Silicosis en trabajadores de conglomerados de cuarzo

Contemporary Concise Review 2023: Environmental and occupational lung diseases

Air pollutants have various effects on human health in environmental and occupational settings. Air pollutants can be a risk factor for incidence, exacerbation/aggravation and death due to various lung diseases, including asthma, chronic obstructive pulmonary disease (COPD), hypersensitivity pneumonitis or pneumonia (HP), pulmonary fibrosis such as pneumoconiosis and malignant respiratory diseases such as lung cancer and malignant pleural mesothelioma. Environmental and occupational respiratory diseases are crucial clinical and social issues worldwide, although the burden of respiratory disease due to environmental and occupational causes varies depending on country/region, demographic variables, geographical location, industrial structure and socioeconomic situation. The correct recognition of environmental and occupational lung diseases and taking appropriate measures are essential to their effective prevention.

Autoimmune findings in patients with silicosis in Spain

Background

Occupational exposure to silica is related to autoimmune diseases and features of autoimmunity, mainly autoantibodies. The study objectives were to estimate the prevalence of silicosis with associated autoimmune findings or diagnosed autoimmune diseases in Spain, and to assess the clinical and functional characteristics of affected patients.

Methods

This is a multicentre prospective study in patients diagnosed with silicosis. Autoantibodies analysed were antinuclear antibodies, isotypes IgA, IgM and IgG, rheumatoid factor, anticyclic citrullinated peptide, anti-Scl70, anti-Ro, and anti-LA. Pulmonary function tests were performed.

Results

Autoimmunity was assessed in 105 patients. Autoimmune findings were recorded in 29 (27%) patients, including antinuclear antibodies (n=21), anti-Ro (n=7), rheumatoid factor (n=5) and anti-Scl70 (n=3). Autoimmune disease was diagnosed in 16 (15%) patients, mainly rheumatoid arthritis (n=7) and systemic lupus erythematosus (n=4). Patients with silicosis and autoimmune findings had a lower mean time of exposure to silica and showed a trend toward lower values in pulmonary function tests.

Conclusions

Autoimmune findings and diagnosis of autoimmune diseases were frequent in patients with silicosis in Spain.

Risk Factors of Silicosis Progression: A Retrospective Cohort Study in China

Background

Silicosis poses a threat to workers’ health due to the irreversible lung lesions.

Design

A retrospective cohort study.

Methods

A total of 259 patients [80 worked with artificial stone (AS), 179 with non-artificial stone (non-AS)] with confirmed silicosis were included in this study. Forty-one of AS and 91 of non-AS had approximately 2 years’ follow-up records [lung function tests and high-resolution computer tomography (HRCT)]. Compared with the first records, increased, densified, or newly emerging lesions in lung HRCT images were judged as progression of the disease. Cox proportional hazards models were used to determine the risk factors. Kaplan–Meier survival curve and log-rank test were used to compare prognostic factors for cumulative risk of progression.

Results

In 132 patients with median follow-up of 24.0 months (IQR, 13.8, 24.9), 66 patients showed progression, in them, 36 (87.8%) were from AS group and 30 (32.9%) from non-AS group. Working experience of AS processing (hazard ratio, 5.671; 95% CI, 3.048–10.550) and complicated silicosis in CT images (hazard ratio, 2.373; 95% CI, 1.379–4.082) were the main risk factors associated with progression. Forced vital capacity decreased after 1-year (241.5 vs. 55.2 mL) and 2-year (328.1 vs. 68.8 mL) follow-up in the two groups (AS vs. non-AS). History of anti-tuberculosis medication, chest oppression and pain, ground-glass opacity, pleural abnormalities, and restrictive pulmonary dysfunction were more frequently found on HRCT images in the AS group than non-AS group. Lung functions (DL_CO, %) were lower in the current/former smokers than the non-smokers (P < 0.05) in AS patients.

Conclusion

Prevention and protection rules are needed to be enforced in the occupation involving AS processing; smoking may be associated with declined lung function in AS patients.

