commons Attribution License(CC-BY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Click here
Submitted on: 22 Nov 2013 09:52:20 AM GMT
Published on: 22 Nov 2013 10:41:38 AM GMT

Summary of changes

Spelling Mistakes Only Corrected.


In India, the Social Security Act, Employees State Insurance Act, 1948 applies to non-seasonal factories employing 10 or more persons. The ESI Act covers workers in the organized sector only. As on 31/03/2012, the scheme applied to 5.80 lakh employers employing 1.71 crore insured persons at 807 centres7. The Employees’State Insurance scheme provides comprehensive medical care to insured persons and also to their dependants. ESI Corporation has set up five  zonal Occupational Disease centers for providing occupational health management and medical treatment thus having pan-India presence. By virtue of their job all our insured persons are exposed to various kind of noxious gases, fumes dusts and particles. With various upper and lower respiratory tract involvement they attend  outdoor and inpatient of the hospitals through dispensaries.

Material method

For this questionnaire and onsite observational study the centers selected was ESIC  super specaiality hospital Kollam Kerala in collaboration with Institute of Occupational Health & Environment Research, ESIC model Hospital Basaidarapur Delhi. 

Duration One Year: October 2012–September 2013.

Inclusion criteria: All our insured persons who have valid insurance(IP) number with

1. Age more than 35.

2. Non-smoker  .

3. Working  in industry for more then 5  yrs

4. Male/female.

5. Can understand English/Hindi/ local language.

Exclusion criteria

1. Invalid IP no.

2. Uncooperative patient

3. Unable to perform spirometery despite best effort by technician on three occasions on three different days.

All subjects surveyed with

  1. COPD diagnostic tool

    (i) Questionnaire. (Basic history and job profile)

    (ii) Spirometery (Gold criteria for defining COPD) after taking informed consent.


Chronic obstructive pulmonary diseases  (COPD): COPD is a common preventable and treatable disease, is characterized by persistent airflow limitation that is usually progressive and associated with enhanced chronic inflammatory response in the airways and the lung to noxious particles or gases. Exacerbations and co-morbidities contribute to overall severity  in individual patients.

A clinical diagnosis of COPD should be considered in any patient who has dyspnea, chronic cough or sputum production, and/or a history of exposure to risk factors for the disease.

Spirometry is required to make the diagnosis; the presence of a post-bronchodilator FEV1/FVC < 0.70 confirms the presence of persistent airflow limitation and thus of COPD.

Occupational  COPD: Chronic obstructive pulmonary diseases caused by inhalation of coal dust, dust from stone quarries, wood dust, dust from cereals and agricultural work, dust in animal stables, dust from textiles, and paper dust, arising from work activities. (LIST OF OCCUPATIONAL DISEASES (revised 2010) Identification and recognition of occupational diseases: Criteria for incorporating diseases in the ILO list of occupational diseases)

Assessment of COPD

To assess symptoms-  The COPD Assessment Test(CAT)18 was administered

Assess degree of airflow limitation using spirometry-

In patients with FEV1/FVC < 0.70:

GOLD 1: Mild; FEV1 > 80% predicted       

GOLD 2: Moderate; 50% ≤ FEV1 < 80% predicted

GOLD 3: Severe; 30% ≤ FEV1 < 50% predicted

GOLD 4: Very Severe; FEV1 ≤ 30% predicted

*Based on Post-Bronchodilator FEV1

Statistical analysis

We had 78 consecutive subjects in factory site visits out of  which 64(82%) were females and 14 (18%) were

males with the  mean  age of subjects-48 yrs. The average duration in job was 18 years in cashew industry and

the majority of the workers were engaged in jobs of sorting, roasting, peeling shelling and segregation of cashew

nuts. Peculiarity of the findings were more female workers than male workers. The mean (N=78) FVC% observed-

64.26%, the mean FEV1% was 56.26% and the mean% ratio of FEV1/FVC was  83.28%.

Mean COPD Assessment test (CAT) score were 23.20, less than 10 were 3 (3.85%), between 10-20 were 21

(26.92%), between 20-30 were 46 (58.97%). More than 30 were 8 (10.26%). 17 out of 78 (21.79%) qualified for

the definition of COPD.

The reduced values of mean FVC, FEV1 suggests the involvement of airway along with the lung parenchyma.  

