Document 1g13BQ1Jb5KYv4EjXX609Xvra

c t 7o T. A. Lincoln Copy to N. E. Bolton S. E. Nine INTERNAL CORRESPONDENCE 39 Old Ridgebury Road. Danbury, Connecticut 06817-0001 Date June 11, 1985 Originating Dept SHSEA (R-4) Subiect Background Information Document - Asbestos Dear Tom: My thanks to Hilton on a job well done. I only have one point of concern and that is to present diagnostic tools "that may be of value" but "not a procedure which is suitable for routine periodic medical surveillance" as part of the text. I would be more comfortable with the document if it simply contained the OSHA requirements for medical surveillance and any additional requirements Corporate Medical believes are needed and necessary. My experience has been that options are troublesome when using contract company doctors. It is similar to waving the carrot in front of the rabbit. Thanks again. EKJ/mbb Eleanor K. Jensen 4?0So UNION CARBIDE CORPORATION HEALTH, SAFETY & ENVIRONMENTAL AFFAIRS 39 OLD RIDGEBURY ROAD DANBURY, CT 06817-0001 TO: DERMS GOHC COPY: T. G. Fortney S. Hallenberg A. A. Lang H. C. Lewinsohn D. Lewis M. G. Ott H. Windwer BB66,vED ,jdMay 31 &85 5 1985 E. K. P-2 SUBJECT: Background Information Documents We in Corporate Medical have been preparing background information documents on subjects which should be of interest to contract physicians as well as HS&EA and Employee Relations managers. As I told you in my letter to you December 5, 1984, these documents are designed to briefly explain the reasons for specific occupational medical and epidemiology programs. They also describe what a manager responsible for administering these programs might reasonably expect from his medical and nursing team. Occasionally, they outline specific details but usually they will emphasize general concepts. We have several documents and the manual ready to go but we decided to wait until we had about 10 documents completed before we sent out the manual. Enclosed is a draft of another one "The Medical Surveillance of Persons Expos what you think of our effort and let me h do not hear from you, I shall assume you h : is called. let me know 1985. If I TAL/cr Enclosure 0390J CORPORATE MEDICAL DEPARTMENT BACKGROUND INFORMATION DOCUMENT THE MEDICAL SURVEILLANCE OF PERSONS EXPOSED TO ASBESTOS By: H. C. Lewinsohn, M.D. Assistant Corporate Medical Director Asbestosis, lung cancer and diffuse malignant mesothelioma of the pleura or peritoneum are the three major asbestos-related diseases which are associated with occupational exposure to asbestos. Less clear-cut associations have been documented for gastro-intestinal tract cancers, laryngeal cancers and non-Hodgkins lymphoma of the gastro-intestinal tract. It has been postulated that renal cancer and pancreatic cancer may be more prevalent among asbestos exposed populations but this association lacks epidemiologic verification. Asbestos exposed persons who smoke cigarettes have at least a 50 times greater chance of dying from lung cancer than non-smoking non-asbestos exposed persons. Because of its increased and widespread use in the USA in many sectors of industry during the past 50 years and lasting up until very recent times, it has been estimated that millions of people have been exposed in various ways to the different commercial forms of asbestos. Most of these workers have experienced low levels of exposure in comparison to asbestos miners and millers, asbestos textile workers, asbestos cement workers and employees of the friction materials industry. Pleural plaques without evidence of other stigmata of asbestos exposure clinically, physiologically or radiographically, are probably an important index to these low level exposures. Medical surveillance of asbestos workers attempts to provide a tool for the detection of the earliest and least harmful effects of exposure at a stage when cessation of such exposure may be of benefit to their continued health and well-being. The asbestos-related diseases are not readily amenable to therapy. The course of asbestosis may be steadily progressive but the physician can intervene and advise the person on ways and means to avoid chest infections and how to treat them effectively, if the condition is diagnosed in the early stages. The outlook for the person with lung cancer is poor and diffuse malignant mesothelioma of the pleura or peritoneum is invariably fatal within a short period of time after diagnosis. The pre-placement medical evaluation is designed to determine the candidates suitability for the job and must also consider the suitability of the job for the individual concerned. This means that the physician must be 6257B A 10586 2 completely familiar with the properties of the variety of asbestos in use, must understand the manufacturing processes in the plant and