Occupational Lung Disease

Occupational lung disease is a major cause of work-related ill health.

It is as a result of exposure to hazardous workplace chemicals, dusts and fumes which result in a wide range of life-threatening or adversely life-changing conditions.

It is essential that we understand how many people are experiencing work-related breathing and lung problems and why. It is important that those who need help engage with healthcare professionals as early as possible.

Employers must create safe working environments to protect their employees from lung conditions by preventing exposure to harmful substances.

What this page tells you

This page gives evidence and information on the burden of occupational lung disease across Great Britain. It monitors progress against the Taskforce recommendation to:

Improve the awareness of and compliance with the Control of Substances Hazardous to Health Regulations 2002 (COSHH) to prevent and control workplace exposures

The success of this recommendation will be measured by a:

Reduction in the incidence rate and number of new cases of occupational lung disease as reported by the Health and Safety Executive

What is occupational lung disease?

Occupational lung disease is any respiratory disease that is caused or made worse by exposures at work, such as breathing in hazardous substances such as gases or dust.

Types of occupational lung diseases include COPDAsthmalung cancerasbestos-related lung diseasepneumoconiosisallergic alveolitissilicosis, infectious diseases

Small and hazardous particles can make it into the lungs

What causes occupational lung disease?

Occupational lung diseases are the result of long term exposure to irritants being breathed into the lungs

 

Types of workplace exposures

Long term exposure to hazardous, toxic, or irritating particles, gases, and even temperature conditions, can have lasting effects on the lung, even once the exposure ends. These particles can come from various sources with some jobs being more at risk than others. For infectious diseases, exposure does not have to be long term, however, mainly focusses on non-infectious occupational lung diseases. 

The largest household study of employment circumstances in the UK, the Labour Force Survey, documented the following causes for self-reported cases of breathing or lung problems from 2009 – 2011:

  • Airborne materials from spray painting or manufacturing foam products (in 13% of cases)
  • Dust from flour, grain/cereal, animal feed or straw (7% of cases)
  • Airborne materials while welding, soldering, or cutting/grinding metals (10% of cases)
  • Dust from stone, cement, brick or concrete (nearly 20% of cases)
  • General work environment  e.g. uncomfortable – hot/cold/damp/wet/dry/etc (20% of cases)

Unfortunately, this data is not regularly collected by the survey, so we do not have up to date data on worker reported exposures.

A recent study found several manual labour jobs are associated with the highest risk for COPD

UK Biobank is a national and international data set following the health and well-being of 500,000 volunteer participants

A recent study looking at COPD in the workplace and using data from the UK Bio-Bank, a national data set, listed the following occupations in order of risk. The study looked at 200,000 people and estimated their risk of occupational lung disease based on their role.

What this data tells us is that, for example, 2 in every 100 people who are Seafarers are at risk of COPD. This does not tell us about the other lung conditions they may be at risk of, however.

The study found the following risk associated with each job:

  • Seafarers: 2.64%
  • Coal mine operatives: 2.30%
  • Industrial cleaners: 1.96%
  • Domestic Cleaners: 1.43
  • Roofers/tilers: 1.86%
  • Packers/bottlers/canners/fillers: 1.60%
  • Horticultural trades: 1.55%
  • Food/drink/tobacco process operatives: 1.46%
  • Floorers/wall tilers: 1.41%
  • Chemical/related process operatives: 1.39%
  • Postal workers/couriers: 1.35%
  • Labourers in building/woodworking trades: 1.32%
  • School mid-day assistants: 1.32% 
  • Kitchen/catering assistants: 1.30%

What's the story so far?

Current data on occupational lung disease is lacking despite an estimated 450,000+ cases of occupational lung disease

The scale of occupational lung disease based on different data sets

Understanding the trend in the number of cases per year is an important step to building a wider picture of occupational lung disease in Britain. This informs strategies to prevent and treat disease. It also informs predictions of the expected burden on the health service, making it easier to plan to deliver care to those who need it most.

The largest national data set on occupational lung disease is captured through the labour force survey (LFS), mentioned above.  It captures all worker-reported cases of breathing or lung problems related to work, along with common causes. 

Current estimates from the survey state that 144,000 people currently live with a work-related breathing problem and there are around 20,000 new cases each year.

