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Cena AC, Cena LG. Silicosis: No longer exclusively a chronic disease. JAAPA 2024; 37:14-20. [PMID: 39162647 DOI: 10.1097/01.jaa.0000000000000103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/21/2024]
Abstract
ABSTRACT Silicosis typically has been classified as a chronic disease that develops after at least 10 years of exposure to silica dust, and often is associated with miners and stone workers. As industries have changed over time, other types of workers (including those in artificial stonework, jewelry polishing, and denim production) have become exposed to high levels of silica, leading to the development of acute and accelerated silicosis. Acute silicosis can develop in as little as a few months, and accelerated silicosis can develop in as little as 2 years. No cure exists for any form of silicosis, and lung transplantation is the only lifesaving treatment. Primary care clinicians must understand when patients are at risk for developing silicosis and not assume that a short time of exposure precludes the development of silicosis.
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Affiliation(s)
- Ashley C Cena
- Ashley C. Cena practices at Stone Run Family Medicine in Rising Sun, Md. Lorenzo G. Cena is an associate professor in the Department of Public Health Sciences at West Chester (Pa.) University. The authors have disclosed no potential conflicts of interest, financial or otherwise
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Ramkissoon C, Gaskin S, Song Y, Pisaniello D, Zosky GR. From Engineered Stone Slab to Silicosis: A Synthesis of Exposure Science and Medical Evidence. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:683. [PMID: 38928930 PMCID: PMC11203299 DOI: 10.3390/ijerph21060683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 05/23/2024] [Accepted: 05/23/2024] [Indexed: 06/28/2024]
Abstract
Engineered stone (ES) is a popular building product, due to its architectural versatility and generally lower cost. However, the fabrication of organic resin-based ES kitchen benchtops from slabs has been associated with alarming rates of silicosis among workers. In 2024, fifteen years after the first reported ES-related cases in the world, Australia became the first country to ban the use and importation of ES. A range of interacting factors are relevant for ES-associated silicosis, including ES material composition, characteristics of dust exposure and lung cell-particle response. In turn, these are influenced by consumer demand, work practices, particle size and chemistry, dust control measures, industry regulation and worker-related characteristics. This literature review provides an evidence synthesis using a narrative approach, with the themes of product, exposure and host. Exposure pathways and pathogenesis are explored. Apart from crystalline silica content, consideration is given to non-siliceous ES components such as resins and metals that may modify chemical interactions and disease risk. Preventive effort can be aligned with each theme and associated evidence.
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Affiliation(s)
- Chandnee Ramkissoon
- Adelaide Exposure Science and Health, School of Public Health, University of Adelaide, Adelaide, SA 5064, Australia; (S.G.); (D.P.)
| | - Sharyn Gaskin
- Adelaide Exposure Science and Health, School of Public Health, University of Adelaide, Adelaide, SA 5064, Australia; (S.G.); (D.P.)
| | - Yong Song
- Menzies Institute for Medical Research, College of Health and Medicine, University of Tasmania, Hobart, TAS 7000, Australia; (Y.S.); (G.R.Z.)
| | - Dino Pisaniello
- Adelaide Exposure Science and Health, School of Public Health, University of Adelaide, Adelaide, SA 5064, Australia; (S.G.); (D.P.)
| | - Graeme R. Zosky
- Menzies Institute for Medical Research, College of Health and Medicine, University of Tasmania, Hobart, TAS 7000, Australia; (Y.S.); (G.R.Z.)
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Weller M, Clemence D, Lau A, Rawlings M, Robertson A, Sankaran B. An assessment of worker exposure to respirable dust and crystalline silica in workshops fabricating engineered stone. Ann Work Expo Health 2024; 68:170-179. [PMID: 38096573 DOI: 10.1093/annweh/wxad072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 11/29/2023] [Indexed: 02/21/2024] Open
Abstract
There is a significant silicosis risk for workers fabricating engineered stone (ES) products containing crystalline silica. The aims of this study by SafeWork NSW were to: (i) assess current worker exposure to respirable dust (RD) and respirable crystalline silica (RCS) following a 5-y awareness and compliance program of inspections in ES workshops and (ii) to identify improvements in work practices from the available evidence base to further reduce exposures. One hundred and twenty-three personal full shift samples taken on as many workers and 34 static samples across 27 workshops fabricating ES were included in the final assessment. The exposure assessment was conducted using Casella Higgins-Dewell cyclones (Casella TSI) placed in the breathing zone of workers attached to SKC Air Check XR 5000 or SKC Chek TOUCH sampling pumps. Sample filters were sent to an ISO (2017) 17025:2017 accredited laboratory for gravimetric analysis for RD and X-Ray Diffraction (XRD) analysis to determine the amount of deposited RCS i.e. alpha-quartz and cristobalite. All workshops used wet methods of fabrication. The geometric mean (GM) of the pooled result for respirable dust (RD) was 0.09 mg/m3 TWA-8 h and 0.034 mg/m3 TWA-8 h for RCS. The highest exposed workers with a GM RCS of 0.062 mg/m3 TWA-8 h were those using pneumatic hand tools for cutting or grinding combined with polishing tasks. Workers operating semiautomated routers and edge polishers had the lowest GM RCS exposures of 0.022 mg/m3 TWA-8 h and 0.018 mg/m3 TWA-8 h respectively. Although ES workers remain exposed to RCS above the workplace exposure limit (WEL) of 0.05 mg/m 3 TWA-8 h, these results point to a very substantial reduction in exposures compared to poorly controlled dry methods of fabrication. Therefore, the wearing of respiratory protection by workers remains necessary until further control measures are more widely adopted across the entire industry e.g. reduction in the crystalline silica content of ES.