Occupational exposure to crystalline silica in artificial stone processing

Respirable Crystalline Silica (RCS) is a hazardous substance with known effects that can be well correlated with exposure levels that still persist in many traditional sectors, such as construction or stone processing. In the past decade, exposure scenarios for RCS have been found in the sector of artificial stone processing. The aim of this study is to evaluate the levels of RCS in facilities specialized in the production of artificial stone countertops and other accessories for the furnishing of kitchens, bathrooms, and offices after the introduction of some preventive technical measures such as wet processing or local exhaust ventilation systems. The study involved 51 subjects in four facilities. Personal silica exposure assessment was carried out using GS3 cyclones positioned in the breathing zone during the work shift. Quantitative determination of silica was carried out by X-ray diffraction analysis. Respirable dust levels were in the range 0.046-1.154 mg/m³ with RCS levels within the range <0.003-0.098 mg/m³. The highest exposure was found in dry finishing operations. Although there was a remarkable reduction in RCS exposure levels compared to what was observed in the past before the introduction of preventive measures, the data still showed hazardous exposure levels for some of the monitored activities.

Association between Crystalline Silica Dust Exposure and Silicosis Development in Artificial Stone Workers

Occupational exposure to respirable crystalline silica (SiO₂) is one of the most common and serious risks because of the health consequences for the workers involved. Silicosis is a progressive, irreversible, and incurable fibrotic lung disease caused by the inhalation of respirable crystalline silica dust. A cross-sectional epidemiological study was carried out to assess the occupational risk factors that may contribute to the onset of silicosis in workers carrying out work activities with the inhalation of silica compact dust. The study population consisted of 311 artificial stone workers from the province of Almeria (southeast of Spain). Among them, 64 were previously diagnosed with silicosis and the rest of the participants (n = 247 workers) were not diagnosed with such a disease. The workers showing a greater risk of developing silicosis were those who installed kitchen worktops at consumers’ homes, as they did not use face-masks or were not provided with personal protective equipment (PPE) by their business. The results of this study provide support for the evidence indicating that silicosis is a major emerging health concern for workers in the artificial stone sector. Exposure to crystalline silica dust thus can influence the development of silicosis in those cases where individual and collective protection measures are not used or adequately applied.

Identification of early-stage silicosis through health screening of stone benchtop industry workers in Victoria, Australia

OBJECTIVES

The popularity of high silica content artificial stone has been associated with emergence of severe, progressive silicosis as a major health issue affecting workers in the stone benchtop industry. This population-based health assessment programme has been implemented with the aim of identifcation of silica-associated disease at a preclinical stage.

METHODS

All current and former workers from the stone benchtop industry in the State of Victoria are offered free health assessments. Primary evaluations include a standardised questionnaire, physical examination, spirometry and gas transfer assessment and International Labour Organisation-categorised chest X-ray. Secondary evaluations include high-resolution CT chest, blood tests and a respiratory physician evaluation.

RESULTS

At the end of the first 12 months, 86/239 (36%) workers who had completed secondary evaluation were diagnosed with silicosis (65 simple silicosis and 21 complicated silicosis). 22 had worked in the industry for less than 10 years at the time of diagnosis. Of those with simple silicosis, 80% of workers reported breathlessness only with strenuous exercise (modified Medical Research Council score of 0), and lung function was well preserved (prebronchodilator forced vital capacity mean 99.8% predicted (SD 13.6), diffusion capacity of the lung for carbon monoxide mean 96.2% predicted (SD 18.0)). Antinuclear antibodies were detected in 37% with silicosis and 24% without silicosis.

CONCLUSION

Early results from this comprehensive health assessment programme have indicated a high proportion of referred artificial stone benchtop workers have silicosis, including many with early-stage disease. The common finding of antinuclear antibodies suggest significant potential for autoimmune disease in this occupational group.

