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.

Contribution of the authors:
Vinnikov D.V. — research concept and design, writing the text, compilation of the list of literature;
Brimkulov N.N. — writing the text, editing.
All authors are responsible for the integrity of all parts of the manuscript and approval of the manuscript final version.

Conflict of interest. The authors declare no conflict of interest.

Funding. The study had no sponsorship.

Received: October 4, 2023 / Accepted: December 20, 2023 / Published: June 30, 2025

1. Vearrier D., Greenberg M.I. Occupational health of miners at altitude: adverse health effects, toxic exposures, pre-placement screening, acclimatization, and worker surveillance. Clin. Toxicol. (Phila). 2011; 49(7): 629–40. https://doi.org/10.3109/15563650.2011.607169

2. Dzhusupov K.O., Colosio C., Tabibi R., Sulaimanova C.T. Occupational health in mountainous Kyrgyzstan. Ann. Glob. Health. 2015; 81(4): 530–7. https://doi.org/10.1016/j.aogh.2015.08.017

3. Burtscher M., Mairer K., Wille M., Gatterer H., Ruedl G., Faulhaber M., et al. Short-term exposure to hypoxia for work and leisure activities in health and disease: which level of hypoxia is safe? Sleep Breath. 2012; 16(2): 435–42. https://doi.org/10.1007/s11325-011-0521-1

4. Vinnikov D. Drillers and mill operators in an open-pit gold mine are at risk for impaired lung function. J. Occup. Med. Toxicol. 2016; 11(1): 27. https://doi.org/10.1186/s12995-016-0114-9

5. Angerer P., Nowak D. Working in permanent hypoxia for fire protection-impact on health. Int. Arch. Occup. Environ. Health. 2003; 76(2): 87–102. https://doi.org/10.1007/s00420-002-0394-5

6. Agustí A., Celli B.R., Criner G.J., Halpin D., Anzueto A., Barnes P., et al. Global initiative for chronic obstructive lung disease 2023 report: GOLD executive summary. Am. J. Respir. Crit. Care Med. 2023; 207(7): 819–37. https://doi.org/10.1164/rccm.202301-0106pp

7. Wu T.Y., Ding S.Q., Liu J.L., Yu M.T., Jia J.H., Chai Z.C., et al. Who should not go high: chronic disease and work at altitude during construction of the Qinghai-Tibet railroad. High Alt. Med. Biol. 2007; 8(2): 88–107. https://doi.org/10.1089/ham.2007.1015

8. Vinnikov D., Krasotski V. Healthy worker survival effect at a high-altitude mine: prospective cohort observation. Sci. Rep. 2022; 12(1): 13903. https://doi.org/10.1038/s41598-022-18331-4

9. Vinnikov D., Blanc P.D., Brimkulov N., Redding-Jones R. Five-year lung function observations and associations with a smoking ban among healthy miners at high altitude (4000 m). J. Occup. Environ. Med. 2013; 55(12): 1421–5. https://doi.org/10.1097/jom.0b013e3182a641e7

10. Vinnikov D., Brimkulov N., Redding-Jones R. Four-year prospective study of lung function in workers in a high altitude (4000 m) mine. High Alt. Med. Biol. 2011; 12(1): 65–9. https://doi.org/10.1089/ham.2010.1033

11. Richalet J.P., Donoso M.V., Jiménez D., Antezana A.M., Hudson C., Cortès G., et al. Chilean miners commuting from sea level to 4500 m: a prospective study. High Alt. Med. Biol. 2002; 3(2): 159–66. https://doi.org/10.1089/15270290260131894

12. Farias J.G., Jimenez D., Osorio J., Zepeda A.B., Figueroa C.A., Pulgar V.M. Acclimatization to chronic intermittent hypoxia in mine workers: a challenge to mountain medicine in Chile. Biol. Res. 2013; 46(1): 59–67. https://doi.org/10.4067/s0716-97602013000100009

13. Farias J.G., Osorio J., Soto G., Brito J., Siques P., Reyes J.G. Sustained acclimatization in Chilean mine workers subjected to chronic intermittent hypoxia. High Alt. Med. Biol. 2006; 7(4): 302–6. https://doi.org/10.1089/ham.2006.7.302

14. Yang S., Tian C., Yang F., Chen Q., Geng R., Liu C., et al. Cardiorespiratory function, resting metabolic rate and heart rate variability in coal miners exposed to hypobaric hypoxia in highland workplace. PeerJ. 2022; 10: e13899. https://doi.org/10.7717/peerj.13899

15. Wang Y., Wang H., Chen Y., Xu N., Lee W., Lam W.K. Pulmonary capacity, blood composition and metabolism among coal mine workers in high- and low-altitude aboveground and underground workplaces. Int. J. Environ. Res. Public Health. 2022; 19(14): 8295. https://doi.org/10.3390/ijerph19148295

