Correspondence (letter to the editor): Occupational Preventive Measures

Burkhardt and Pankow are right to point out the late diagnosis of chronic obstructive pulmonary disease (COPD) in clinical practice (1), but unfortunately they do not discuss the options regarding occupational measures for the early detection and prevention, nor the results thereof. A retrospective evaluation of a COPD screening initiative in a large waste disposal company statistically analyzed COPD questionnaires and lung function test results from 645 volunteer participants under occupational medical aspects (2). On checking the questionnaire data it immediately became obvious that in active smokers, a “regular cough with or without expectorate” did not register consciously as a disease symptom or had even be redefined as the normal state of affairs. Such a subjective misjudgment also contributes substantially to delays in diagnosis in the general practice setting. The cited 50% of non-diagnosed COPD patients in general practice therefore seem to indicate the underestimate of the addressed COPD problem.

No unequivocal signs were noted, however, for a clustering of symptoms suspected of indicating COPD in occupational areas with particular exposures to dust, such as waste disposal. Rather, in analogy to the general population, individual characteristics took priority, such as active smoking status, sex, and age. The high rate of smokers (42%) in the study cohort was visibly exceeded by the 90% of smokers among the employees identified as having suspected COPD.

The high acceptance of such health initiatives by employees from all sectors emphasized the advantages of a setting that is not associated with illness and can contribute to avoiding a late diagnosis. The occupational setting provides low-threshold access to preventive (occupational) medical diagnostic evaluation by an occupational physician, in contrast to actively seeking a GP consultation when required. Information about potential COPD patients in a company enables not only a targeted risk-assessment and an opportunity to initiate necessary workplace-related protective measures, but it also provides an opportunity for the most important individual preventive measures for COPD: smoking cessation and nicotine withdrawal programs.