Characterization of Silica Exposure during Manufacturing of Artificial Stone Countertops

Artificial stone is increasing in popularity in construction applications, including commercial and residential countertops. Eco-friendliness, durability, and resistance to staining, make artificial stone attractive to consumers. Health concerns have arisen during manufacturing of artificial stone due to increased incidence of silicosis after relatively short exposure. Three artificial stone samples (A, B, and C) and one natural granite sample were subjected to cutting and grinding in a controlled environment. Gravimetric analysis, X-Ray diffraction, and scanning electron microscopy with energy dispersive spectroscopy were employed to determine crystalline silica concentrations and particle morphology of bulk and respirable particles. Silica content of bulk dust from artificial samples A and B was 91%, sample C was <10%, while granite was 31%. Silica percent in the respirable fraction for samples A and B was 53% and 54%, respectively, while sample C was <5% and granite was 8%. Number concentrations for samples A and B were mainly in the nano-fraction, indicating potential for translocation of silica particles to other organs outside of the lungs. Respirable dust concentrations inside the chamber were well above Occupational Safety and Health Administration standards for all materials, indicating that confined-space exposures require ventilation to lower risks of acute silicosis regardless of the nature of the stone.

Chemical variability of artificial stone powders in relation to their health effects

The occurrence of highly severe silica-related diseases among the resin- and silica-based artificial stone workers was claimed, associated to an extremely short latency. High levels of exposure and intrinsic properties of AS are thought to modulate the development of silicosis and auto-immune diseases. This study compares parent materials and processed dusts, to shed light on changes of AS occurring in the manufacturing process, through an XRF, EPR and XAS investigation. We point out the extremely wide variability of the materials, the occurrence of chemical signatures impressed by the processing techniques, and the unprecedented generation of stable radicals associated to the lysis of the Si-O chemical bond inside the resin coated respirable crystalline silica. These results suggest that the AS processing in industrial stone workshops can create respirable dusts with peculiar physical and chemical properties, to be correlated to the observed clinical evidences.

Artificial Stone Associated Silicosis: A Systematic Review

Silicosis is a progressive fibrotic lung disease that is caused by the inhalation of respirable crystalline silica. Due to its high silica content, artificial stone (AS) can become a possible source of hazardous dust exposure for workers that are employed in the manufacturing, finishing, and installing of AS countertops. Therefore, the aim of this review was to verify the association between AS derived silica exposure and silicosis development, and also then define the pathological characteristics of the disease in relation to specific work practices and preventive and protective measures that were adopted in the workplace. A systematic review of articles available on Pubmed, Scopus, and Isi Web of Knowledge databases was performed. Although the characteristics of AS-associated silicosis were comparable to those that were reported for the disease in traditional silica exposure settings, some critical issues emerged concerning the general lack of suitable strategies for assessing/managing silica risks in these innovative occupational fields. Further research that is designed to assess the hazardous properties of AS dusts, levels of exposure in workplaces, and the effectiveness of protective equipment appears to be needed to increase awareness concerning AS risks and induce employers, employees, and all factory figures that are engaged in prevention to take action to define/adopt proper measures to protect the health of exposed workers.

Experimental Evaluation of Respirable Dust and Crystalline Silica Controls During Simulated Performance of Stone Countertop Fabrication Tasks With Powered Hand Tools

OBJECTIVES

Workers who fabricate stone countertops using hand tools are at risk of silicosis from overexposure to respirable crystalline silica. This study explored the efficacy of simple engineering controls that can be used for dust suppression during use of hand tools by stone countertop fabricators.

METHODS

Controlled experiments were conducted to measure whether wet methods and on-tool local exhaust ventilation (LEV) reduced respirable dust (RD) exposures during use of various powered hand tools on quartz-rich engineered stone. RD samples collected during edge grinding with a diamond cup wheel and a silicon carbide abrasive wheel were analyzed gravimetrically as well as by X-ray diffraction to determine silica content. A personal optical aerosol monitor was used simultaneously with the RD samples and also for rapid assessment of controls for polishing, blade cutting, and core drilling.

RESULTS

On-tool LEV and sheet-flow-wetting were effective in reducing exposures, especially when used in combination. Sheet-flow-wetting with LEV reduced geometric mean exposures by as much as 95%. However, typical water-spray-wetting on a grinding cup was less effective when combined with LEV than without LEV. Mean silica content of RD samples from grinding operations was 53%, and respirable mass and silica mass were very highly correlated (r = 0.980). Optical concentration measures were moderately well correlated with gravimetric measures (r = 0.817), but on average the optical measures during a single trial using the factory calibration were only one-fifth the simultaneous gravimetric measures.

