Wolfgang Raab

Empfehlung für die Begutachtung asbestbedingter Berufskrankheiten - Falkensteiner Empfehlungen

Recommendation for the Assessment of Asbestos-Related Occupational Diseases – Falkenstein Recommendation The Falkenstein Recommendation opens up a new chapter in the assessment of asbestosrelated occupational diseases. For the first time, the medical and legal foundations of this assessment are being outlined comprehensively in a publication. The list of industrial diseases currently comprises four types of disease resulting from contact with asbestos: asbestosis or diseases of the pleura (occupational disease No. 4103), lung cancer or cancer of the larynx (occupational disease No. 4104), mesothelioma of the diaphragm, peritoneum or pericardium (occupational disease No. 4105) as well as lung cancer following the effects of asbestos and polycyclic aromatic hydrocarbons (PAHs) (occupational disease No. 4114). Illnesses resulting from contact with asbestos at work, at 14.1% of all reported and 24.1% of all confirmed industrial diseases in 2009, still represent a considerable proportion of all occupational diseases in Germany, even though the manufacture and use of asbestos have been banned in Germany since 1993. This is explained by the well known fact that generally several decades lie between the first contact with asbestos and a possible illness. German Statutory Accident Insurance [Deutsche Gesetzliche Unfallversicherung (DGUV)], the German society for Industrial Medicine and Environmental Medicine [Deutsche Gesellschaft für Arbeitsmedizin und Umweltmedizin (DGAUM)] and the German Society for Pulmonology and Respiratory Medicine [Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin (DGP)], together with representatives of other medical specialities, have jointly drawn up this consensus after extensive evaluations of the literature and intensive discussions. Decisions about the recognition of asbestos-related occupational diseases can thus be better made and implemented according to uniform criteria in future. This is especially important because the number of illnesses caused by contact with asbestos will probably not fall noticeably in the years ahead. Falkensteiner Empfehlung

Is an Individual Prediction of Maximal Work Rate by 6-Minute Walk Distance and Further Measurements Reliable in Male Patients with Different Lung Diseases?

Background: In patients with chronic lung diseases, the work rate for endurance training is calculated by the maximal work rate (Wmax). Because the assessment bears side effects, a prediction by easier accessible tests would be of practical use. Objective: We addressed the reliability of predicting Wmax on the basis of the 6-min walk distance (6MWD) test and a set of further parameters in patients with different lung diseases. Methods: Baseline data of a longitudinal study including 6MWD, Wmax, peripheral muscle force, lung function, fat-free mass and dyspnea (Modified Medical Research Council score) of 255 men with occupational lung diseases (104 asthma, 69 asbestosis, 42 silicosis, 40 chronic obstructive pulmonary disease) were evaluated. Results: 6MWD correlated with Wmax (r = 0.51, p < 0.05). The product of 6MWD and body weight, in particular fat-free mass, led to an improvement in the correlation of Wmax with 6MWD. Muscle force, lung function and Modified Medical Research Council score correlated moderately but significantly with Wmax (p < 0.05 each). The maximum correlation gained by including 6MWD and further parameters in the prediction equations was r = 0.76 in patients with obstructive lung function impairment and r = 0.61 in asbestosis patients. The residual standard deviations of Wmax predicted by the calculated equations ranged between 20 and 28 W, and the 95% prediction intervals of Wmax ranged between ±47 and ±65 W. Conclusions: A reliable prediction of individual Wmax by 6MWD or related measures and therefore a replacement by other tests is not possible. Nevertheless, it may be useful for the comparison of average values in epidemiological and clinical studies.

Obstruktive Atemwegserkrankungen@@@Occupational obstructive airway disease: Diagnostik und Begutachtung

Im aktuellen Berufskrankheitengeschehen spielen obstruktive Atemwegserkrankungen eine wichtige Rolle. Ursächlich für Berufskrankheiten kann die Einwirkung allergisierender oder chemisch-irritativer bzw. toxischer Stoffe am Arbeitsplatz sein. Auch eine Schädigung durch Isozyanate gewinnt zunehmende Bedeutung. Beim Nachweis einer Feinstaubexposition entsprechend 100 Staubjahren im untertägigen Steinkohlenbergbau ist die Anerkennung einer chronischen obstruktiven Bronchitis bzw. eines Emphysems als Berufskrankheit möglich. BK-rechtlich ist eine Abgrenzung gegenüber potenziell konkurrierenden Krankheitsursachen erforderlich. Die Beurteilung der Minderung der Erwerbsfähigkeit hat anamnestische Kriterien, den klinischen Befund sowie das Ausmaß der Funktionsbeeinträchtigung zu berücksichtigen.ZusammenfassungObstructive airway disease caused by work-related effects is a frequent occupational disease. It can be triggered by allergenic, chemically irritating or toxic substances present at the workplace. Isocyanates have becomee an increasingly important cause of occupational asthma in recent years. If there is proof of exposure to cumulative fine dust dose at, usually, 100 mg/m3 per year during underground work mining bituminous coal chronic obstructive bronchitis or emphysema can be recognized as an occupational illness. The law requires that any potential non-occupational causes of obstructive airway disease be identified. The degree of disability assigned depends on the history, the clinical findings, and the extent of impairment of respiration.