Module 4: Chronic Obstructive Pulmonary Disease and Occupations - Management of COPD

MANAGEMENT OF COPD:

The GOLD strategy approaches the management of COPD according to the following 5 steps:

• Recognition of disease (early diagnosis and staging).
• Smoking cessation (secondary prevention).
• Improvement of breathlessness (treatment of airflow limitation).
• Pulmonary rehabilitation and education (improving quality of life).
• Prevention and treatment of complications and limitation of progression of disease.

Whilst this approach is useful, occupational health practitioners will see most COPD cases at either of two stages: early and late.

Early COPD can be detected by medical surveillance programmes utilising spirometry. In fact this is often the commonest single finding in such a programme. Early diagnosis provides opportunities for secondary prevention and limitation of progression of disease that occupational health practitioners are well placed to implement and assist workers with.

Late COPD comes to the occupational health practitioners’ attention when the worker is having difficulty managing the usual requirements of his or her occupation because of breathlessness. Secondary prevention, effective medical treatment and accommodating the worker through job modification or alternative placement are all important strategies.

Smoking Cessation:

This is the only proven step that slows progression of COPD. Limited improvement occurs in many cases. Smoking cessation strategies must be implemented, including:

• outside motivation for setting a quit date,
• encouraging compliance,
• nicotine substitution and antidepressants.

Medical treatment of COPD:

See the SA Thoracic Society Guideline: www.pulmonology.co.za.

OCCUPATIONAL IMPLICATIONS OF COPD:

COPD is a relatively common cause for workers no longer being considered fit to meet the usual requirements of their work. If they cannot be significantly improved medically or accommodated, medical separation is inevitable. This usually means that the occupational health practitioner will be called on to provide an assessment of the individual’s capacity for work and, following due process, ultimately to assist the individual with applications related to provident or pension fund benefits.

Compensation may be available for workers with COPD under the COID Act. The ODMW Act has provided specifically for COPD since the 1950’s. Workers with gold or coal dust exposure and COPD with a lung function test showing moderate or severe abnormality, may qualify for compensation if the MBOD considers they have sufficient exposure and their last exposure is not remote in time (< 10 years).