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Affiliation(s)
- Michael Weller
- Hygiene and Toxicology; (Chemicals, Explosives and Safety Auditing Directorate) SafeWork New South Wales, Parramatta 2150, Australia
| | - Dennis Clemence
- Hygiene and Toxicology; (Chemicals, Explosives and Safety Auditing Directorate) SafeWork New South Wales, Parramatta 2150, Australia
| | - Abe Lau
- Hygiene and Toxicology; (Chemicals, Explosives and Safety Auditing Directorate) SafeWork New South Wales, Parramatta 2150, Australia
| | - Mark Rawlings
- Hygiene and Toxicology; (Chemicals, Explosives and Safety Auditing Directorate) SafeWork New South Wales, Parramatta 2150, Australia
| | - Amy Robertson
- Hygiene and Toxicology; (Chemicals, Explosives and Safety Auditing Directorate) SafeWork New South Wales, Parramatta 2150, Australia
| | - Bhoopathy Sankaran
- Hygiene and Toxicology; (Chemicals, Explosives and Safety Auditing Directorate) SafeWork New South Wales, Parramatta 2150, Australia
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Zhang Y, Rajaram N, Lau A, Mehta K, Holness DL, Tarlo SM, Arrandale VH. Silicosis, asbestosis, and pulmonary fibrosis in Ontario, Canada from 1996 to 2019. Am J Ind Med 2023; 66:670-678. [PMID: 37302125 DOI: 10.1002/ajim.23504] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 03/31/2023] [Accepted: 05/16/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND Silicosis is a fibrotic lung disease caused by exposure to respirable crystalline silica. Historically, silicosis was common among miners and other professions in the 20th century, and in recent decades has re-emerged in coal mining and appeared in new workplaces, including the manufacture of distressed jeans and artificial stone countertops. METHODS Physician billing data for the province of Ontario between 1992 and 2019 were analyzed across six time-periods (1993-1995, 1996-2000, 2001-2005, 2006-2010, 2011-2015, and 2016-2019). The case definition was two or more billing records within 24 months with a silicosis diagnosis code (ICD-9 502, ICD-10 J62). Cases from 1993 to 1995 were excluded as prevalent cases. Crude incidence rates per 100,000 persons were calculated by time-period, age, sex, and region. Analyses were repeated in parallel for pulmonary fibrosis (PF) (ICD-9 515, ICD-10 J84) and asbestosis (ICD-9 501; ICD-10 J61). RESULTS From 1996 to 2019, 444 cases of silicosis, 2719 cases of asbestosis and 59,228 cases of PF were identified. Silicosis rates decreased from 0.42 cases per 100,000 in 1996-2000 to 0.06 per 100,000 people in 2016-2019. A similar trend was observed for asbestosis (1.66 to 0.51 per 100,000 persons) but the incidence rate of PF increased from 11.6 to 33.9 per 100,000 persons. Incidence rates for all outcomes were higher among men and older adults. CONCLUSIONS A decreasing incidence of silicosis was observed in this analysis. However, the incidence of PF increased, consistent with findings from other jurisdictions. While cases of silicosis have been recorded among artificial stone workers in Ontario these cases do not seem to have impacted the population rates thus far. Ongoing, periodic surveillance of occupational diseases is helpful for tracking population-level trends over time.