While this is the largest recorded number of occupational lung disease cases the Health and Safety Executive estimates that 15% of all COPD cases are attributable to work. The current estimate for the number of people living with COPD in the UK is 3 million which would mean 450,000 people are living with work-related lung disease just from COPD alone. This highlights the scale of the gaps in the data collected on occupational lung disease. 

Unfortunately, the LFS only captures very basic data on occupational lung disease and all results are from the workers' own perspective. Without confirmed diagnoses and established links to occupational exposures, the use of this data is limited. For the cases captured in the LFS, we lack the understanding of these people’s health status and we need better data throughout the healthcare system to understand this.

We don't have data on the awareness of and compliance with the Control of Substances Hazardous to Health Regulations 2002 (COSHH). We need data on the current implementation of safety measures at work and current exposures rates and risks to prevent and control workplace exposures.

Data sets on occupational lung disease do little to address the estimated scale of the problem

There are other smaller data sets that assess occupational lung disease. Each of these has its benefits and drawbacks but ultimately, they shed little light on the number of people currently estimated to be living with occupational lung disease and they offer no insight into current workplace exposures and risks.

Comparison of occupational lung disease datasets

DatasetNumber of cases
LFS - 201721000
Deaths12000
IIDB3910
THOR1283

The 4 main data sources for occupational lung disease are as follows:

  • The Labour Force Survey as discussed above.
  • The Industrial Injuries Disablement Benefit (IIDB) which captures people who are able to seek disability benefits.
  • The Health and Occupation Research Network (THOR) which looks at cases referred into chest physicians. 
  • Annual deaths which combines death certificates with an attributed fraction of deaths from respiratory disease, determined by epidemiological research.

Click through to learn more about these data capture schemes.

DatasetNumber of cases
LFS - 201721000

New cases of occupational lung disease have ranged from a minimum of 18,000 per year (2015) to a maximum of 22,000 per year (2016).

The LFS includes the broadest definition of occupational lung disease and offers the current best insight into the total number of people whose respiratory health is affected by work.

To improve the value of this data we need follow up studies on these cases, looking at workplace exposures, diagnosis, treatment and recovery rates as well as information on any workplace adjustments and safety measures put in place. 

DatasetNumber of cases
LFS - 201721000
Deaths12000

The Health and Safety Executive estimates there are 12,000 annual deaths from occupational lung disease in the UK. This is calculated through a combination of death certificates and an attributed number of deaths from respiratory diseases based on epidemiological research.

For diseases where workplace exposures are the known cause, death certificates are used. This is the case with disease like mesothelioma, whereby asbestos exposure is the cause. For other diseases where there are many causes, such as COPD, researchers attribute a proportion of the total cases and deaths to workplace exposures. In this case of COPD, this is 15% of all cases and deaths are considered to be as a result of work. 

It is important to remember that current deaths can be different from current exposures or even current cases due to the long latency or slow progression of many respiratory diseases.

DatasetNumber of cases
LFS - 201721000
Deaths12000
IIDB3910

In 2018 only 4,255 people claimed Industrial Injuries Disablement Benefit (IIDB). This is up from 2017 where there were only 3,910, and very similar to 2016 where there were 4,240 cases. You can find advice on claiming this benefit on the BLF website

The above gives us some insight into occupational lung diseases, but many people with work-related breathing problems would not be captured through this scheme. People are only eligible to claim this benefit if the link to work is sufficiently strong and the level of compensation available for even those who are severely disabled may also not provide enough incentive for all eligible individuals to apply. People who are self-employed are not covered by the IIDB scheme

DatasetNumber of cases
LFS - 201721000
Deaths12000
IIDB3910
THOR1283

The Health and Occupation Research Network (THOR) looks at cases seen by chest physicians.

In 2017, only 1,283 people were seen by chest physicians regarding occupational lung disease.  Similar figures were reported in 2016. However, cases are down from 2015 where there were 1,463 cases. Overtime cases recorded through THOR have dropped, however, according to the Health and Saftey Executive. Some of this is due to reporter fatigue, whereby doctors using the scheme lose motivation to record cases, rather than genuine drops in cases. Nonetheless, the overall trend is still a fall in cases over time. 

