A review of the evidence for malignant and non-malignant respiratory disease prescriptions commissioned by the Industrial Injuries Advisory Council (IIAC)
The Industrial Injuries Advisory Council (IIAC) commissioned the Institute of Occupational Medicine to carry out a review of the published literature on selected work-related malignant and non-malignant respiratory diseases.
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The Industrial Injuries Advisory Council (IIAC) is aware that the current list of prescribed diseases does not always reflect modern work practices given the increasing complexity of some working environments such as in the construction industry, and the introduction of new materials and practices as with the handling of artificial/composite stone that contains a high percentage of silica. Many of these changes have potential impacts on lung diseases such as cancer and chronic obstructive pulmonary disease (COPD).
Currently, cancer of the lung is prescribed in relation to exposure to several exposures or occupations including arsenic, nickel, asbestos, tin mining, coke oven work and silica with accompanying silicosis. COPD is currently only prescribed in relation to coal mining.
Against this background of changing work practices and exposures, IIAC commissioned the Institute of Occupational Medicine to carry out a comprehensive review and evaluation of the literature on selected work-related malignant and non-malignant respiratory diseases (lung cancer and COPD; other respiratory diseases such as asthma and various types of pneumoconiosis were excluded). The aim was to inform any future update or expansion of the Industrial Injuries Disablement Benefit (IIDB) scheme.
The review was planned in two substantive phases. The purpose of the first phase was to use existing published reviews (and, if relevant, large epidemiological studies) to identify key industries, occupations and exposures associated with lung cancer and COPD. The second phase was to update recent reviews of epidemiological literature or, where necessary, carry out a new review of the epidemiological literature on priority exposures, occupations and/or industries as agreed with the Council.
The Institute of Medicine (IOM) has critically reviewed a substantial literature on six important respiratory disease/exposure combinations and the findings provide IIAC with a strong basis for taking the issues forward. IIAC notes the comments by IOM concerning the limitations of the evidence-base in relation to several of the topics. Some additional information might be available from general population studies and studies of lung function abnormalities that were outside the scope of this review. Changes in occupational exposures with time might limit the application of some of the findings in relation to current and future generations of IIDB claimants. IIAC notes the suggestions relating to the revision of the wording of several of the prescriptions and the absence of any recommendation by IOM about currently extending prescriptions (for lung cancer and COPD). Finally, IIAC notes the recommendations regarding future work and will consider these individually and prioritise them in relation to its other work.