have a clear concept of the plant design and layout. Armed with this knowledge decisions can be made about prospective employees when contra-indications to asbestos exposure are present. Certain broadly defined conditions are regarded as contraindications to work with a potential for asbestos exposure. These include: - a history of previous work in another industry with a recognized dust hazard such as coal mining or stone quarrying; - an existing pulmonary impairment due to pneumoconiosis or other respiratory disease; - chronic obstructive pulmonary disorders; - organic heart disease. Some more specific contraindications are: - nasal obstruction or deformity of such a degree as to make the wearing of respiratory protection devices impossible; - gross physical deformity of the chest such as scoliosis or kyphosis; - chronic bronchitis, bronchiectasis or emphysema; - gross hypertension with cardiac impairment; - the presence of rheumatoid arthritis, because of the association of this condition with pneumoconiosis, an example being Caplan's Syndrome. The pre-placement evaluation serves the purpose of establishing base-line data which will be useful in observing the exposed persons throughout their lifetime, noting changes in measured parameters, and providing data for epidemiologic studies. * The pre-placement evaluation affords the examining physician with an opportunity to counsel and advise the job applicant regarding the known facts about the effects of asbestos exposure. It is essential to emphasize the special risks the worker runs if he or she smokes cigarettes. This habit should be strongly discouraged. Persons exposed to asbestos should be kept under medical surveillance. The object of periodic examinations is to detect early changes in the worker's physiologic status, radiologic appearances and work capacity. The findings are recorded systematically on an on-going basis to allow comparison from one evaluation to the next. OSHA requires that every employer shall provide, or make available, at least annually, comprehensive medical examinations to each employee engaged in 6257B 3 an occupation exposed to airborne concentrations of asbestos fibers. minimum requirement is for The "a chest roentgenogram (posterior-anterior 14 x 17 inches), a history to elicit symptomatology of respiratory disease, and pulmonary function tests to include forced vital capacity (FVC) and forced expiratory volume at 1 second (FEV1>0).- Early effects of exposure may be discovered as the result of periodic medical surveillance examinations. They may occur at a stage when removal from further occupational exposure, to asbestos could possibly arrest or significantly delay the progress of asbestosis, or the occurrence of other asbestos-related conditions. As mentioned previously, the physician can help the asbestotic patient prevent serious complications from respiratory infections and counsel the individual about the increased risks from cigarette smoking. Table 1 lists the minimum requirements of a satisfactory medical surveillance program for asbestos exposed persons to satisfy OSHA's Asbestos Standard.. It is generally agreed that OSHA's present requirement for annual examinations may not be necessary in the light of present conditions in industry but they are still in force. When the current asbestos standard is revised, it is expected that the frequency and periodicity of the components listed in Table 1 will change. The medical examiner should concentrate on eliciting the symptoms and signs of pulmonary fibrosis. The findings include progressive effort dyspnoea, finger-clubbing and bilateral end-respiratory fine crackles on auscultation of the chest. In the case of the more heavily exposed employees, in those with long service and in those who are cigarette smokers, the possibility of lung cancer must always be borne in mind. Transient plueral effusions, often asymptomatic, can occur in asbestos workers. Pleural lesions are often the first indicator of exposure effects. Pleural plaques, with or without calcification, not usually producing any physiological impairment, may be the most frequently identified radiologic abnormality. Diffuse pleural thickening is sometimes seen and in rare cases can lead to impairment of lung function. Pleural plaques must not be called asbestosis, a term reserved for the pulmonary fibrosis characteristic of this disease. They are an index to exposure and no more. Pleural plaques should be recorded as such on OSHA Form 200 and must not be called asbestosis. Asbestosis may occur in cases with plaques and both conditions should then be recorded in the log. Radiographic lesions in the lung parenchyma are often subtle in the early stages and skilled x-ray reading techniques should be employed which are based on the ILO