1. Respiratory, HAVS and Noise Dr Munna Roy, Medical Director

2. What is an Occupational Disease? Respiratory Occupational Disease Hand Arm Vibration Syndrome (HAVS) Noise Induced Hearing Loss Presentation topics

3. What is an Occupational Disease? Must have an occupational exposure..... at a high enough dose........... for long enough......... giving rise to a clinically detectable disease

4. Occupational Asthma is by far the most common - still Allergic Alveolitis e.g. Farmer’s lung Malignancy – lung cancer/mesothelioma COPD Silicosis Respiratory Occupational Diseases

5. Respiratory exposures in the College setting

6. Exposures in the College setting

10. Variable airways obstruction in response to allergens or irritants encountered in the workplace There is a dose-response relationship There is a relationship with work Many known asthmagens – chemicals, plants, proteins What is occupational asthma?

12. How quickly can Occupational Asthma develop? Irritant asthma can occur immediately –cold, dusts in known asthmatics Sensitisation can arise within a few weeks Often employees will have eye and nose symptoms for some weeks or months prior to the development of OA The average time from onset of symptoms to formal diagnosis is 18-24 months

13. OA Health Surveillance Schedule At commencement of exposure 6 weeks 12 weeks Annually More frequently for known asthmatics

14. Information for employees - essential

16. Investigation of suspected OA Occupational Physician consultation Serial Peak Flow measurements – over 4 weeks with computer analysis of readings IgE blood tests Provocation tests – specialist units only

17. Serial Peak Flow measurements

18. What happens if exposure continues? Asthmatics get more and more sensitised Small amounts of exposure causes significant symptoms as time goes on Late diagnosis of OA reduces the recovery chances Avoidance of exposure through redeployment, substitution, environmental controls and even PPE (airstream helmet etc)

19. What is the Hand Arm Vibration Syndrome (HAVS) Peripheral vascular effects (VWF) Peripheral neurological effects Connective tissue damage

20. Vascular component of HAVS

21. When is Health Surveillance required for HAVS? When employees are regularly exposed above the Exposure Action Value EAV=2.5m/s 2 A(8) When employees are occasionally exposed above the EAV and have a predisposing health condition Employees with HAVS even if exposed below the EAV

22. How is HAVS Health Surveillance carried out? Tiered Approach – annual assessment (at least) Tier 1 - Baseline Tier 2 – screening questionnaire Tier 3 – Nurse questionnaire Tier 4 – OHP with specific HAVS training

23. How is HAVS Health Surveillance carried out?

26. HAVS Staging – Stockholm

27. Essential for the management of HAVS Traffic light system for employees to understand exposure Sensible work regimes Information leaflets Information, Instruction and training

28. Disability increases greatly at Stage 3 Employees should not progress to stage 3 Late Stage 2 vascular or sensorineural should stop significant exposure Clinical judgement – based on multiple factors When should employees cease vibration exposure?

29. Noise Induced Hearing Loss Tinnitus Safety implications e.g. Warning signals NIHL adds on to presbycusis Increased non-occupational exposure e.g. iPods Damage from Noise

30. Lower exposure value – 80 dB (A) Higher exposure value – 85 dB (A) If noise levels are frequently above the upper exposure value Between the lower and upper, or occasionally above the upper level where there is predisposing risk Unilateral hearing loss, pre-existing hearing loss When is Health Surveillance indicated?

31. Questionnaire – may show increased risk factors Otoscopic examination Standardised Audiometry Categorisation of hearing results What does health surveillance consist of?

32. Noise induced hearing loss audiogram - mild

33. Noise induced hearing loss audiogram - severe

34. Category 1 – acceptable hearing Category 2 – mild hearing impairment Category 3 – poor hearing Category 4 – rapid hearing loss Unilateral hearing loss Categorisation of hearing tests

35. 7th December 2009 Compensation for welder with disabled hands Vibrating tools damaged hands A welder has received £58,000 in compensation after prolonged use of vibrating tools left his hands permanently damaged. The Unite member from Wolverhampton was diagnosed with Carpal Tunnel Syndrome and Hand Arm Vibration Syndrome (HAVS) after he found he was unable to use his hands properly.compensation Hand Arm Vibration Syndrome (HAVS) HAVS Payout

36. 4th November 2009 Worker receives compensation for industrial asthma Diagnosed with Occupational Asthma A factory worker has received £20,000 compensation after she developed asthma within weeks of being exposed to dangerous fumes. The 42-year-old from the Gateshead area was diagnosed with occupational asthma after she was exposed to soldering fumes at Turbo Power Systems Limited, based in Team Valley.compensationoccupational asthma She started working for the company, which makes electric generators and motors for the aerospace industry, in June 2007, where she spent up to six hours a day soldering. Exposed to rosin-based soldering wire She worked with rosin-based soldering wire, which is known to cause occupational asthma, but was never given any training or warning about the dangers. She was soldering in an enclosed space with inadequate extraction and within a few weeks began to suffer from difficulty breathing Occupational Asthma Payout