An interdisciplinary approach to occupational respiratory disorders

The World Health Organization estimates that worldwide about 50 million new cases of occupational respiratory diseases emerge every year. Without preventative action, the burden of occupational diseases is expected to increase. In this thesis an alternative approach to deliver occupational health care is explored concerning work-related respiratory disorders in various worker populations. This approach is illustrated by a series of structured case studies. As a result of those studies it was concluded that: • Exposure to an agent during diacetyl production appears to be responsible for causing bronchiolitis obliterans syndrome. • Workers exposed to liquid detergent enzymes are at risk of developing sensitisation and respiratory allergy. • Working in the cast-house of an aluminium plant poses a respiratory hazard. • A simple triage system is capable of detecting occupational asthma among bakery workers that likely otherwise would not have been detected. The studies explored work-related respiratory health problems in an interdisciplinary way by integrating concepts from industrial hygiene, occupational medicine, epidemiology and clinical health care. The interdisciplinary approach appeared to be essential in elucidating respiratory health problems in the work environment beyond the competence of the common occupational health service. Interdisciplinary collaboration delivered the necessary knowledge and infrastructure to investigate individual workers and populations in a systematic way leading to recognition, diagnosis and management of occupational respiratory health problems and provided an impulse to implement preventive measures. However, in the present situation, such interdisciplinary approaches can only develop in more specialized units in the occupational health care system or in more specialized expertise centres. Unfortunately, there appears to be no public monetary means for further developing this kind of specific occupational health care in the Netherlands. Similarly, occupational health also becomes isolated on the European level since there is no access to European research funds because programmes in occupational health do not exist. This leads to a fragmented, nationally oriented health care system with limited access to research facilities and this will eventually limit research and development in the years to come. The interdisciplinary approach to work-related respiratory health problems should not be ignored and is a suitable approach in the field of occupational medicine to improve the quality of medical care available to workers facing work-related respiratory health problems. Despite the benefits of the interdisciplinary approach to work-related respiratory disorders and progress made, concerns remain. Future needs are a change of attitude among occupational physicians towards collaboration with clinical health care, improvement of knowledge, a good infrastructure and funding for occupational health care. Therefore, in order to improve the quality of occupational health care, the infrastructure of current occupational health care and funding of health care centres should be improved. All stakeholders involved?employees, employers, government, insurance companies and occupational health professionals?are faced with huge challenges to develop this kind of integrated occupational health care. Even more so in the perspective of the ongoing public debate regarding sustainable employability in work due to plans to raise the age of retirement under the General Old Age Pensions Act (AOW) to 6