Limitations of this observational study were 

1. More elaborate workup for categorizing of obstructive/restrictive/mixed disorder of the lungs with complete PFT.

And for indicated patients the diffusion capacity of carbon monoxide to assess the integrity of alveolo capillary


2. Radiological studies including CT chest for those who have presented severe lung function disorders as indicated.


Chronic Obstructive Pulmonary Disease (COPD) is the fourth leading cause of death worldwide.1 In the UK, COPD is given as the cause of death on about 30 000 death certificates annually.2 This represents 5.1% of all deaths. The prevalence of COPD is difficult to determine because the condition does not usually manifest until mid-life, when it is already moderately advanced. In England and Wales, it is estimated that there are currently 900 000 diagnosed cases, and allowing for under-diagnosis the true prevalence is estimated to be 1.5 million.3

Occupations linked to increased prevalence of COPD include construction,4,5,6 leather, rubber, plastics manufacturing,4 plastics and rubber workers,5 textiles,4 12 food products,4 7,8 spray painters,7 and welders.7 Specific substances linked to higher prevalence of COPD include quartz,6 ,9 welding fumes,11 wood dust,11 sawdust,10 asbestos,6, 9 and solvents.6

Our study population of    78 persons 17 (21.79%) qualified for the definition of COPD .Though the number is small but a fair indicator of the presence of the disorder . The non copd group also have fall in FVC( FVC% observed 64.26%,) and FEV1(the mean FEV1% observed 56.26%)  which also is a pointer towards the  insult on lung architecture.

One should consider COPD and perform spirometery in any patient whose age is more than 40 yrs  and having following indicators  as mentioned below .

The recognition of a disease as being occupational is a specific example of clinical decision-making or applied clinical epidemiology. Deciding on the cause of a disease is not an “exact science” but rather a question of judgement based on a critical review of all the available evidence.In Bhopal gas tragedy victims in  a paper by Sajal De17  showed that the obstructive pattern was the commonest spirometric abnormality among the surviving gas victims , compared to non-exposed subjects .Thus environment plays a contributing factor.

Large number of COPD patients remain undiagnosed or wrongly diagnosed in clinical practice due to one of the reasons that  that COPD is only caused by tobacco smoking, this leads to under-diagnosis of COPD in never smokers. this contribute to around half of all COPD cases ,underutilization of Spirometry as a diagnostic tool mainly due to lack of knowledge and availability of spirometers, and difficulty in differentiating it from asthma.12

COPD kills half a million people in India every year, more than those who die due to Tuberculosis, Malaria or HIV-AIDS. Moreover, these numbers are expected to grow by 160% over the next 2 decades, in contrast to the decline in the number of deaths anticipated due to malaria, TB or HIV-AIDS.13 reviewing the population studies available from India; Of the 14 studies which were reviewed, there were 11 conducted in general populations. The median values of different prevalence rates (i.e. 5 percent in male and 2.7 percent in female population) were accepted as the most appropriate figures to calculate the overall estimates.14 The COPD prevalence varied from 3% to 8% amongst Indian males and approximately 2.5% to 4.5 % among Indian females. 15

COPD is now a much better understood disease than before. Most COPD patients do not die because of the lung disease, but because of the other co-morbid conditions that accompany COPD16.


