Occupational exposure and respiratory disease

Exposure to a wide variety of substances and risk factors causing or contributing to respiratory disease happens in the workplace or in relation to a wide variety of occupations. As mentioned in a previous EEA web report on cancer, malignant neoplasms of the bronchus and lung, along with mesothelioma (a malignant tumour caused by inhaled asbestos fibres), are all still key occupational diseases in Europe. Occupational exposure also causes infections, including Legionnaire’s disease. In healthcare workers, workplace exposure can lead to several possible bacterial or viral respiratory diseases, along with a great variety of chronic respiratory diseases. These include asthma, COPD, chronic bronchitis, idiopathic pulmonary fibrosis, hypersensitivity pneumonitis, sarcoidosis and pneumoconiosis.

Occupational risk factors for chronic respiratory disease include exposure to extreme temperatures, metal particles, dust, welding fumes, second-hand smoke and a great variety of toxic chemicals, including diisocyanates, nitrogen and sulphur oxides, ammonia, chlorine, ozone, benzene and fuel vapours (Blanc et al., 2019; Baatjies et al., 2023; Feary et al., 2023; Silver et al., 2021). Bioaerosols and dust from grain, animals, plants or latex, among other sources, can contain sensitisers and cause occupational asthma. Biological agents, organic dust and endotoxins from microorganisms also play an important role in the development of some work-related respiratory diseases. This includes farmers’ lung in the agricultural sector, diseases caused by dust from food stuff such as coffee, herbs or grain in the food industry, byssinosis caused by textile fibres in the textile industry, and other diseases prevalent among bakers. In addition, zoonoses (infectious diseases transmitted by animals) may also play a role and some (such as influenza viruses) are transmitted by the air (EU-OSHA, 2019, 2020; Anyfantis et al., 2017a, 2017b).

Asthma is the most common work-related lung disease, with work-related exposure thought to account for about 15% of all adulthood asthma in Europe. One in seven severe asthma exacerbations are linked to work-related exposure (Matteis et al., 2017; ELF, 2024).

Occupational exposure causes around 10% of all chronic respiratory deaths in the EU (IHME, 2024). The burden is much higher in men, who are estimated to suffer an occupational burden of respiratory disease about three times larger than that of women, possibly due to gender differences in occupations (and underestimation in women). These estimates should be considered with care, however. Occupational CRDs are still thought to be underdiagnosed, due to the difficulties in attributing the disease to the occupation, particularly in the presence of other known risk factors (Murgia and Gambelunghe, 2022).

Trends in occupational chronic respiratory disease and relevant exposure

Estimates suggest that occupationally-related chronic respiratory disease has decreased in the EU-27 in the past two decades (from 2001 to 2021), but only by less than 10%. Its prevalence continues to be far higher for men than for women, although that difference has decreased. The rate of Disability-Adjusted Life Years (DALYs) lost to occupational chronic respiratory disease was estimated to be 3.3 times higher for men than for women in 2001 and 2.6 times higher in 2021 (see Figure 5).

Some important occupational chronic respiratory health outcomes do not show signs of decreasing in the EU. Figures 6 and 7 present the prevalence of work-related respiratory COPD and asthma in EU countries between 2000 and 2016. No clear decline is observed in most countries, while some exhibit increasing incidents (EU-OSHA, 2023).

Pneumoconiosis is another notable occupational respiratory chronic disease group in the EU. It is caused by the inhalation of dust, including mineral fibres (such as asbestos) and dust containing silica (silicon dioxide). The prevalence of pneumoconiosis has declined significantly over the past decade, according to national data submitted to the EU (Eurostat, 2024b). 

As environmental conditions are impacted by climate change, they are expected to become increasingly relevant in the context of the workplace. Temperatures have increased and altered the growth of microorganisms. A wider spread of specific infectious agents and changes in dust loads in ambient air may ultimately affect workers and alter the risk factors for respiratory disease at work, as well as the likelihood of different diseases occurring. First responders such as firefighters may also be affected by the increase in natural disasters and forest fires. They can be impacted by increased dust load, or respiratory irritants and microorganism growth in damp environments due to floods, for instance.

What the EU is doing about occupational exposure

A comprehensive legislative framework sets out employers’ responsibilities for workers’ health and safety. General requirements were set by the OSH Framework Directive (89/391/EEC). Employers must carry out a workplace risk assessment, and implement protective and preventive measures, following a hierarchy of prevention. For chemicals and process-generated substances, this hierarchy prioritises first eliminating dangerous substances, followed by substituting them with less hazardous substances. Finally — where neither is possible — collective prevention measures should be applied, such as using local exhaust ventilation or limiting the number of workers exposed. Employers also have to involve, inform and train workers, and consult them on the measures (EU-OSHA, 2018a, 2018b, 2019). Personal protection measures such as the use of personal protective equipment are only foreseen as a last resort, if all the other measures do not sufficiently protect workers.

Three directives apply specifically to chemicals and mixtures of dangerous substances, such as process-generated substances. Directive 98/24/EC addresses workplace risks related to chemical agents at work and sets out employers’ obligations (including, for instance, health surveillance). Directive 2004/37/EC on the protection of workers from the risks related to exposure to carcinogenic, mutagenic or reprotoxic (CMR) substances at work has been amended several times from 2017 until 2024 to expand its scope and reduce the risk to workers from CMR substances. The latest amendment of Directive 2009/148/EC, on the protection of workers from the risks related to exposure to asbestos at work, significantly lowers the current asbestos limits and offers more accurate ways to measure asbestos exposure levels.

Binding and indicative occupational limit values have also been set and are continuously revised, with specific provisions in Directive (2009/148/EC), which addresses asbestos exposure at work. Member States must implement these minimum regulations in national legislation and may go beyond the provisions or produce more detailed regulations. A Europe-wide healthy workplaces campaign raised awareness of these risks in 2018/19.

Other occupational risk factors for respiratory diseases at work identified in this review, such as thermal risks, infectious agents and second-hand smoke, are covered either by the OSH Framework Directive or specific provisions, like the Biological Agents Directive (2000/54/EC). Employers must address these risk factors in their workplace risk assessment and set appropriate measures. There are additional provisions to protect vulnerable worker groups such as pregnant or breastfeeding women and young workers. Enterprises are supported through risk assessment tools, which focus either on risk or sector, as well as through access to national guidance and tools. A number of other directives set requirements for workplaces, equipment or specialised workplaces such as construction sites.