When it comes to lung disorders, health experts say they always result from direct or indirect exposure from the environment caused by inhalation of dusts, fumes, and smoke, gases and vapors substances. 

The most common substances that can injure the lungs, they say, include wood, cotton, coal, asbestos, silica and talc among others.

Smoke, fumes and gases from industrial organic materials or mists or sprays from paints, hairspray, pesticides, cleaning goods, as well as acids, are among the substances that can pose danger to the health of a human being.

Dr Cyprien Ntiringanya, a specialist in internal medicine Kigali, says the most common occupational lung disease is asthma, which is mainly caused or made worse by environmental exposure to dust and smoke.

He says that this is the most common form of lung disease, and such occupational lung diseases are capable of affecting air paths.

Apart from that, another common occupational lung disease is occupational chronic obstructive pulmonary diseases (COPD).

These, he says, includes diseases such as chronic bronchitis and emphysema. COPD is mostly attributed to smoke in factories and industries.

Understanding occupational lung diseases

In Rwanda, according to reports from different health centres across the country, data from Rwanda Biomedical Centre (RBC) indicates that occupation lung diseases contribute to the growing cases of chronic respiratory diseases.

It shows that the number of patients who consulted with chronic respiratory conditions was 27,730 in 2014, and the figure rose to 54,609 patients in 2016. 

Dr Edison Rwagasore, Senior Officer — Diabetes, Chronic Diseases and Other Metabolic Diseases, Rwanda Biomedical Centre (RBC), says occupational lung diseases are an important public health issue, the good thing, however, is that these diseases are avoidable through preventive interventions at the workplace or any other place that exposes one to them.

He notes that there are a number of industry and workplace activities which are linked to a high risk of respiratory disease.

This, Rwagasore says, is either because there is a large population potentially exposed, or there is evidence of a high incidence rate. He says such activities include construction, agriculture, and vehicle spraying, among others.

"Due to the exposure to different kinds of work, many people are at a risk of getting occupational or work-related lung disease. These are a group of pulmonary disorders that develop from inhalation of specific particles, which are caused or made worse by breathing in hazardous substances,” he says.

He adds that these particles are capable of damaging the lungs, and they include dusts, fumes and gases. However, the the most common of these diseases are chronic obstructive pulmonary disease (COPD), asthma and silicosis.

Rwagasore further explains that the airways from nares (nostrils) to alveoli, come into contact with air in the workplace during working hours, and that the physical activity can increase ventilation, thus expose one to contaminants.

"As ventilation increases, breathing shifts from nasal to a combination of oral and nasal, allowing a greater volume of air to bypass the cleansing nasopharynx, and further increase the exposure of the lower airways to inhaled materials,” he says.

Additionally, Rwagasore says strong irritants (such as ammonia) produce an aversive response, whereas materials with little sensory effect (such as asbestos) can be inhaled for prolonged periods and result in serious injury.

Although the incidence of occupational lung disease has decreased in many countries, in parts of the world, occupational exposure continues to impose a heavy burden.

Who is at risk and what are the complications?

Yvan Ntwari, a general practitioner at University Teaching Hospital (CHUK), says that when it comes to lung disease, anyone can get exposed to the condition. However, he notes that a specific group of people are at higher risk as compared to others.

For example, he says that diabetics and people with HIV, those under treatment for cancer, especially when undergoing chemotherapy, as well as pregnant women and other conditions that make ones immunity low, are at risk of occupational lung diseases.

Ntwari says that to avoid the condition one has to eat well, maintain good hygiene in all areas, immunise children, protect oneself from HIV, and get early treatment for diabetes, among things. 

If the disease progresses, he says, it can destroy one’s lungs, and even after the treatment, one can still develop serious complications.

"Some of the complications include destroying alveoli, decrease of oxygen due to the destroyed lungs and other chronic problems,” he says.

At late stage, Ntiringanya explains that it can affect the functioning of the heart. He points out that the lung and the heart work together, and if one is not working, it can affect the other, leading to serious complications.

For one to experience the signs of some lung diseases, Ntiringanya says one has to have a certain time of exposure to offending factors, and that it’s not like acute manifestations, rather, symptoms grow gradually.

"The function of the lungs is to provide oxygen, the first sign is respiratory symptoms such as shortness of breath which can progress with time,” he says.

Depending on the stage of the disease and the complications, Dr Janvier Rusizina, a general practitioner at La Nouvelle Clinic in Remera, says it can be managed by avoiding some risk factors.

Most of the times, however, patients show up at a late stage, making the treatment impossible and the only option is putting patients in palliative care.

He advises that if and when one starts to experience such signs, they should immediately seek medical attention to avoid further complications.

How to prevent the disease

Ntiringanya says although it depends on where one works, it’s still hard to prevent the inhalation of toxic gases. For instance, he says for those working in places that expose them to toxic gas, if such an environment doesn’t provide equipment for protection against inhalation, then it is hard to prevent the conditions.

On the other hand, when it comes to environmental factors such as fumes emitted from cars, people should avoid using such cars. For teachers, he says, using chalk that isn’t of high quality could pose a risk, and that wearing a mask when cleaning the blackboard is important.

People should avoid smoking in public, because they are exposing other people to diseases that occur due to secondhand smoking.

Government intervention

Rwagasore points out that the Ministry of Health has so far put in a lot of effort, especially when it comes to its prevention.

He cites prevention strategies such as phasing out of asbestos roofing in the country, and the emphasis that has been put on awareness and advocating for use of personal protective equipment, such as masks at the workplace to avoid exposure to health complications. 

"These primary preventive interventions aimed at reducing exposure levels at the workplace remain pivotal for elimination of the occupational lung disease burden,” he says.

On the other hand, new occupational agents with unknown respiratory health effects are constantly introduced to the market and require periodic health surveillance, along with exposed workers to detect early signs of adverse respiratory effects. 

Rwagasore advises that in the case of any alarming signs and symptoms, people should consult health facilities early to avoid complications due to delayed diagnosis and treatment.

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