1. European Respiratory Society and the European Lung Foundation. Lung health in Europe. Facts & figures. ‘‘European Lung White Book’’. European Respiratory Society and European Lung Foundation, 2003. Cited in The role of occupation in the development of chronic obstructive pulmonary disease (COPD) M Meldrum, R Rawbone, A D Curran, D Fishwick, Occup Environ Med 2005;62:212–214.
2. Health and Safety Executive. Epidemiology and Medical Statistics Unit Mortality Databank—data compiled from death statistics from the Office for National Statistics and the General Register Office for Scotland. Cited in The role of occupation in the development of chronic obstructive pulmonary disease (COPD) M Meldrum, R Rawbone, A D Curran, D Fishwick, Occup Environ Med 2005;62:212–214.
3. Anon. Chronic obstructive pulmonary disease. NICE clinical guideline on management of chronic obstructive pulmonary disease in adults in primary and secondary care. Thorax 2004;59(s 1):1–232.
4. Hnizdo E, Sullivan PA, Moon Bang K, et al.Association between chronic obstructive pulmonary disease and employment by industry and occupation in the US population: a study of data from the Third National Health and Nutrition Examination Survey. Am J Epidemiol 2002;156:738–46.
5. Bakke PS, Baste V, Hanoa R, et al. Prevalence of obstructive lung disease in a general population: relation to occupational title and exposure to some airborne agents. Thorax 1991;46:863–70.
6. Lebowitz MD. Occupational exposures in relation to symptomatology and lung function in a community population. Environ Res 1977;14:59–67.
7. http://esic.nic.in/Publications/StandardNote190813.pdf
8. Krzyzanowski M, Jedrychowski W. Occupational exposure and incidence of chronic respiratory symptoms among residents of Cracow followed for 13 years. Int Arch Occup Environ Health 1990;62:311–17.
9. Viegi G, Prediletto R, Paoletti P, et al. Respiratory effects of occupational exposure in a general population sample in north Italy. Am Rev Respir Dis 1991;143:510–15.
10. Sunyer J, Kogevinas M, Kromhout H, et al.Pulmonary ventilatory defects and occupational exposures in a population-based study in Spain Am J Respir Crit Care Med 1998;157:512–17.
11. Post WK, Heederik D, Kromhout H, et al. Occupational exposures estimated by a population specific job exposure matrix and 25 year incidence rate of chronic non-specific lung disease (CNSLD): the Zutphen Study. Eur Respir J .1994;7:1048–55.
12. Sundeep Salvi, Anurag Agrawal. India Needs a National COPD Prevention and Control Programme editorial in JAPI  .2012 •. 60
13. The Global Burden of Disease, WHO 2008 Oct, www.who.int/healthinfo/global_burden_disease/projections/en/index.html.
14. S.K. Jindal, A.N. Aggarwal and D. Gupta A Review of Population Studies from India to Estimate National Burden of Chronic Obstructive Pulmonary Disease and Its Association with Smoking Indian J Chest Dis Allied Sci 2001; 43 : 139-1471.
15. Bhome A .COPD in India: Iceberg or volcano? .B. J Thorac Dis 2012;4(3):298-309.
16. Nussbaumer-Ochsner Y, Rabe KF. Systemic manifestations of COPD. Chest 2011;139:165-173.
17. Sajal  De Retrospective analysis of lung function abnormalities of Bhopal gas tragedy affected population Indian J Med Res. 2012; 135(2): 193–200.
18. http://www.catestonline.org/images/pdfs/CATest.pdf

Source(s) of Funding


Competing Interests


3 reviews posted so far

occupational obstuctive lung disorders
Posted by Dr. Logamurthy Ramaswamy on 23 Nov 2013 08:07:10 AM GMT Reviewed by Interested Peers

Comments to the author
Posted by Dr. Nobuyuki Koyama on 08 Jan 2014 03:03:34 AM GMT Reviewed by WMC Editors

Very aptly selected wording for the title
Posted by Dr. Manas K Sen on 21 Nov 2013 03:57:12 PM GMT Reviewed by Author Invited Reviewers

Respected Sir , thanks for pointing out spelling errors , I tried to correct those in the new submission, I hope this new version is free from these errors . UMESH CHANDRA OJHA . MD,FCCP... View more
Responded by Dr. Umesh C Ojha on 22 Nov 2013 01:57:25 PM GMT

0 comments posted so far

Please use this functionality to flag objectionable, inappropriate, inaccurate, and offensive content to WebmedCentral Team and the authors.


Author Comments
0 comments posted so far


What is article Popularity?

Article popularity is calculated by considering the scores: age of the article
Popularity = (P - 1) / (T + 2)^1.5
P : points is the sum of individual scores, which includes article Views, Downloads, Reviews, Comments and their weightage

Scores   Weightage
Views Points X 1
Download Points X 2
Comment Points X 5
Review Points X 10
Points= sum(Views Points + Download Points + Comment Points + Review Points)
T : time since submission in hours.
P is subtracted by 1 to negate submitter's vote.
Age factor is (time since submission in hours plus two) to the power of 1.5.factor.

How Article Quality Works?

For each article Authors/Readers, Reviewers and WMC Editors can review/rate the articles. These ratings are used to determine Feedback Scores.

In most cases, article receive ratings in the range of 0 to 10. We calculate average of all the ratings and consider it as article quality.

Quality=Average(Authors/Readers Ratings + Reviewers Ratings + WMC Editor Ratings)