Common Occupational Disorders: Asthma, COPD, Dermatitis, and Musculoskeletal Disorders

 

An occupational illness is an event or exposure that occurs in the workplace that causes or contributes to a condition or worsens a preexisting condition. If an occupational disorder is suspected, a directed history should be taken with particular attention to establishing a temporal relationship of symptoms and exposure at work. Occupational asthma is the most prevalent occupational lung disorder in industrialized countries and presents with classic asthma symptoms (cough, difficulty breathing, chest tightness, wheezing). Occupational chronic obstructive pulmonary disease has been linked with exposure to nonspecific vapors, gases, dusts, fumes, and cigarette smoke. Occupational contact dermatitis is the most common dermal exposure. It can be caused by exposure to a variety of agents, including primary irritants or sensitizers, physical agents, mechanical trauma, and biologic agents. Occupational musculoskeletal disorders include many common repetitive injuries such as carpal tunnel syndrome and medial or lateral epicondylitis. Treatment of occupational disorders is generally the same as for nonoccupational disorders. Ideally, the exposure should be controlled to protect the worker. The impact of an occupational injury reaches beyond lost wages and can have a negative impact on quality of life.

Occupational disorder is an event or exposure that occurs in the workplace that causes or contributes to a condition or worsens a preexisting condition. Occupational disorders are underreported, with upwards of 69% of these injuries and illnesses not being reported.1 In 2013, the U.S. Bureau of Labor Statistics reported about 3 million nonfatal occupational injuries and illnesses.2 In 2007, the estimated medical costs for nonfatal occupational illness in the United States was $67 billion.3  Common occupational disorders are summarized in eTable A.

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SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

Avoiding exposure to the offending agent is associated with greater likelihood of improvement in cases of occupational asthma and occupational dermatitis.

C

4, 7, 9, 13, 14

Routine application of fragrance-free postwork creams can help prevent occupational contact dermatitis. Prework creams are generally not helpful and may lead to complacency in other, more beneficial preventive measures.

C

6, 7, 9

Employers should consider offering workers with carpal tunnel syndrome differently configured keyboards.

C

41

Employers should consider offering temporarily modified duties to workers with carpal tunnel syndrome or epicondylitis that is aggravated by work to allow time for the condition to improve.

C

41


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to http://www.aafp.org/afpsort.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

Avoiding exposure to the offending agent is associated with greater likelihood of improvement in cases of occupational asthma and occupational dermatitis.

C

4, 7, 9, 13, 14

Routine application of fragrance-free postwork creams can help prevent occupational contact dermatitis. Prework creams are generally not helpful and may lead to complacency in other, more beneficial preventive measures.

C

6, 7, 9

Employers should consider offering workers with carpal tunnel syndrome differently configured keyboards.

C

41

Employers should consider offering temporarily modified duties to workers with carpal tunnel syndrome or epicondylitis that is aggravated by work to allow time for the condition to improve.

C

41


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to http://www.aafp.org/afpsort.

View/Print Table

BEST PRACTICES IN OCCUPATIONAL MEDICINE: RECOMMENDATIONS FROM THE CHOOSING WISELY CAMPAIGN

RecommendationSponsoring organization

Do not initially obtain radiographs for injured workers with acute nonspecific low back pain.

American College of Occupational and Environmental Medicine

Do not prescribe opioids for treatment of chronic or acute pain for workers who perform safety-sensitive jobs, such as operating motor vehicles, forklifts, cranes, or other heavy equipment.

American College of Occupational and Environmental Medicine


Source: For more information on the Choosing Wisely Campaign, see http://www.choosingwisely.org. For supporting citations and to search Choosing Wisely recommendations relevant to primary care, see http://www.aafp.org/afp/recommendations/search.htm.

BEST PRACTICES IN OCCUPATIONAL MEDICINE: RECOMMENDATIONS FROM THE CHOOSING WISELY CAMPAIGN

RecommendationSponsoring organization

Do not initially obtain radiographs for

The Authors

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JENNIFER BEPKO, MD, is a faculty member at David Grant Medical Center, Travis Air Force Base, Calif....

KATHERINE MANSALIS, MD, is a faculty member at David Grant Medical Center.

Address correspondence to Jennifer Bepko, MD, David Grant Medical Center, 101 Bodin Cir., Travis Air Force Base, CA 94535. Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

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