16. Vinnikov D., Rybina T., Strizhakov L., Babanov S., Mukatova I. Occupational burden of chronic obstructive pulmonary disease in the commonwealth of independent states: systematic review and meta-analysis. Front. Med. (Lausanne). 2021; 7: 614827. https://doi.org/10.3389/fmed.2020.614827

17. Luks A.M., Swenson E.R. Travel to high altitude with pre-existing lung disease. Eur. Respir. J. 2007; 29(4): 770–92. https://doi.org/10.1183/09031936.00052606

18. Ezzati M., Murray Horwitz M.E., Thomas D.S.K., Friedman A.B., Roach R., Clark T., et al. Altitude, life expectancy and mortality from ischaemic heart disease, stroke, COPD and cancers: national population-based analysis of US counties. J. Epidemiol. Community Health. 2012; 66(7): e17. https://doi.org/10.1136/jech.2010.112938

19. Hwang J., Jang M., Kim N., Choi S., Oh Y.M., Seo J.B. Positive association between moderate altitude and chronic lower respiratory disease mortality in United States counties. PloS One. 2018; 13(7): e0200557. https://doi.org/10.1371/journal.pone.0200557

20. Wang L., Wang F., Tuo Y., Wan H., Luo F. Clinical characteristics and predictors of pulmonary hypertension in chronic obstructive pulmonary disease at different altitudes. BMC Pulm. Med. 2023; 23(1): 127. https://doi.org/10.1186/s12890-023-02405-8

21. Bloch K.E., Sooronbaev T.M., Ulrich S., Lichtblau M., Furian M. Counseling patients with chronic obstructive pulmonary disease traveling to high altitude. High Alt. Med. Biol. 2023; 24(3): 158. https://doi.org/10.1089/ham.2023.0053

22. Furian M., Hartmann S.E., Latshang T.D., Flueck D., Murer C., Scheiwiller P.M., et al. Exercise performance of lowlanders with COPD at 2,590 m: data from a randomized trial. Respir. Int. Rev. Thorac. Dis. 2018; 95(6): 422–32. https://doi.org/10.1159/000486450

23. Furian M., Flueck D., Latshang T.D., Scheiwiller P.M., Segitz S.D., Mueller-Mottet S., et al. Exercise performance and symptoms in lowlanders with COPD ascending to moderate altitude: randomized trial. Int. J. Chron. Obstruct. Pulmon. Dis. 2018; 13: 3529–38. https://doi.org/10.2147/copd.s173039

24. Bitos K., Kuehne T., Latshang T.D., Aeschbacher S.S., Huber F., Flueck D., et al. Exercise performance of lowlanders with chronic obstructive pulmonary disease acutely exposed to 2048 m: a randomized cross-over trial. Int. J. Chron. Obstruct. Pulmon. Dis. 2023; 18: 1753–62. https://doi.org/10.2147/copd.s400816

25. Vinnikov D., Brimkulov N., Redding-Jones R., Jumabaeva K. Exhaled nitric oxide is reduced upon chronic intermittent hypoxia exposure in well-acclimatized mine workers. Respir. Physiol. Neurobiol. 2011; 175(2): 261–4. https://doi.org/10.1016/j.resp.2010.11.013

26. Acero Colmenares R., Lombo Moreno C.E. SaO2 as a predictor of exercise-induced hypoxemia in chronic obstructive pulmonary disease at moderate altitude. Int. J. Chron. Obstruct. Pulmon. Dis. 2019; 14: 1951–8. https://doi.org/10.2147/copd.s207467

27. Vinnikov D., Brimkulov N., Krasotski V. Chronic intermittent hypoxia and blood pressure: is there risk for hypertension in healthy individuals? High Alt. Med. Biol. 2016; 17(1): 5–10. https://doi.org/10.1089/ham.2015.0067

28. Singh D., Agusti A., Anzueto A., Barnes P.J., Bourbeau J., Celli B.R., et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive lung disease: the GOLD science committee report 2019. Eur. Respir. J. 2019; 53(5): 1900164. https://doi.org/10.1183/13993003.00164-2019

29. Wei X., Guo K., Shang X., Wang S., Yang C., Li J., et al. Effects of different interventions on smoking cessation in chronic obstructive pulmonary disease patients: A systematic review and network meta-analysis. Int. J. Nurs. Stud. 2022; 136: 104362. https://doi.org/10.1016/j.ijnurstu.2022.104362

30. Vinnikov D., Burjubaeva A., Brimkulov N. A double-blind, randomised, placebo-controlled trial of cytisine for smoking cessation in medium-dependent workers. J. Smok. Cessat. 2008; 3(1): 57–62. https://doi.org/10.1375/jsc.3.1.57 https://elibrary.ru/xmsesy