Cases captured within THOR tend to be shorter latency diseases such as asthma and allergic alveolitis or instances where cases can be readily attributed to work on a case-by-case basis.

DatasetNumber of cases
LFS - 201721000
Deaths12000
IIDB3910
THOR1283

The number of cases captured within THOR, IIDB and mortality statistics falls short of addressing the 21,000 new cases a year seen within the LFS.

Mortality statistics show us that there are at least 12,000 cases of occupational lung disease per year. However, a lot of these diseases will have developed a long time ago, so this data may not be relevant to disease rates now. As a result, we cannot use this data to accurately compare to current cases found within the LFS or other data sets. An example of this is COPD, which often progresses relatively slowly, yet accounts for 4,000 out of the 12,000 deaths annually. These cases will not be new cases but cases which developed several years ago.  

In comparison, Mesothelioma can progress rapidly. For diseases like mesothelioma and asbestos-related lung cancer, annual deaths are close to new annual cases.

At least 100,000 cases (72%) reported through the labour force survey don’t have a recorded follow-up

We know too little about the people who have been recorded in these data sets. There is no way of knowing how these data sets fit together - whether the people reporting work-related breathing or lung problems through the LFS are the same cases captured through the THOR or IIDB schemes, or if any of the cases resulted in death. Based on the case numbers of these data sets, at least 72-100% of cases reported through the LFS do not have a recorded follow up seeking disability benefit or visiting a chest physician. 

An animation showing the potential relationships between the three main occupational lung disease data sets

We need follow up studies to understand the health outcomes of people reporting “breathing and lung problems” through the LFS. This should include a breakdown of those who went on to receive a diagnosis and treatment, suffer long term or make a full recovery. As well as information on the medical care they needed and if the required workplace changes to protect them took place

Not all cases reported through the LFS will be accurate

Not all cases reported in the LFS will be accurate or require follow up.  The LFS will include a range of cases including those where the link to work is invalid or the symptoms are as a result of a non-respiratory issue. We need studies to validate, follow-up, and analyse LFS cases to improve our understanding of occupational lung disease.  

If you think you have been affected by work-related exposures in any way you should:

  • Notify your employer and ask them to ensure the workplace is safe and you have the correct protection.
  • Talk to your GP
  • Call the British Lung Foundation helpline
  • If you are a trade union member, seek advice from your union rep

How have occupational lung disease rates changed over time?

Rates of occupational lung disease are not improving

Estimates from the LFS show that the overall proportion of people living and working with a self-reported ‘breathing or lung problem’, known as the prevalence rate, has remained flat since 2015. Whereas, the proportion new cases each year, known as the incidence rate, has risen slightly between 2015 and 2018. 

These figures are affected by several factors:

  • The number of people in the working population
  • The number of new cases of occupational lung disease
  • The number of people leaving the working population due to retirement or death
  • The number of cases of occupational lung disease that recover.

Incidence and prevalence rates depend on the balance of all these factors and this is why you can have trends where incidence is rising but prevalence is constant. 

A graphic describing the factors that affect the incidence and prevalence of occupational lung disease

The Taskforce recommendation calls for a reduction in the number of new cases as well as a reduction in the incidence rate (the rate of new cases as a proportion of the working population). With both these figures having risen slightly since 2015 it suggests we need to improve the awareness of and compliance with the Control of Substances Hazardous to Health Regulations 2002 (COSHH) to prevent and control workplace exposures and bring down new cases of occupational lung disease. 

Looking at occupational lung disease rates over time

Year%age of workers self-reportingMissing dataBaseline
19990.0013
20000.0013
20010.00200.00200.0013
20020.00200.0013
20030.00200.00200.0013
20040.00150.0013
20050.00150.0013
20060.00150.0013
20070.00120.0013
20080.00130.0013
20090.00130.0013
20100.00100.0013
20110.00110.00110.0013
20120.00100.0013
20130.00090.00090.0013
20140.00120.0013
20150.00140.0013
20160.00130.0013
20170.00130.0013
20180.00130.0013
20190.0013
20200.0013

Rates of occupational lung disease have not improved since 2008

Here we are looking at the proportion of the working population that are currently living with an occupational lung disease, known as the prevalence.

