Construction of domestic and commercial structures as well as roads and other public works is performed in virtually all societies. In 2007, 7.8 million workers were employed in the construction sector in the USA, representing 5-6% of total nonfarm employment (source: US Bureau of Labor Statistics, Current Employment Statistics Survey). Occupational health issues, including respiratory disorders, among construction workers are often quite challenging. The great variation in work processes and tasks, as well as the continually changing workplace settings often impede the ability of managers and workers to anticipate, document and prevent hazardous exposures.

The multiplicity of potential respiratory hazards associated with construction jobs guarantees that many physicians will be challenged to manage respiratory diseases among construction workers and to assess the significance of job exposures on disease occurrence in the clinical findings. In this section, we discuss the types of exposures to respiratory hazards that may be encountered in the construction setting and the potential health effects, including (1) nonmalignant conditions; (2) malignancies; and (3) immunologic conditions, with an emphasis on asthma.

The scope of construction projects ranges from simple, small-scale jobs such as building a deck or patio at a single family home, to massive and complex undertakings such as construction of dams, highways, power plants and office towers. Because of the nature of construction, workers in this industry may experience a diversity of worksite exposures. While a limited number of companies have hundreds or even thousands of employees, construction enterprises are typically small, often employing 75 or fewer individuals, with limited resources to address workplace safety and health. Work settings are frequently nonstandardized and changeable, and to maintain employment, workers often must change jobs and employers as some projects are completed and others are started. On the other hand, there are also large construction companies that can employ several thousand workers. Adjacent construction activities can result in exposures to substances that are unrelated to the worker’s particular job tasks. Considering these factors, as well as the almost daily changes in weather and work locations, the evaluation and control of hazardous airborne exposures for a construction worker are uniquely challenging.

Construction respiratory hazards can be grouped into three main categories: particulates (including fumes), gases and vapors, and sensitizers. This chapter summarizes some of the most commonly recognized hazards in construction work. Exposure to welding fumes can be encountered on construction sites with potential for acute and chronic lung effects, and metal fume fever; however, welding is covered elsewhere in this book (chapter 14) and is not considered further here. Paints are frequently present during construction activities but the health effects of exposure to paints are covered elsewhere (chapter 18). Building materials used in construction are often obtained in the region of the project, to reduce transportation costs of these often bulky and dense materials. The content of masonry, stone and other building materials is thus often determined by the locally available raw materials. To better anticipate potential workplace respiratory hazards, occupational physicians should become familiar with the mineralogy (and particularly the content of free silica and asbestiform fibers) of the materials commonly used for construction in their region. Other exposures often encountered are wood dust and asbestos in removing old pipe fittings in renovations and demolition construction work.

Respirable particles

These include silicates, crystalline silica, fibers, fumes, fungal and mold spores, and wood.

Chronic obstructive pulmonary disease (COPD) is characterized by airflow limitation that is not fully reversible. Predominant pathological features of COPD are emphysema, small airways disease and chronic bronchitis. The association between occupational exposures to dusts, gases and fumes and COPD was firmly established through a series of systematic epidemiological investigations. In 2002, the American Thoracic Society estimated that, based on the available epidemiologic evidence, about 15% of all cases of COPD in the US population were attributable to occupational exposures. Nevertheless, because COPD is also associated with tobacco smoking, which is prevalent among construction workers and other blue collar populations, the role of occupational exposures in the etiology of COPD is often neglected.

Depending on the specific work processes and the effectiveness of dust control activities, construction workers can potentially be exposed to relatively high levels of fibrogenic mineral dusts (e.g. asbestos and silica), causing pneumoconiosis, and non- or weakly-fibrogenic dusts, which can also be associated with adverse lung effects (e.g. emery, graphite, gypsum, marble, mica, plaster of Paris, Portland cement, silicon, soapstone). Other harmful exposures in construction that can increase the risk of chronic airflow limitation include irritant gases and fumes (e.g. welding, painting, blasting fumes, combustion exhaust, asphalt, adhesives, sealants, hydrochloric acid), man-made mineral fibers and organic dust (e.g. wood). Airflow limitation in construction workers may thus be related to mineral dust-induced pneumoconiosis and nonfibrotic changes in airways associated with exposures to dusts, gases and fumes. The effects of each of these agents may be aggravated in some exposed individuals by associated mycobacterial lung infections. Although the adverse effects of many of these agents has been established in epidemiologic studies conducted across a wide spectrum of industrial workers, epidemiologic research carried out among construction workers has helped to ascertain the potential of the above agents for causing respiratory mortality and morbidity in these workers.

COPD Mortality Studies

Taken together, studies carried out among construction workers in different countries have shown a clear pattern of elevated respiratory disease mortality, although there is variation in the strength of the association with construction employment; the differences may in part be explained by differing construction techniques, materials, and dust control programs.

In the USA, surveillance data indicate that the number of deaths from asbestosis and silicosis is highest in workers who report they have worked primarily in the construction industry. Asbestosis deaths represented about one-third of all pneumoconiosis mortality during the 10-year period from 1990 to 1999 and the annual number of asbestosis deaths among US residents continues to increase. Occupations with the highest adjusted proportional mortality rate (PMR) from asbestosis are insulation workers, boilermakers, plumbers, pipe-fitters, plasterers, electricians, welders, brick and stone masons, crane and tower machine operators, and carpenters. Reports of deaths from silicosis in the USA declined from 1968 to 1999; in recent years the construction industry has accounted for 13.4% of all deaths from silicosis. Occupations with elevated PMR from silicosis included machine operators and construction labourers.