Sandblasting denim using silica has emerged as a new cause of silicosis in Turkey. Following the discovery of several cases of silicosis in (young) workers who used this process, the frequency and main occupational risk factors of silicosis among former denim sandblasters in the region of Erzurum (Turkey) were evaluated. Demographic characteristics and information on working conditions were obtained by questionnaire and interview. In addition, spirometry testing was performed and chest radiographs were evaluated according to International Labour Office (ILO) classification of pneumoconioses in 157 former denim sandblasters. All subjects were male, with a mean (range) age of 23 (15-44) yrs. They had worked for a mean (range) of 36 (1-120) months, starting employment at a 17 (10-38) yrs of age. Most subjects (83%) had respiratory symptoms, especially dyspnoea (52%) but also chest pain (46%). Radiological evidence of silicosis (ILO score 1/0 or higher) was present in 77 (53%) out of 145 subjects with interpretable chest radiographs. These subjects had lower forced expiratory volume in one second and forced vital capacity. The risk of silicosis correlated with seniority (i.e. working as a foreman), exposure duration and number of places of work. Considering the high prevalence rate of silicosis in such workplaces, further problems are inevitable in the future unless effective measures are taken.

https://erj.ersjournals.com/content/erj/32/5/1295.full.pdf

An epidemic of silicosis among former denim sandblasters

Excessive exposures to airborne crystalline silica have been known for over 100 years to pose a serious health hazard. Work practices and regulatory standards advanced as the knowledge of the hazards of crystalline silica evolved. This article presents a comprehensive historical examination of the literature on exposure, health effects, and personal protective equipment related to silica and abrasive blasting operations over the last century. In the early 1900s, increased death rates and prevalence of pulmonary disease were observed in industries that involved dusty operations. Studies of these occupational cohorts served as the basis for the first occupational exposure limits in the 1930s. Early exposure studies in foundries revealed that abrasive blasting operations were particularly hazardous and provided the basis for many of the engineering control and respiratory protection requirements that are still in place today. Studies involving abrasive blasters over the years revealed that engineering controls were often not completely effective at reducing airborne silica concentrations to a safe level; consequently, respiratory protection has always been an important component of protecting workers. During the last 15-20 yr, quantitative exposure-response modeling, experimental animal studies, and in vitro methods were used to better understand the relationship between exposure to silica and disease in the workplace. In light of Occupational Safety and Health Administration efforts to reexamine the protectiveness of the current permissible exposure limit (PEL) for crystalline silica and its focus on protecting workers who are known to still be exposed to silica in the workplace (including abrasive blasters), this state-of-the-science review of one of the most hazardous operations involving crystalline silica should provide useful background to employers, researchers, and regulators interested in the historical evolution of the recognized occupational health hazards of crystalline silica and abrasive blasting operations and the related requirements for respiratory protection.

State-of-the-science review of the occupational health hazards of crystalline silica in abrasive blasting operations and related requirements for respiratory protection.

Chest radiographs and spirometric tests were performed on 81 patients who had silicosis from two granite quarries in 1975, 73 of whom were followed up for two to 10 (mean 7.2) years. Each patient's initial and most recent chest radiographs were assessed independently by three experienced readers, and the yearly declines in forced expiratory volume in one second and forced vital capacity were estimated from two to four (mean 3.45) serial spirometric readings. Estimates of individual dust exposure were based on extensive historical data on hygiene. All but 11 patients were no longer exposed to dust by the start of follow up, but 24 (45%) of 53 patients who had simple silicosis and 11 (55%) of 20 who had the complicated disease showed radiological evidence of disease progression. In patients who had simple silicosis and showed no radiological progression the yearly declines in forced expiratory volume in one second and forced vital capacity were modest (64 ml/year and 59 ml/year, respectively), whereas significantly greater declines in lung function were seen in those who showed radiological evidence of progression (97 ml/year and 95 ml/year, respectively). In addition to radiological progression the previous average dust concentration to which patients had been exposed also influenced declines in both forced expiratory volume in one second and forced vital capacity after allowing for the effects of age, smoking, duration of exposure, history of tuberculosis, initial state of disease, and baseline lung function. The probability of radiological progression was most strongly influenced by the average dust concentration previously exposed to. The progression of simple silicosis is thus accompanied by appreciable declines in lung function and is strongly affected by previous levels of exposure to dust.

https://www.bmj.com/content/bmj/295/6591/164.full.pdf

Radiological progression and lung function in silicosis: a ten year follow up study.

