In This Issue of Occupational Medicine

<span class="paragraphSection">Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death worldwide. In England and Wales, it is estimated that there are currently 900000 diagnosed cases, and an estimated 2 million people are thought to have the disease but remain undiagnosed. The primary cause is cigarette smoking, accounting for 80% of the disease burden but other environmental risk factors have been identified including coal, cadmium, silica and biomass. Occupational Medicine has previously published evidence-based guidance for the management of workers with COPD [<a href="#CIT0001" class="reflinks">1</a>]. In this issue, Reynolds <span style="font-style:italic;">et al.</span> studied Welsh slate miners using data from the 1975 cross-sectional survey carried out by the Medical Research Council (Pneumoconiosis Unit) [<a href="#CIT0002" class="reflinks">2</a>]. They found that those who worked in slate mining had reduced lung function which could not be wholly explained by smoking or pneumoconiosis. In never-smokers, there were significant reductions in lung function in miners but no statistically significant increase in COPD. The authors recommend that occupational health providers to slate mines should seek to minimize slate dust exposure and consider workplace surveillance measures for COPD. They note that slate miners are exposed to slate dust containing respirable crystalline silica (RCS). The Health & Safety Executive (HSE) have recently issued renewed guidelines on health surveillance for those exposed to RCS and this now includes a requirement for periodic chest x-rays [<a href="#CIT0003" class="reflinks">3</a>]. However, the workplace exposure level remains unchanged at 0.1 mg·m³ whilst other countries are reducing their exposure levels. The USA have reduced their exposure level to 0.05 mg·m³ which if implemented is more likely to prevent silicosis than health surveillance alone.</span>

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