Post on 01-Jan-2016
description
Occupational Lung Disease in ThailandPerspective from a
Chest PhysicianNitipatana Chierakul
Faculty of Medicine Siriraj Hospital
Secretary General of The Thoracic Society of Thailand
Consultant of Workmen’s Compensation Fund
1997-2000
2002-2004 No. submitted
No. considered
Percentage of decision (%)
Silicosis (%)
Byssinosis (%)
Occupational asthma (%)
Bronchitis (%)
145 32
91 12
63
4535
10
8
32
428
17
25
Siriraj Siriraj Occupational Lung Occupational Lung
ClinicClinic Patient profiles :•Silicosis 46•Byssinosis 5•Occupational asthma 3
Silicosis Silicosis •Male : female 19 : 27
•Smoking : non-smoking 19 : 27•Continue : discontinue 11 : 35•TB : No TB 11 : 35•Dead : alive 4 : 42
Factors Factors determining determining
severity of FEVseverity of FEV11 Sex TB Smoking
Profusion
Opacity
Large
opacity
M F + - + - 1 2 3 round
irreg
+ -
Severe
3 4 2 5 3 4 0 7 0 2 5 7 0
Non-severe
7 20
3 24
10
17
3 16
8 20 7 9 18
P-value
0.4 0.268
0.55 0.434 0.07 0.02
Byssinosis•All 32 cases were female •Mostly were textile workers•Irreversible airflow obstruction in 11 cases
•Post-shift drop of FEV1 in 2 cases
•Clinical compatible in 19 cases
Occupational Asthma•Glue 2 cases
•Dye for clothing 2 cases •Cooking 2 cases•Wood dust 2 cases•Seafood packaging 2 cases•RADS from inadvertent burning of bitumen 1 case
Occupational COPD
•Metal fume 3 cases•Noxious gases 3 cases •Mixed inorganic dust 2 cases
•Volatile agents 2 cases•Painter 1 case
STRENGTH•Established guidelines for
diagnosis and compensate evaluation since 1998
•Good support from the Workmen’s Compensation Fund, Social Security Office
•Strong international support•Effective anti-smoking campaign
WEAKNESS•No clearly context in the medical
curriculum •Low awareness from physicians•Penumbra in the guidelines•Unease assess to the supporting system•Unfair amount of compensation
–Upper limit of 60 months (80 % of salary)– Initial 35,000 Baht for treatment, and additional 50,000 Baht
OPPORTUNITY•Collaboration between academic
centers and professional organizations
•Concerning of the new generation•Direction of the country towards
sufficiency economy•Acceptance for civil politic and
peaceful coexistence
THREAT•Political driven of some profit-
baring groups•Public over expectation for
medical services•Complicated legal procedures•System for determining work-
related illness by only one specialist