Objectives This study examined the association between silicosis and lung cancer in a systematic review (and meta-analysis) of the epidemiologic literature, with special reference to the methodological quality of observational studies.

Methods We searched Medline, Toxline, BIOSIS and Embase (1966–May 2004) for original articles published in any language and systematically reviewed the bibliographies of the retrieved articles. Observational studies (cohort and case–control studies) were selected if they reported a measure of association [standardized mortality ratio (SMR), relative risk or odds ratio] relating lung cancer to silicosis.

Results Thirty-one studies (27 cohort studies, 4 case–control studies) met the inclusion criteria of the meta-analysis. Without any adjustment for smoking, the meta-analysis of the cohort studies indicated that the common SMR was 2.45 [95% confidence interval (95% CI) 1.63–3.66; homogeneity P<0.0001]. By pooling the results of the cohorts for which mortality data were adjusted for smoking, the common SMR was 1.60 (95% CI 1.33–1.93; homogeneity P=0.52). In a “dose–response” analysis, the profusion of small and large opacities found in chest X-rays correlated with the risk of death from lung cancer. Overall, the case–control studies were more conservative in their conclusions.

Conclusions Because of biases inherent to observational studies, it is likely that the risk of lung cancer among silicosis patients is overestimated in the current literature. There is nevertheless evidence, from data restricted to never smokers and from a “dose–response” analysis, that silicosis and lung cancer are associated.

Meta-analysis of silicosis and lung cancer.

Pneumoconioses are characterized as irreversible, progressive respiratory diseases. No effective therapy exists to prevent progression of these diseases. Whole-lung lavage (WLL) might limit the rate of disease progression through the removal of dust, inflammatory cells, and cytokines. We performed WLL on a 54-year-old underground miner employed as a motorman and roof bolter and a 55-year-old driller at a surface coal mine. Both demonstrated normal lung function and chest radiographs showing ILO profusion category 2 nodular interstitial changes. From Subject 1, we recovered 5.24 x 10(8) cells (90% macrophages) from the right lung and 3.45 x 10(8) cells (94% macrophages) from the left lung. WLL removed 1.82 g of mineral dust (non-coal) on the right and 1.64 g on the left. From Subject 2, we recovered 7.49 x 10(8) cells (46% macrophages) from the right and 9.78 x 10(8) cells (69% macrophages) from the left lung. WLL removed 0.40 g of mineral dust on the right and 0.53 g on the left. Proinflammatory cytokines, growth factors, and cellular enzymes were also recovered. In cases of pneumoconiosis, WLL is capable of removing relatively large quantities of dust, cells, and soluble materials from the lungs. Only long-term follow-ups of individuals with progressive dust-induced disease who receive WLL therapy in the context of a clinical trial will provide information regarding the importance of removing mineral dust and inflammatory cells from the lung.

Reduction of lung dust burden in pneumoconiosis by whole-lung lavage

Chest roentgenograms and pulmonary function studies were completed on 83 silicotic sandblasters; 61 returned for longitudinal study, with follow-up ranging from 1 to 7 yr. Estimates of respirable free silica concentrations were based on extensive measurements of airborne dust and protective equipment used. Sixty-three percent exhibited X-ray evidence of disease progression between initial and latest films. Probability of progression increased as duration and level of past silica dust exposure increased and was higher among blacks than whites. Those with large opacities and/or certain symbols (ILO U/C classification) on initial X-ray had a higher probability of progression than those with only small opacities. Declines in pulmonary function were associated with average concentration of silica dust exposure. Those in the lowest category (≤ 1.25 mg m-3) experienced normal mean annual rates of decline (29 ml for FEV1 although 50% (5/10) had exhibited X-ray progression over the same period. Mean annual decline in FEV for the middle and upper (> 3.0 mg m-3) concentration categories were 87 and 166 ml, respectively; 59 and 100% of these categories, respectively, exhibited X-ray progression. Antibody prevalences and immunoglobulin levels were high but unrelated to disease state, X-ray progression or pulmonary function decline.

Determinants of progression in sandblasters' silicosis

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Determinants of progression in sandblasters' silicosis