The proportion of people living and working with an occupational lung disease has fallen by over a third since 2001. In 2001 0.20% of current workers reported work related breathing or lung problems. This has dropped to 0.13% as of 2018. Despite this overall improvement, rates are at the same level as they were in 2008, with little sustained progress throughout this period. There was a slight dip in figures throughout 2010 – 2013 but rates came back up in 2014 and have remained that way since.

Year%age of workers self-reportingMissing dataBaseline
19990.0013
20000.0013
20010.00200.00200.0013
20020.00200.0013
20030.00200.00200.0013
20040.00150.0013
20050.00150.0013
20060.00150.0013
20070.00120.0013
20080.00130.0013
20090.00130.0013
20100.00100.0013
20110.00110.00110.0013
20120.00100.0013
20130.00090.00090.0013
20140.00120.0013
20150.00140.0013
20160.00130.0013
20170.00130.0013
20180.00130.0013
20190.0013
20200.0013

Prevalence figures tell us how many people are affected and need help

If occupational lung disease rates improve, this would suggest workplaces are getting safer. Prevalence figures are useful because they give a sense of the burden of disease - how many people are suffering from occupational lung disease and how many people will likely need support from public services including healthcare and disability benefits. In contrast to this, the number of new cases of occupational lung disease each year gives us a better indication of current exposures within the workplace and if any improvements are being made there. Click next to see how we’re getting on there.

Year%age of workers self-reportingMissing dataBaseline
19990.00070000
20000.00070000
20010.001000000.001000000.00070000
20020.000850000.00070000
20030.000700000.000700000.00070000
20040.000500000.00070000
20050.000600000.00070000
20060.000500000.00070000
20070.000500000.00070000
20080.000600000.00070000
20090.000500000.000500000.00070000
20100.000516670.00070000
20110.000533330.00070000
20120.000550000.00070000
20130.000566670.00070000
20140.000583330.00070000
20150.000600000.000600000.00070000
20160.000700000.00070000
20170.000700000.00070000
20180.00070000
20190.00070000
20200.00070000

We lack several years of data on the number of new cases of occupational lung disease each year

The number of new cases in a given year, as a proportion of the total population, is known as the incidence rate. There are several years where incidence data is missing. The sample size (number of participants) for the survey from 2010 – 2014 and again in 2018 was too small to provide reliable estimates. We need to ensure that reliable data is captured on new case rates.

Year%age of workers self-reportingMissing dataBaseline
19990.00070000
20000.00070000
20010.001000000.001000000.00070000
20020.000850000.00070000
20030.000700000.000700000.00070000
20040.000500000.00070000
20050.000600000.00070000
20060.000500000.00070000
20070.000500000.00070000
20080.000600000.00070000
20090.000500000.000500000.00070000
20100.000516670.00070000
20110.000533330.00070000
20120.000550000.00070000
20130.000566670.00070000
20140.000583330.00070000
20150.000600000.000600000.00070000
20160.000700000.00070000
20170.000700000.00070000
20180.00070000
20190.00070000
20200.00070000

There has been no improvement in incidence rates for two decades

From what we can see, incidence rates halved between 2001 to 2004 but have since risen slightly back to the levels seen in 2003. This suggests no sustained improvement has been made in nearly two decades. It’s important to note however that current rates of self-reported lung problems aren’t necessarily an accurate representation of current workplace exposures. Sometimes lung conditions can take years to present with symptoms. Nonetheless, the lack of progress in incidence rates is still a cause for concern and we want to see better compliance with regulations and better monitoring of current exposures. 

Year%age of workers self-reportingMissing data (%)No. of workersMissing data (No.)
1999
2000
20010.0010.0012800028000
20020.0008524500
20030.00070.00072100021000
20040.000516000
20050.000617000
20060.000514000
20070.000516000
20080.000620000
20090.00050.00051600016000
20100.000516666666716333
20110.000533333333316667
20120.0005517000
20130.000566666666717333
20140.000583333333317667
20150.00060.00061800018000
20160.000722000
20170.000721000
2018
2019
2020

It's important to look at both rates of occupational lung disease and the actual number of cases

It is important to look at both the rate of new cases as well as the actual number of new cases as sometimes these tell different stories.

For example, in a growing population, the rate of occupational lung disease can remain constant while the actual number of new cases each year rises. This is true when the increase in the number of new cases is the same as the growth of the general population. One way to think about this that the chance of developing occupational lung disease remains the same, there are just more workers now and therefore more cases overall.

