Occupational Lung Disease in ThailandPerspective from a

Chest PhysicianNitipatana Chierakul

Faculty of Medicine Siriraj Hospital

Secretary General of The Thoracic Society of Thailand

Consultant of Workmen’s Compensation Fund

SCOPE Magnitude Strength Weakness Opportunity Threat

1997-2000

2002-2004 No. submitted

No. considered

Percentage of decision (%)

Silicosis (%)

Byssinosis (%)

Occupational asthma (%)

Bronchitis (%)

145 32

91 12

63

4535

10

8

32

428

17

25

Chronic Simple Silicosis FEV1 52 %, FVC 66 %, FEV1/FVC 55 %

Progressive Massive Fibrosis FEV1 35 %, FVC 48 %, FEV1/FVC 75 %

Accelerated Silicosis FEV1 41 %,

FVC 54 %, FEV1/FVC 82 %, DLCO 38 %

Small Nodular Opacity FEV1 83 %, FVC 82 %, FEV1/FVC 87 %

Small Nodular Opacity

Mediastinal Node Calcification

Mediastinal Node Calcification

Air Trapping

Inspiration Expiration

Siriraj Siriraj Occupational Lung Occupational Lung

ClinicClinic Patient profiles :•Silicosis 46•Byssinosis 5•Occupational asthma 3

Silicosis Silicosis •Male : female 19 : 27

•Smoking : non-smoking 19 : 27•Continue : discontinue 11 : 35•TB : No TB 11 : 35•Dead : alive 4 : 42

Factors Factors determining determining

severity of FEVseverity of FEV11 Sex TB Smoking

Profusion

Opacity

Large

opacity

M F + - + - 1 2 3 round

irreg

+ -

Severe

3 4 2 5 3 4 0 7 0 2 5 7 0

Non-severe

7 20

3 24

10

17

3 16

8 20 7 9 18

P-value

0.4 0.268

0.55 0.434 0.07 0.02

Byssinosis•All 32 cases were female •Mostly were textile workers•Irreversible airflow obstruction in 11 cases

•Post-shift drop of FEV1 in 2 cases

•Clinical compatible in 19 cases

Occupational Asthma•Glue 2 cases

•Dye for clothing 2 cases •Cooking 2 cases•Wood dust 2 cases•Seafood packaging 2 cases•RADS from inadvertent burning of bitumen 1 case

Occupational COPD

•Metal fume 3 cases•Noxious gases 3 cases •Mixed inorganic dust 2 cases

•Volatile agents 2 cases•Painter 1 case

STRENGTH•Established guidelines for

diagnosis and compensate evaluation since 1998

•Good support from the Workmen’s Compensation Fund, Social Security Office

•Strong international support•Effective anti-smoking campaign

WEAKNESS•No clearly context in the medical

curriculum •Low awareness from physicians•Penumbra in the guidelines•Unease assess to the supporting system•Unfair amount of compensation

–Upper limit of 60 months (80 % of salary)– Initial 35,000 Baht for treatment, and additional 50,000 Baht

OPPORTUNITY•Collaboration between academic

centers and professional organizations

•Concerning of the new generation•Direction of the country towards

sufficiency economy•Acceptance for civil politic and

peaceful coexistence

THREAT•Political driven of some profit-

baring groups•Public over expectation for

medical services•Complicated legal procedures•System for determining work-

related illness by only one specialist