The incidence of occupational bronchopulmonary pathologies exceeds the national average in 25 constituent entities of the Russian Federation. This was reported by Sergey Avdeev, chief freelance pulmonologist of the Ministry of Health, at a conference organized by the All-Russian Union of Patients. The most acute situation is in Kuzbass: the occupational morbidity rate in the region is 7.88 cases per 10,000 population, compared to 0.79 per 10,000 population on average in Russia. Excesses of this level are also recorded in the Komi Republic (6.51) and Khakassia (5.15), Murmansk (4.88) and Belgorod (2.02) regions.
According to Avdeev, about 80% of all occupational lung diseases are diagnosed in employees of mining, manufacturing, and chemical industries. Russians working in dusty and gas-hazardous industries often have chronic obstructive pulmonary disease (COPD). Avdeev named pneumoconiosis—chronic diseases resulting from prolonged inhalation of industrial dust—as the leading pathologies among metallurgists. Workers also frequently suffer from occupational asthma and toxic-dust bronchitis.
In this regard, Avdeev proposed strengthening cancer vigilance and increasing coverage of Russians with functional respiratory diagnostics. According to him, uniform rules for accounting and routing patients, expansion of interdepartmental cooperation, and targeted support for industrially developed regions are also needed. Reducing the growth of disability from occupational lung diseases will also be helped by informing citizens about the consequences of such pathologies, said Roman Shcheglevatykh, vice president for medical insurance of the All-Russian Union of Insurers.
Timely detection of occupational lung diseases is hindered by systemic difficulties, believes Igor Bukhtiyarov, chief freelance occupational pathologist of the Ministry of Health. According to him, employers try to hide the presence of harmful factors in production to avoid additional inspections and fines. Sometimes employees themselves are not interested in identifying diseases: for residents of single-industry towns, an occupational diagnosis may mean the loss of their only place of work, explained Bukhtiyarov.
To prevent occupational diseases, a new technology has been developed in the country—remote dynamic monitoring of workers using spirometers, audiometers, and vibrotesters. Soon it will be included in updated draft orders of the Ministry of Health, said Bukhtiyarov. The technology has already been tested at three production sites with the participation of about 900 workers—more than 20% of them were classified as high-risk for developing pathologies, he noted.
Occupational diseases develop asymptomatically for years, said pulmonologist Olga Markova at the Scandinavian Health Center clinic. Harmful dust in production—quartz, coal, asbestos, metal—settles in the lungs and gradually triggers fibrosis, i.e., replacement of normal lung tissue with scar tissue. The scar "cannot breathe," so dust lung disease (pneumoconiosis) is irreversible. A doctor can slow its progression, but cannot return the patient's lungs to their original state, Markova clarified.
She called the idea of remote monitoring for workers sound—especially in regions where specialists and medical equipment are currently lacking. Nevertheless, the technology cannot completely replace an in-person appointment, she said: dust lung diseases and fibrosis are detected through examination, auscultation of the lungs, X-rays, and CT scans.
The problems with identifying occupational pathologies are explained by a lack of resource provision, including diagnostic equipment, the absence of a unified digital framework, and a shortage of personnel, explained Natalya Zhuravleva, leading expert at Aktiom Medicine (part of the Aktiom group). There are extremely few occupational pathologists in the country, and medical commissions that should determine the connection of a disease with exposure to occupational factors are not present in every region. All this means that the link between the disease and work is not formally established, and even if a pathology is detected, the patient is treated "according to the general profile," she emphasized.
Stimulating employers and employees to care about health could be helped by introducing a differentiated discount on the insurance tariff for active prevention of occupational diseases, Zhuravleva believes. Along with this, tax benefits or deductions should be provided for enterprises implementing corporate health programs, as well as an increase in fines for repeated cases of concealing harmful production factors (currently 5,000–10,000 rubles for legal entities).
The opportunities for employers to minimize risks for employees are "small," Bukhtiyarov believes. Moreover, in the event of illness, they need to change profession, explained therapist Anastasia Polyakova from the medical company SberZdorovye. According to Zhuravleva, guarantees of employment retention should be introduced for workers with occupational pathologies.
Vedomosti sent inquiries to large mining and manufacturing enterprises in regions with high levels of occupational morbidity, asking them to talk about measures to prevent pathologies.
Vasily Milkin contributed to the preparation of the material.