U/C Classification of Radiographs for the Pneumoconioses. The earliest effects of exposure may be those detected by lung function tests. The measurement of the timed components of the vital capacity is valuable in demonstrating the development of the characteristic restriction of 6257B 4 lung function which occurs with pulmonary fibrosis. Where facilities exist for more complete lung function studies, the single-breath carbon monoxide diffusing capacity should be done. The value of sputum cytology in the periodic follow-up of asbestos workers has not yet been adequately quantified. Computed tomography may be of value as a diagnostic tool to differentiate pleural tumors from plaques and to detect early asbestosis. This is not a procedure which is suitable for routine periodic medical surveillance. Persons who have been exposed to asbestos should be kept under surveillance even though exposure has ceased. The long lapsed period between first exposure and observation of any of the biological effects mandates careful follow-up for many years. In some cases this could lead to the early detection of lung cancer and possible life prolonging or pain relieving treatment. The prevention of asbestos-related diseases depends on good engineering technology and dust control. The technique of medical surveillance is merely one cog in the wheel which comprises the total effort required to safeguard employee health. 6257B TABLE I * Complete, Detailed, Occupational History Since Obtaining First Job * Family History * Smoking History * Social History (Drugs. Alcohol, Etc.) * Previous Illnesses of Note, Especially Respiratory Ailments * Detailed Respiratory Symptoms History (Respiratory Questionnaire Table II) * Complete Physical Examination * 17" x 14" Postero-Anterior Chest X-ray* Interpreted by a Radiologist/"B-Reader" * Measurement of Lung Function (FVC, FEV^, FEV^/FVC) * Optional - Lateral and oblique x-rays of the chest may occasionally be required to clarify abnormalities. Computerized Axial Tomography may be used to investigate puzzling lesions. - Sputum cytology in smokers over age 40, if indicated and feasible. * Oblique Chest X-rays, and occasionally lateral views, may be required to clarify pleural abnormalities. Computerized Axial Tomography may be used to investigate puzzling lesions, but it not yet a practicable surveillance technique. 0375J A:060C TABLE II RESPIRATORY QUESTIONNAIRE CHEST COLDS AND CHEST ILLNESSES If you get a cold, does it usually go to your chest? (Usually means more than 1/2 the time.) During the past 3 years, have you had any chest illnesses that have kept you off work, indoors at home, or in bed? 1. Yes 2. No_ 3. Don't get colds 1. Yes 2. No_ IF YES Did you produce phlegm with any of these chest illnesses? In the last 3 years, how many such illnesses with (increased) phlegm, did you have which lasted a week or more? 1. Yes 2. No^ _____Number of illnesses No such illnesses Did you have any lung trouble before the age of 16? 1. Yes 2. No Have you ever had any of the following? Attacks of bronchitis? IF YES Was it confirmed by a doctor? At what age was your first attack? Pneumonia (include bronchopneumonia)? IF YES Was it confirmed by a doctor? At what age did you first have it? 1. Yes 2. No__________ 1. Yes 2. No__________ _______ Age in years 1. Yes 2. No__________ 1. Yes 2. No_________ _ __________ Age in years 4 '060; ' Hay fever? IF YES Nas it confirmed by a doctor? At what age did it start? 0 Have you ever had chronic bronchitis? IF YES Do you still have it? Was it confirmed by a doctor? At what age did it start? Have you ever had emphysema? IF YES Do you still have it? Was it confirmed by a doctor? At what age did it start? Have you ever had asthma? IF YES Do you still have it? Was it confirmed by a doctor? At what age did it start? If you no longer have it, at what age did it stop? COUGH Do you usually have a cough (Count a cough with first smoke or on first going out-ofdoors. Exclude clearing of throat.) [If No, skip to questions on PHLEGM.] Do you usually cough as much as 4 to 6 times a day, 4 or more days out of the week? 1. Yes 2. No 1. Yes 2. No Age in years 1. Yes 2. No 1. Yes 2. No 1. Yes 2. No Age in years 1. Yes 2. No 1. Yes 2. No 1. Yes 2. No Age in years 1. Yes 2. No 1. Yes 2. No 1. Yes 2. No Age in years Age stopped 1. Yes 2. No 1. Yes 2. No 0387J -2- A 10602 Do you usually cough at all on getting up, or first thing in the morning? Do you usually cough at all during the rest0of day or at night? 1. Yes 2. No 1. Yes 2. No IF YES Do you usually cough like this on most days for 5 consecutive months or more during the year? For how many years have you had this cough? 1. Yes 2. No_ ______________________ Number of Years PHLEGM Do you usually bring up phlegm from your chest? (Count phlegm with the first smoke or on first going out-of-doors. Exclude phlegm from the nose. Count swallowed phlegm.) 