Year%age of workers self-reportingMissing data (%)No. of workersMissing data (No.)
1999
2000
20010.0010.0012800028000
20020.0008524500
20030.00070.00072100021000
20040.000516000
20050.000617000
20060.000514000
20070.000516000
20080.000620000
20090.00050.00051600016000
20100.000516666666716333
20110.000533333333316667
20120.0005517000
20130.000566666666717333
20140.000583333333317667
20150.00060.00061800018000
20160.000722000
20170.000721000
2018
2019
2020

We need to be able to accurately assess the scale of the problem to ensure our healthcare services are well equipped to support people

Looking at both rates of new cases and the number of new cases means that we can ensure decision-makers are as informed as possible. For example, if the rate is flat, it might encourage decision-makers to think that present resources can support the care of these individuals. However, if actual case numbers are in fact rising, then more resources will be needed overall. This makes it essential to evaluate both when planning healthcare.

In this case, the trends are very similar in actual cases and incidence rates. 

How common are the different types of occupational lung disease?

Looking at THOR, IIDB and Annual Deaths:

Each data set paints a different picture of occupational lung disease based on the type of cases they capture. By combining these we can better understand the full scope of occupational lung disease along with the gaps and shortcomings of the data currently collected. 

Asbestos-related lung disease is the most prevalent type of occupational lung disease across all three datasets. Beyond this, each dataset showcases differing levels of prevalence for each occupational lung disease.

The Health and Safety Executive states that the LFS likely captures reports from people with chronic conditions like COPD and Asthma that may otherwise be missed by other datasets. Both THOR and IIDB dramatically underrepresent cases of COPD, with COPD making up a third of deaths from occupational lung disease.

There is no universally accepted definition of occupational asthma. Under a broad definition of work-related and work-aggravated asthma, the Health and Safety Executive expects that a substantial proportion of cases within the LFS are likely to be asthma. An investigation of THOR-GP data found than 15% of respiratory disease cases was asthma aggravated by work and 10% were asthma caused by workplace agents. This suggests that SWORD data likely greatly understate the incidence of asthma.  

DiseaseAsbestos Related Lung DiseaseCOPDLung cancer due to other agentsOther (pneumoconiosis and allergic alveolitis)AsthmaOther (silicosis, infectious disease, other)
Deaths0.410846340.328677070.230073950.03040263
THOR0.679611650.012696040.030619870.065720690.158327110.05302465
IIDB0.923273660.023017900.001278770.040920720.01150895

Data issues

Current case data doesn't tell the whole story

Many occupational lung diseases are long-latency diseases (meaning that cases tend to develop a number of years after first exposure), and current data on these diseases does not give an accurate picture of exposures today.

A clear example of this is asbestos. Statutory control procedures for asbestos exposure have been in place for over 30 years through the Control of Asbestos at Work Regulations (1987), yet rates of mesothelioma as a result of asbestos exposure are still rising as the disease takes time to present in people with past exposures.

YearDeathsAsbestos exposure ended by law (1987)Projected deaths
1982507
1983571
1984623
1985618
1986706
1987814814
1988872
1989909
1990895
19911023
19921097
19931152
19941246
19951317
19961322
19971367
19981541
19991615
20001633
20011860
20021867
20031887
20041978
20052049
20062060
20072176
20082265
20092336
20102360
20112312
20122549
20132560
20142522
20152547
20162606
201725262526
20182068
20192036
20201994
20211943
20221885

To understand the realistic and potential effect policy and regulatory changes can have, we really need data on exposure to harmful substances. This, along with a better prevalence and incidence data, will allow us to build a complete picture of the scale and impact of occupational lung disease.

Our asks

  • Data to be collected on the compliance with the Control of Substances Hazardous to Health Regulations 2002 (COSHH).
  • Data to be collected on current exposure rates and risks.
  • Follow up studies on the LFS survey population to understand diagnosis, exposures, treatment, recovery, and resultant safety measures.
  • New data capture schemes to monitor the number of occupation lung disease cases.
  • Joined up record-keeping across the health care system to monitor occupational lung disease cases.

Data sources

All data sources can be found on our data sources page