CONCLUSIONS

Sheet-flow-wetting combined with on-tool LEV is an effective engineering control for reducing RD exposures during engineered stone edge grinding and blade cutting. On the other hand, addition of LEV to some water-spray-wetted tools may reduce the effectiveness of the wet method.

Silicosis in Workers Exposed to Artificial Quartz Conglomerates: Does It Differ From Chronic Simple Silicosis?

Recently, a number of reports have been published on silicosis in workers exposed to artificial quartz conglomerates containing high levels of crystalline silica particles (70-90%) used in the construction of kitchen and bathroom surfaces. Three cases of silicosis in workers exposed to artificial quartz conglomerates are reported. The diagnosis was derived from both the International Labour Office and the International Classification of HRCT for Occupational and Environmental Respiratory Diseases (ICOERD) classifications and cytological analysis of bronchoalveolar lavage fluid. In 2 cases, levels of respirable silica greatly in excess of recommended standards were measured in the workplace, and cytological analysis of bronchoalveolar lavage fluid highlighted a prevalence of lymphocytes, meeting criteria for the diagnosis of accelerated silicosis. The prevention of pneumoconiosis caused by the use of innovative materials, such as artificial conglomerates with high crystalline silica content must be addressed.

Respirable silica dust suppression during artificial stone countertop cutting

PURPOSE

To assess the relative efficacy of three types of controls in reducing respirable silica exposure during artificial stone countertop cutting with a handheld circular saw.

APPROACH

A handheld worm drive circular saw equipped with a diamond segmented blade was fitted with water supply to wet the blade as is typical. The normal wetted-blade condition was compared to (i) wetted-blade plus 'water curtain' spray and (ii) wetted-blade plus local exhaust ventilation (LEV). Four replicate 30-min trials of 6-mm deep, 3-mm wide cuts in artificial quartz countertop stone were conducted at each condition in a 24-m(3) unventilated tent. One dry cutting trial was also conducted for comparison. Respirable cyclone breathing zone samples were collected on the saw operator and analyzed gravimetrically for respirable mass and by X-ray diffraction for respirable quartz mass.

RESULTS

Mean quartz content of the respirable dust was 58.5%. The ranges of 30-min mass and quartz task concentrations in mg m(-3) were as follows-wet blade alone: 3.54-7.51 and 1.87-4.85; wet blade + curtain: 1.81-5.97 and 0.92-3.41; and wet blade + LEV: 0.20-0.69 and <0.12-0.20. Dry cutting task concentrations were 69.6 mg m(-3) mass and 44.6 mg m(-3) quartz. There was a statistically significant difference (α = 0.05) between the wet blade + LEV and wet blade only conditions, but not between the wet blade + curtain and wet blade only conditions, for both respirable dust and respirable silica.

CONCLUSIONS

Sawing with a wetted blade plus LEV reduced mean respirable dust and quartz task exposures by a factor of 10 compared to the wet blade only condition. We were unable to show a statistically significant benefit of a water curtain in the ejection path, but the data suggested some respirable dust suppression.

Outbreak of silicosis in Spanish quartz conglomerate workers

OBJECTIVES

To describe the epidemiological and clinical characteristics of an outbreak of occupational silicosis and the associated working conditions.

METHODS

Cases were defined as men working in the stone cutting, shaping, and finishing industry in the province of Cádiz, diagnosed with silicosis between July 2009 and May 2012, and were identified and diagnosed by the department of pulmonology of the University Hospital of Puerto Real (Cádiz). A census of workplaces using quartz conglomerates was carried out to determine total numbers of potentially exposed workers. A patient telephone survey on occupational exposures and a review of medical records for all participants were conducted.

RESULTS

Silicosis was diagnosed in 46 men with a median age of 33 years and a median of 11 years working in the manufacturing of countertops. Of these cases, 91.3% were diagnosed with simple chronic silicosis, with an abnormal high-resolution computerized tomography (HRCT) scan. One patient died during the study period. Employer non-compliance in prevention and control measures was frequently reported, as were environmental and individual protection failures.

CONCLUSIONS

The use of new construction materials such as quartz conglomerates has increased silicosis incidence due to intensive occupational exposures, in the context of high demand fuelled by the housing boom. This widespread exposure poses a risk if appropriate preventive measures are not undertaken.