Occupational lung diseases make up a small portion of workers’ comp claims, but they can incur significant costs as these diseases are often present for life, developing over the course of years and progressing slowly, requiring life-long monitoring, treatment, and medication, leading to high costs and significant claim complexity.
While these types of claims have been present in workers’ comp for decades, in recent years, increased wildfire activity has brought greater attention to occupational lung diseases, particularly among firefighters.
According to NASA, climate change has amplified wildfire activity, with extreme wildfires becoming larger, more intense, and more frequent. Hotter weather, the earlier melting of snow, warmer nighttime temperatures, and a decrease in rainfall have led to fire seasons that are a month longer than ever before.1
Approximately 64,987 wildfires were reported in 2024 by the National Interagency Fire Center, a significant increase from 56,580 in 2023.2 The Palisades Wildfires alone resulted in 122 workers’ comp claims, 80% of which were for respiratory-related injuries.3
Many states have expanded cancer presumptions for firefighters, particularly lung cancer. However, there is significant diversity in which jurisdictions consider different occupational lung diseases compensable – both within firefighter populations and beyond. Regardless, legislatures across the country continue to introduce bills that could potentially expand various workers’ comp presumptions.
And while the conversation surrounding occupational lung diseases may have grown larger due to increased wildfire activity, it is important to understand how other industries see higher rates of lung diseases due to occupational exposure to various particles, fumes, vapors, and other exposures.
Occupational lung diseases – regardless of which occupation they originate from – can drive up costs in workers’ comp claims, as these conditions are typically chronic, can involve long-term medical treatment that potentially includes high-cost therapies, and often result in higher claim severity compared to acute injuries. While there’s limited data about the financial impact of lung disease specific to workers’ comp, the overall medical cost of all respiratory diseases annually in the U.S. is $170.8 billion.4
However, due to the diversity of lung diseases, the breakdown of costs varies. For instance, $11.9 billion is spent annually for COPD (chronic obstructive pulmonary disease) prescription drugs.5 Meanwhile, the CDC reports that medical expenditures for occupational asthma exceed $1 billion annually.6
The medications and therapies used to treat occupational lung diseases vary as well, requiring a deeper dive into the different types of diseases.
There is an incredible range to what constitutes an occupational lung disease. However, they can be divided into three groups, each of which contains multiple subcategories:
Interstitial lung diseases (ILDs) are a group of lung disorders that cause inflammation and scarring (also known as fibrosis) in the tissues surrounding the air sacs, impacting the ability to breathe and leading to shortness of breath and a dry cough.7-8 These conditions are typically irreversible and require lifelong management.
Common occupational causes include:9
Why ILDs matter in workers’ comp:
Carpenters, boiler room workers, construction workers, shipyard workers, maintenance and insulation workers, vehicle brake mechanics, tile workers, shingles workers, textile workers
Agricultural workers, animal-related workers, food processing workers, manufacturing workers
Mining, tunneling, and quarry workers, construction workers, stonemasonry and stonewashing workers, ceramic and pottery workers
Workers in the electronics, aerospace, telecommunications, and nuclear industries
Workers involved in aluminum plants, welding and smelting, automotive industries, milling and grinding, paint production, aircraft and aerospace industries, and the nuclear industry
Occupations with exposure to silica dust, asbestos fibers, hard metal dusts, mold, and bird and animal droppings
Coal workers and textile workers
These diseases narrow the airways, trapping air and making it difficult to exhale, leading to chronic shortness of breath, wheezing and coughing 9-10, 12-13 In workers’ comp, OLD claims are relatively uncommon but can become costly due to chronic symptom management, frequent exacerbations, and the need for ongoing medication therapy.
Common occupational contributors include:9-10, 12-13
Why OLDs matter in workers’ comp:
Primarily associated with those working in mining, agriculture, manufacturing, specifically textiles, rubber, and plastic
Adhesive handlers, users of plastic or epoxy resins, chemical manufacturers, spray painters, textile workers, insulation installers, plastics and foam workers, welders, metal workers, animal handlers, veterinarians, food production workers, hairdressers, seafood processors, forest workers, carpenters, cabinet makers, carpet makers, healthcare workers and pharmaceutical workers
Impacts those who work with flavoring chemicals used in food flavoring and production industries, including microwave popcorn, bakers mix, and flavored coffee industries
This condition often occurs with other lung conditions, due to damage to the walls of the airways. This damage can cause mucus to flare up, allowing for infections
It is important to understand the difference between occupational asthma, work-related asthma, and work-aggravated asthma.
“Work-related asthma” can include pre-existing asthma that is exacerbated by workplace exposure to irritants; with these flare-ups of symptoms, removing an individual from the irritants can help reduce symptoms. However, “work-aggravated asthma” can refer to pre-existing asthma that is persistently worsened due to exposure to certain irritants.
“Occupational asthma” typically requires a period of repeated allergen exposure before the onset of symptoms. During this latent period the body becomes sensitive to the allergen(s) and immunological responses develop.10 However, irritant-induced occupational asthma can develop after exposures to high concentrations of airborne agents with corrosive or oxidative properties (e.g. strong acids and bases) and may develop after a single massive exposure to irritants, which usually occur in chemical accidents, fires or other hazardous events.10
At times, the terms “occupational asthma,” “work-related asthma,” and “work-aggravated asthma,” may incorrectly be used interchangeably, making it important to understand their differences, prevalence in the workforce, as well as applicable presumptions.
