Chronic obstructive pulmonary disease as a contraindication to work in harmful industrial conditions at high altitudes (literature review)

Fitness to work in the harmful environment including working conditions found in the high-altitude mining, are pivotal agenda in the occupational medicine and public health. Most current legislation in place, which covers fitness to work requirements including those for high-altitude mining, were introduced prior to the era of so-called “evidence-based medicine”, thus calling for clarification and update at present. Chronic obstructive pulmonary disease (COPD) is one in a wide array of diagnoses which can make the decision related to fitness to work challenging. We searched for published studies of COPD at high altitude in Pubmed and Scopus databases using the keywords ‘altitude’ AND ‘COPD’. We demonstrate very few published studies reflecting observations of mining employees at high-altitude in general and COPD workers in particular. Those few published studies fail to appraise COPD clinical prognosis in such conditions, because none of those studies was initially designed to test COPD specifically. We emphasize apparent shortage of evidence to make a sound decision whether a subject with COPD is fit to work in high-altitude mining. We advocate for future prospective observational studies of COPD prognosis in mining workers at high altitude to assist a panel doctor make a conclusion related to fitness for work. We also rationalize shifting the focus from making a potential worker unfit to work towards smoking cessation accompanied by detailed disease monitoring whenever mild disease is present. This applies to pre-employment and annual screening of workers employed for high-altitude mining.