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Assessment of Clinical and Functional Indicators of the Risk of Developing Pneumoconiosis in Combination with Chronic Obstructive Pulmonary Disease among Workers in the Mining and Metallurgical Industry

Assessment of Clinical and Functional Indicators of the Risk of Developing Pneumoconiosis in Combination with Chronic Obstructive Pulmonary Disease among Workers in the Mining and Metallurgical Industry

ISSN 2223-6775 Ukrainian journal of occupational health Vol.20, No 2, 2024


https://doi.org/10.33573/ujoh2024.02.120

Assessment of Clinical and Functional Indicators of the Risk of Developing Pneumoconiosis in Combination with Chronic Obstructive Pulmonary Disease among Workers in the Mining and Metallurgical Industry

Kovalchuk T.A., Rubtsov R.V.
State Institution Ukrainian Research Institute of Industrial Medicine Kryvyi Rih, Ukraine


Full article (PDF): UKR

Introduction. Occupational morbidity is a leading component of the overall morbidity indicators of the working population in most countries. It reflects the complex impact of environmental and genetic factors, the quality of medical care, lifestyle, and working conditions. Pneumoconiosis, a leading form of occupational lung disease, is caused by the inhalation of mineral dust during certain professional activities. The combined occurrence of pneumoconiosis and chronic obstructive pulmonary disease (COPD) among workers in the mining and metallurgical industry necessitates monitoring affected workers, developing measures to reduce exposure to industrial pollutants, and identifying the risks of clinical, functional, laboratory, and radiological signs typical for these combined diseases.

Purpose. To determine the significance of clinical and functional indicators in assessing the risk of developing pneumoconiosis in combination with COPD among workers in the mining and metallurgical industry and to develop measures aimed at preventing this occupational disease.

Materials and Methods. To assess the clinical and functional risk indicators for developing pneumoconiosis in combination with COPD, we examined 98 workers in the mining and metallurgical industry who were diagnosed with both conditions. We evaluated the severity of shortness of breath using the International Research Council scale, overall patient well-being using the Disease Assessment Test, and various lung function parameters, including vital capacity, forced vital capacity, forced expiratory volume in one second, peak expiratory flow rate, and maximum expiratory flow rate at 25–75% of forced vital capacity. We also measured the increase in forced expiratory volume in one second using the bronchodilation test. Significant risk indicators for developing pneumoconiosis in combination with COPD were determined, including critical value (Mcr), sensitivity (se), conditional probability of diagnostic value appearance (R1), background probability (R0), etiological share (EF), prevalence (pr), specificity (sp), false negative rate (f-), false positive rate (f+), negative predictive value (PV-), positive predictive value (PV+), percentage of agreement (P0), percentage of expected agreement (Pe), and Kappa index.

Results and Discussion. The study found that workers in the mining and metallurgical industry with pneumoconiosis combined with COPD had the highest sensitivity for several indicators: Disease Assessment Test scores above 11 points, forced vital capacity of the lungs below 60%, vital capacity of the lungs below 67%, and increase in forced expiratory volume in one second after the bronchodilation test below 16.1%. The highest conditional probability was associated with a peak expiratory flow rate below 40.8%. The background probability was linked to the given functional indicators, as well as a maximum expiratory flow rate at 75% of forced vital capacity below 59%. The etiological share of the relative risk of pneumoconiosis impacting COPD occurrence was significant for the Disease Assessment Test, forced vital capacity, vital capacity, and bronchodilation test, ranging from 52.1% to 63.2%. These indicators, along with peak expiratory flow rate, pointed to trends of inflammatory processes in the broncho-pulmonary system, leading to irreversible bronchial obstruction and the formation of pneumofibrosis in the lung parenchyma and interstitium. The diagnostic specificity of these indicators ranged from 0.88 to 0.95, with prevalence among affected workers ranging from 24% to 60%. The bronchodilation test, lung vital capacity, peak expiratory flow rate, and Disease Assessment Test had the highest positive predictive value, ranging from 0.79 to 0.93, indicating the most significant risks for disease occurrence and progression. The percentage of expected agreement for diagnosing pneumoconiosis combined with COPD ranged from 0.57 to 0.68 based on the Disease Assessment Test, forced vital capacity, forced expiratory volume in one second, and the ratio of forced vital capacity to forced expiratory volume in one second. The Kappa statistic, indicating the highest risks for the combined course of these diseases, showed a "reliable," albeit modest, agreement for these clinical and functional indicators, ranging from 0.22 to 0.34 (p<0.05).

Keywords: employees, pneumoconiosis, chronic obstructive pulmonary disease, risks, clinical indicators, functional state.

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