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Reducing Respiratory Disease

Published: 29th Oct 2014

Jill Joyce addresses the importance of using respiratory protection.

Worldwide, hundreds of millions of people suffer from preventable chronic respiratory diseases. These account for four million deaths annually. Preventable chronic respiratory diseases not only adversely affect the quality of life for individuals, but cause economic burdens on their families and communities as well as society.

A lack of data about chronic respiratory diseases means that the impact on health services and society is not recognised, and it is viewed as a low priority on public health agendas with the official focus being communicable diseases and injuries.

Reducing respiratory disease is a priority for the Middle East and Africa. The latest figures from the World Health Organization (WHO) indicate that in the Middle East alone there were more than 400,000 deaths from respiratory infection. Within these, 160,000 deaths were associated with chronic obstructive pulmonary disorder (COPD) and asthma, and 25,000 attributed to cancers.

Some of these respiratory problems are brought about by environmental factors; for example, in the desert area of the Middle East there are extreme temperature changes, which can worsen chronic lung diseases such as asthma. Local poor lifestyle choices, such as smoking water pipes or cigarettes can also be a factor.

In sub-Saharan Africa there is little information available regarding the prevalence and fatalities due to chronic respiratory disease. South Africa, however, does have guidelines for asthma and chronic obstructive pulmonary disease (COPD). Miners have long been known to suffer from pneumoconiosis, but COPD caused by occupational exposure is also an issue in developing countries, where some technologies now obsolete in industrialised countries are still used. Silicosis is also a serious occupational disease among gold and platinum miners in South Africa, whereas diamond miners are at risk of developing asbestos-related diseases due to the composition of the rock.

Respiratory disease is termed a ‘long latency disease’. This means that it may take a long time to appear after exposure to the contaminants in the workplace that cause it.

Airborne contaminants can include:

• Solids - dust, powder and fibres

• Gases and vapours - usually resulting from a chemical process

• Mists and aerosols - finely dispersed liquids

• Fumes

Some contaminants can trigger an allergic reaction in the respiratory system. Asbestos fibres cause illness by becoming embedded in the lungs. The fibres cause scarring of lung tissue and can reduce the effectiveness of the lungs. In some cases, this can result in cancer.

Respiratory illnesses may be chronic, with long-term discomfort and the effects made worse by repeated and prolonged exposure over a working life. Respiratory failure can also be acute, however, where workers die within a short time of being exposed to a respiratory irritant or poison. This can occur when exposure to isocyanates occurs, for example, when spraying paint.

The workplace is one area where the practical step of introducing a respiratory protection programme can be taken to fight respiratory disease, and reduce the human suffering and cost to companies and society.

Defining RPE

RPE is a type of personal protective equipment (PPE), designed to protect the wearer against inhaling hazardous substances in the workplace. It is divided into two main types: respirators, which use filters to remove contaminants in the workplace air, but are never used where there are low oxygen levels; and breathing apparatus (BA), which needs a supply of air from a clean source such as an air cylinder or air compressor. BA may be used in situations with reduced oxygen levels.

Both types are available with a range of face pieces, including masks, hoods, helmets and visors. Masks are tight fitting face pieces that rely on having a good seal with the wearer’s face. Hoods, helmets and visors are loose fitting face pieces. They are suitable for those who wear glasses, have facial hair or facial markings such as deep scars in the face seal region. These face pieces rely on an adequate flow of clean air being delivered to them to prevent contaminant leaking in. They are only used on fan-powered respirators and air-fed breathing apparatus.

Actions before RPE

Before relying on RPE, it’s important to think about how contaminants can be eliminated or reduced. You need to consider the following five controls as a hierarchy.

Elimination and substitution

You will need to identify which substances are being used that can result in respiratory illnesses. Safety data sheets should warn you if a substance is a respiratory sensitiser. Be aware that common substances such as sawdust, hay and flour can create problems. Factsheet 39 from the European Agency for Safety and Health at Work provides useful advice on where natural and chemical sensitisers may be found.

Having identified the hazardous substances, ask yourself these questions: can you stop using or producing the substances that cause problems? Are there safer alternatives to the substances used? If so, substitute the hazardous substance for the safer one.

Isolation and ventilation

If a significant risk remains, consider how the substance can be isolated. Enclosing a process that produces a respiratory sensitiser is a more effective safeguard than expecting every person who walks through an area to wear respiratory protection.

Contaminants from the enclosed area must be safely ventilated and dealt with, for example, with a filter to catch solid particles. Where the work area cannot be completely enclosed, try to reduce the number of people exposed and the amount of time they’re exposed for. Where some workers are still exposed, ventilation needs to be provided. Enclosures and ventilation systems must be maintained and checked to make sure they’re working effectively. Care should also be taken in developing cleaning procedures so that the cleaning staff isn’t exposed to respiratory sensitisers more than necessary. Wet cleaning or vacuum cleaners, for example, should be used in preference to sweeping.

Local exhaust ventilation (LEV) systems, sometimes called dust and/or fume extraction systems, can help to clean the air before workers breathe in the harmful substances. If you decide that you may need an LEV and know which jobs and activities cause exposure, it’s worth getting a reputable supplier to give you advice. Workers can also be involved in the design and selection of the LEV. It is important to make sure the LEV is installed properly and that it has airflow indicators so that you can see it is working correctly. You need to ensure you get a user manual from your supplier and there may also be a log book so that you can record repairs. Once a year the LEV needs to be examined in detail and tested by a competent person.

