COPD durch berufliche Noxen

Zusammenfassung

Die chronisch obstruktive Lungenerkrankung (COPD), charakterisiert durch eine großteils nicht reversible bronchiale Obstruktion mit Flusslimitierung und typischerweise progredientem Verlauf, zählt weltweit zu den führenden Ursachen der Morbidität und Mortalität. Neben dem ursächlich im Vordergrund stehenden Zigarettenrauchen und Umweltexpositionen (v. a. Abbrennen organischer Materialien an offenen Kochstellen) sind in etwa 15 % berufliche Schadstoffexpositionen und eher selten (ca. 6 %) keine exogenen Faktoren festzustellen. Berufliche Auslöser werden häufig infolge unzureichender arbeitsanamnestischer Erhebungen übersehen. Dies wird insbesondere in der Diskrepanz zwischen den in einer Reihe von Studien belegten Prävalenzen und Inzidenzen und den laut Berufskrankheitenstatistik relativ niedrigen Anzeigezahlen, Anerkennungen und Entschädigungen deutlich. Eine Herausforderung stellt im Einzelfall die Frage dar, ob, neben außerberuflichen Faktoren (zum Beispiel Rauchen), beruflichen Schadstoffbelastungen eine im Rechtssinn wesentliche Teilursache zukommt. Anhand von Fallberichten wird auf neuere Entscheidungen der Sozialgerichtsbarkeit in solchen Fällen eingegangen.

Abstract

The chronic obstructive pulmonary disease (COPD) is characterised by mainly non-reversible bronchial obstruction with airflow limitation. Typically, it exhibits a progressive course. It is one of the leading causes of morbidity and mortality worldwide. In addition to dominating causative smoking and environmental exposures (especially biomass smoke from cooking with open fire stoves), about 15 % are due to occupational exposure. Relatively rare cases (ca. 6 %) do not show an external noxious influence. Occupational causes are frequently not recognised because a detailed occupational history has not been taken. This is especially evident by the discrepancy in the identified COPD prevalences and incidences shown in many studies on the one hand and relatively low numbers in the official statistics on reports, acknowledgements and compensations of the disorder on the other hand. Whether occupational exposures to inhalative noxae are – in addition to non-occupational factors (e. g. smoking) – causative according to legal definitions is frequently a challenging question. Respective decisions of social courts in litigations are presented.

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