1. Yes 2. No (If No, skip to questions on BREATHLESSNESS.) Do you usually bring up phlegm like this as much as twice a day, 4 or more days out of the week? 1. Yes 2. No Do you usually bring up phlegm at all on getting up, or first thing in the morning? 1. Yes 2. No_ BREATHLESSNESS If disabled from walking by any condition other than heart or lung disease, please describe and proceed to next question. Nature of condition(s): * Are you troubled by shortness of breath when 1. Yes 2. No_ hurrying on the level or walking up a slight hill? IF YES B. Do you have to walk slower than people of your age on the level because of breathlessness? 1. Yes 2. No C. Do you ever have to stop for breath when walk 1. Yes 2. No ing at your own pace on the level? 0387J ^'0603 D. Do you ever have to stop for breath after walking about 100 yards (or after a few minutes) on the level? 1. Yes 2. No E. Are you too breathless to leave the house or 1. Yes 2. No breathless on dressing or undressing? TOBACCO SMOKING Have you ever smoked cigarettes? (No means less than 20 packs of cigarettes or 12 oz. of tobacco in a lifetime or less than 1 cigarette a day for 1 year. 1. Yes 2. No IF YES Do you now smoke cigarettes (as of 1 month ago) ? How old were you when you first started regular cigarette smoking? If you have stopped smoking cigarettes completely, how old were you when you stopped? How many cigarettes do you smoke per day now? On the average of the entire time you smoked, how many cigarettes did you smoke per day? Do or did you inhale the cigarette smoke? 1. Yes 2. No __________ Age in years __________Age stopped Check if still Smoking ___________ ______ Cigarettes per day ______ Cigarettes per day Not at all Slightly Moderately Deeply _______________ NOTE: These questions are derived from the "Epidemiology Standardization Project" (Benjamin G. Ferris, M.D., Principal Investigator) published by the American Thoracic Society in American Review of Respiratory Disease, (1978) Vo., 118(6). 0387J A 10604 -4- To: General Occupational Health Committee B. L. Barton - Electrode Systems Division - Parma - Loc. 742 N. E. Bolton - Linde - Danbury R-4651 R. L. Bujalski - Tarrytown - Loc. 323 J. M. Cleverdon - Catalysts & Process Systems Division - Danbury - Q1633 T. L. Collins - Engineering & Technology Services - S. Charleston - Loc. 511 r. w. Cope - HS&EA - Danbury - P2608 J. M. Cwikla - HS&EA - Danbury P-2 V. D. Dutcher - UCAR Emulsion Systems - 410 Gregson Drive - Cary, NC 27511 W. S. Everett - Films-Packaging - Chicago-Summit - Loc. 358 T. A. Gagner - Home & Automotive - East Hartford - Loc. 329 N. W. Gaines - HS&EA - Danbury - P-2606 W. F. Gorham - Specialty Chemicals Division - Bound Brook - Bldg 200 D. A. Gosselin - Silicone & Urethane Intermediates - So. Chas. - 511 J. P. Gracie - UCCL Toronto - Loc. 440 R. E. Graebert - Polyolefins Div/Unipol Systems - Danbury - K-2 T. J. Hall - UC Europe/South Africa - Danbury P-4624 A. J. Hart - Medical & Industrial Services, Indianapolis, IN S. E. Hine - Linde Division - Danbury, CT R4 J. C. Hovious/D. T. Watters - Engineering & Technology Services South Charleston - Loc 511 E. K. Jensen - Linde - Danbury - R4656 V. H. Johnkoski - Ethylene Oxide/Glycol - So. Chas. - Loc. 511 J. M. Kettmann - UCAME - Danbury P-4 R. P. Lavlor- Law Department - Danbury - E-2282 R. M. Lawton- UCC Canada - Toronto - Loc 440 J. A. Leonard - Agricultural Products Co. Inc. - Loc. 985 D. Liebeskind - Silicone & Urethane Intermediates - Danbury - L-1494 T. A. Lincoln - HS&EA - Danbury - P-2594 W. H. Long - Carbon Products - Parma - Loc. 742 D. E. MacNab - UC Pan America, Inc., Danbury - P - 4 D. Pearson - Safety & Health - Rickmansworth, England R. E. Plevan - Specialty Polymers and Composites - Danbury - M-1548 R. R. Rankin- HS&EA - Danbury - P-2605 H. B. Rhodes- Metals Division - Grand Junction, CO 81502 - p.o. 1029 - Loc. 250 J. F. Rooney - Battery Products - Rocky River - Loc. 781 H. D. Smilie - Electronics Division - Greenville, S.C. E. D. Southard - Specialty Chemicals - Bldg. 98-208 - Bound Brook, NJ J. L. Stahl - Union Carbide Eastern, Inc. - Hong Kong W. R. van der Hoeven - Ethylene Oxide/Glycol - Danbury - M-3536 R. Van Mynen - HS&EA - Danbury - P-2607 K. W. Weinzheimer - UC Southern Africa - Johannesburg - Loc. 4435 B. L. White - Law Department - Danbury - E-22B1 R. C. Wise - Solvents & Coatings Materials - Danbury - K-3 R. F. Wolff - Corporate Benefits - Danbury B3-159 cc: O. H. Cunningham - Solvents & Coatings Materials - Danbury K4 R. G. Hanlon - HS&EA - Danbury - P-2622 W. C. Kuryla - HS&EA - Danbury - P2 H. C. Lewinsohn - HS&EA - Danbury - P-2 0. P. Mukheja - HS&EA - Danbury - P-2 M. G. Ott - HS&EA - Danbury - P-2589 1529B 6/3/85