Workers need to be alert to noticing whether the indicator is showing that the LEV is working properly as they might not be able to see all the harmful dusts or fumes, many of which are invisible. They also need to be aware of any unusual noises or vibration and to notice any smells or dust that were not there before, which might indicate that the LEV is not working properly, and tell their supervisor if this is the case.

Only when everything has been done to eliminate or reduce the hazard through substitution, isolation and ventilation should RPE be considered.

Deciding which type of RPE to use

Don’t be tempted to buy cheap masks from the internet. A mask with the wrong type of filter provides no protection at all. If you can, take advice from a reputable supplier. Although only available in English, the free RPE Selector Tool available at can help by guiding you through questions about the quantity of particular chemicals, fumes and dust producing materials used in your company and how long your workers are exposed to them. It will then recommend the correct type of RPE to use.

Selection of RPE should take into account:

1. Individual factors - Facial hair, glasses or contact lenses, medical conditions such as existing respiratory illnesses, high blood pressure, claustrophobia, heart disease, difficulties with hearing, and skin conditions such as eczema.

2. Task factors - Duration of task, temperature, humidity, work rate (sedentary, moderate or heavy, which might demand an increased air supply), tools being used, other PPE needed, requirements to see fine detail, to move around or to communicate, congestion in the work area.

3. Hazard factors - Risk phrase (R-phrase) from the safety data sheet, amount of substance used, dustiness (of solids such as pellets, grains or powder) or volatility of liquids. For asbestos it would be the expected concentration of asbestos fibres in the air. It is important to note that particulate filters, which might protect against asbestos, will not protect against oxygen deficiency, gases or vapours.

Each RPE type and class is categorised by an assigned protection factor (APF). The APF is a number rating that indicates how much protection that RPE is capable of providing. The ratings are international and were developed by carrying out experiments to measure the ratio of concentration of a contaminant outside the respirator to what is inside the respirator. A higher level of APF indicates that a respirator provides a higher level of protection. If RPE is to be effective, however, it needs to be worn correctly.

Encouraging compliance

Workers may find RPE uncomfortable to wear and be tempted to remove their mask if they get hot, uncomfortable or find it hard to breathe. They may alter the position of the straps and make the mask ineffective. This is why face fitting is important. Every mask should be tested for a good fit. If the worker cannot see or smell the contaminant then they are less likely to want to wear a mask. If a worker feels claustrophobic when wearing a mask and finds it hard to get air into their lungs, this will make them anxious. This is a reason to offer alternatives, such as hoods or helmets if possible.

It is useful to offer workers a choice of masks or at least involve them in selection decisions so that they feel part of the solution. Supervisors and managers play a crucial role in promoting a safety culture where all workers recognise the importance of RPE. They must set a good example through their actions.


It’s important to train workers not only in how to wear the RPE but how to look after it, as if it is badly maintained it will not provide sufficient protection. It needs to be cleaned and stored correctly after each use. For breathing apparatus it is essential to check the flow rate and pressure of the air supply at the beginning and end of each shift. Filters need to be changed regularly and valves checked for cracks and wear.

Air quality monitoring

Air quality should be monitored to make sure levels of contaminants in the air stay below an acceptable level.

There are three approaches that can be used to evaluate a worker's exposure to airborne contaminants. Environmental monitoring indicates presence or not of airborne contaminants; biological monitoring documents the absorption of contaminants into the body; and medical surveillance is used to detect adverse health effects (including biological effect monitoring) that may be due to exposure.

To assess the level of airborne contaminants in the workplace atmosphere air sampling can be used. This can form part of routine surveillance and can also be used to help to design and evaluate the effectiveness of existing control measures. It helps to measure the dose of a hazardous agent that is absorbed by workers. Records of air monitoring can be documented to show compliance with government regulations and standards.

Air sampling involves taking a known volume of air through a sampling medium, this is normally a filter paper for solids and a sorbent tube or glass impinger for gases, on or in which the contaminant is captured. The sample can then be sent to a laboratory for analysis. The concentration of the contaminant is calculated using the volume of air and the amount of pollutant captured. Standardised air sampling and analytical methods have been developed to ensure accurate and meaningful information is collected.

Monitoring worker health

It is important to assess a worker’s respiratory health before they start a potentially hazardous job. A suitably qualified health professional can help you decide how often the worker should be re-assessed. Records should be kept of all assessments, along with a description of the work undertaken. If health problems are identified through regular checks, or if workers report symptoms between tests, action may be needed to remove the worker from the job until a further assessment is made.

Successful RPE programmes

Recent research has stressed the influential role of management if RPE programmes are to be successful. Lack of knowledge and training, poor maintenance and storage and poor supervision can affect the success of an RPE implementation programme. It is essential, therefore, to:

• Have a targeted communications strategy for RPE

• Support managers in the implementation of RPE programmes

• Work closely with intermediaries including suppliers and insurers

Don’t ignore respiratory risks or be tempted to take a chance. Your employees’ future health is at stake here. Make sure you comply with the law and have good procedures in place. If in doubt, get expert help. If you learn to manage the respiratory risks in your work place, you will ensure that today’s employees and contractors do not suffer from work related respiratory diseases later in life.

Published: 29th Oct 2014 in Health and Safety Middle East

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Jill Joyce