Lung cancer is one of the most severe occupational lung conditions and carries the highest potential for catastrophic claim costs. Symptoms often do not appear until the disease is advanced, leading to delayed diagnosis and intensive treatment once identified.
Although lung cancer claims are rare in workers’ compensation, they are among the most complex to manage due to long latency periods, high treatment costs, and evolving therapeutic approaches.
Occupations frequently impacted by lung cancer include:16-19
1 in 19 Americans will develop lung cancer in their lifetime20
54-75% of occupational cancers are lung cancer21
It is important to note the distinction between lung cancer and mesothelioma, because they arise from different tissues and therefore require different treatment approaches.
Mesothelioma is cancer of the mesothelium, the lining of tissue around the organs, usually the lining of the lungs. While this cancer is not formed within the lungs and is technically not a lung cancer, it is often grouped together with lung cancer. Mesothelioma is caused by exposure to asbestos. Symptoms include shortness of breath, pain in the chest, persistent cough, night sweats, swallowing problems, fatigue, fever, and weight loss without trying.22
Occupations frequently impacted by mesothelioma include:22
Due to the sheer variety of chronic lung diseases, the medications used to treat lung diseases which are occupational in origin – if those conditions have effective drug therapies – are diverse. While there are non-pharmacological therapies for various lung diseases, medications help to slow down the progression of some diseases and/or to treat symptoms, flare-ups, and other conditions that can aggravate lung diseases.
While patient-specific factors can help determine which medications can best treat a particular occupational lung disease – the success of these treatments are determinable by exposure removal – there are larger considerations for these medication classes.
Because many occupational lung diseases are life-long conditions – with exceptions like occupational asthma, which can improve after exposure removal – patients may require long-term medications, often having to switch or combine medications over the course of a claim. This requires effective drug monitoring and can incur significant costs over time.
Common drugs used for the long-term treatment of lung diseases such as COPD, asthma, ILD, and pulmonary fibrosis can include:
These inhalers relax the muscles around the airways to relieve coughing and make breathing easier
These drugs help reduce airway inflammation in the lungs to provide relief for various lung diseases
These drugs combine multiple bronchodilators and/or inhaled corticosteroids
An alternative to corticosteroids, these drugs are used for the long-term management of obstructive lung diseases, helping to reduce inflammation
These drugs slow the formation of scar tissue, as excess scar tissue in the lungs makes breathing more difficult
These drugs suppress an overactive immune system from further damaging lung tissue
These drugs block certain enzymes to reduce inflammatory activity
At times, the symptoms of occupational lung diseases can worsen, flare up, or be exacerbated by other conditions. This can result in the need for additional medications.
For instance, a flare-up of symptoms could require the temporary use of short-acting bronchodilators or oral corticosteroids in addition to long-term medications, in order to provide more acute, short-term relief.
Occupational lung diseases can also be exacerbated by infections, a buildup of mucus, and gastroesophageal reflux diseases (GERD).15, 24-25 This can require the prescription of various antibiotics, mucus thinners, or GERD agents such as antacids, H2 blockers, or proton pump inhibitors.
Each of these medication classes not only incur additional costs, but they add additional elements of complexity within pharmacy management.
The medications used to treat occupational lung diseases come with various safety considerations, especially as patients may be taking several of these drugs at a time. To promote safe and effective therapy, pharmacy management requires a deep understanding of these medications and their potential risks.
This can include but is not limited to:
Cardiovascular considerations for bronchodilators and leukotriene modifiers26-27
Gastrointestinal effects associated with antifibrotics, immunosuppressants, and leukotriene modifiers26-32
Liver concerns with antifibrotics and PDE4 inhibitors 28, 33
Hematological issues with immunosuppressants31-32
Mental health considerations for PDE4 inhibitors and leukotriene modifiers27,33
The heightened risk of developing or progressing diabetes, weight gain, cataracts, osteoporosis, or infection with high doses of corticosteroids34
In addition to possible surgery, radiation, and chemotherapy, there are medications that can help treat lung cancer patients. However, cancer therapies are constantly evolving, and the newer, more effective, and least toxic drugs tend to come with the highest price tags. Many of these newer drugs are becoming part of the standard of care.
This means that while cancer survival rates are higher than ever – cancer deaths have decreased by 33% over the last 30 years35 – the cost of cancer care continues to rise as new drugs enter the market.
Given the complexity and long-term nature of occupational lung diseases, drug adherence is a significant factor in providing optimal care, as treatment needs may evolve over time.
In workers’ compensation, these claims often demand specialized expertise, and appropriate treatment decisions often hinge on the clinical judgment and insights of the treating physician. However, additional healthcare professionals can play a supportive role. For example, connecting patients with a clinical pharmacist can support medication adherence and advise patients on managing side effects.
Additionally, when it comes to various inhaler-based medications, patient understanding of how to use these medications can impact effectiveness. As many as 70% to 80% of people with asthma are unable to use their inhaler devices correctly, making it important to evaluate if patients understand safe and effective techniques for using their inhalers.36
$468.56
$5,622.72
$614.44
$7,373.28
Estimated Total Monthly cost on current therapy: $1,083
Estimated Total Yearly cost on current therapy: $12,996
$357.08
$4,284.96
Estimated Monthly Savings: $725.92
Estimated Annualized Savings: $8,711