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Affiliation(s)
- Yizhi Zhang
- Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Nikhil Rajaram
- Department of Medicine, Division of Occupational Medicine, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
- Ministry of Labour, Immigration, Training and Skills Development, Ontario, Canada
| | - Ambrose Lau
- Department of Medicine, Toronto Western Hospital, Ontario, Canada
- Department of Medicine, Division of Respirology, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
- Department of Medicine, St Michael's Hospital, Unity Health Toronto, Ontario, Canada
| | - Kruti Mehta
- Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - D Linn Holness
- Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
- Department of Medicine, Division of Occupational Medicine, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
- Department of Medicine, St Michael's Hospital, Unity Health Toronto, Ontario, Canada
- MAP Centre for Urban Health Solutions, Unity Health Toronto-St Michaels, Ontario, Canada
- Center for Research Expertise in Occupational Disease, Toronto, Ontario, Canada
| | - Susan M Tarlo
- Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
- Department of Medicine, Toronto Western Hospital, Ontario, Canada
- Department of Medicine, Division of Respirology, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
- Department of Medicine, St Michael's Hospital, Unity Health Toronto, Ontario, Canada
- Center for Research Expertise in Occupational Disease, Toronto, Ontario, Canada
| | - Victoria H Arrandale
- Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
- Occupational Cancer Research Centre, Ontario Health, Toronto, Ontario, Canada
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Surasi K, Ballen B, Weinberg JL, Materna BL, Harrison R, Cummings KJ, Heinzerling A. Elevated exposures to respirable crystalline silica among engineered stone fabrication workers in California, January 2019-February 2020. Am J Ind Med 2022; 65:701-707. [PMID: 35899403 DOI: 10.1002/ajim.23416] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 07/12/2022] [Accepted: 07/12/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Workers fabricating engineered stone face high risk for exposure to respirable crystalline silica (RCS) and subsequent development of silicosis. In response, the California Division of Occupational Safety and Health (Cal/OSHA) performed targeted enforcement inspections at engineered stone fabrication worksites. We investigated RCS exposures and employer adherence to Cal/OSHA's RCS and respiratory protection standards from these inspections to assess ongoing risk to stone fabrication workers. METHODS We extracted employee personal air sampling results from Cal/OSHA inspection files and calculated RCS exposures. Standards require that employers continue monitoring employee RCS exposures and perform medical surveillance when exposures are at or above the action level (AL; 25 μg/m3 ); exposures above the permissible exposure limit (PEL; 50 μg/m3 ) are prohibited. We obtained RCS and respiratory protection standard violation citations from a federal database. RESULTS We analyzed RCS exposures for 152 employees at 47 workplaces. Thirty-eight (25%) employees had exposures above the PEL (median = 89.7 μg/m3 ; range = 50.7-670.7 μg/m3 ); 17 (11%) had exposures between the AL and PEL. Twenty-four (51%) workplaces had ≥1 exposure above the PEL; 7 (15%) had ≥1 exposure between the AL and PEL. Thirty-four (72%) workplaces were cited for ≥1 RCS standard violation. Twenty-seven (57%) workplaces were cited for ≥1 respiratory protection standard violation. CONCLUSIONS Our investigation demonstrates widespread RCS overexposure among workers and numerous employer Cal/OSHA standard violation citations. More enforcement and educational efforts could improve employer compliance with Cal/OSHA standards and inform employers and employees of the risks for RCS exposure and strategies for reducing exposure.
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Affiliation(s)
- Krishna Surasi
- Occupational Health Branch, California Department of Public Health, Richmond, California, USA
- Centers for Disease Control and Prevention, Epidemic Intelligence Service, Atlanta, Georgia, USA
| | - Brittany Ballen
- Occupational Health Branch, California Department of Public Health, Richmond, California, USA
- University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Justine L Weinberg
- Occupational Health Branch, California Department of Public Health, Richmond, California, USA
- Public Health Institute, Richmond, Richmond, USA
| | - Barbara L Materna
- Occupational Health Branch, California Department of Public Health, Richmond, California, USA
| | - Robert Harrison
- Occupational Health Branch, California Department of Public Health, Richmond, California, USA
- University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Kristin J Cummings
- Occupational Health Branch, California Department of Public Health, Richmond, California, USA
| | - Amy Heinzerling
- Occupational Health Branch, California Department of Public Health, Richmond, California, USA
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Murgia N, Gambelunghe A. Occupational COPD-The most under-recognized occupational lung disease? Respirology 2022; 27:399-410. [PMID: 35513770 PMCID: PMC9321745 DOI: 10.1111/resp.14272] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 03/16/2022] [Accepted: 04/19/2022] [Indexed: 11/29/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is caused by exposure to noxious particles and gases. Smoking is the main risk factor, but other factors are also associated with COPD. Occupational exposure to vapours, gases, dusts and fumes contributes to the development and progression of COPD, accounting for a population attributable fraction of 14%. Workplace pollutants, in particular inorganic dust, can initiate airway damage and inflammation, which are the hallmarks of COPD pathogenesis. Occupational COPD is still underdiagnosed, mainly due to the challenges of assessing the occupational component of the disease in clinical settings, especially if other risk factors are present. There is a need for specific education and training for clinicians, and research with a focus on evaluating the role of occupational exposure in causing COPD. Early diagnosis and identification of occupational causes is very important to prevent further decline in lung function and to reduce the health and socio-economic burden of COPD. Establishing details of the occupational history by general practitioners or respiratory physicians could help to define the occupational burden of COPD for individual patients, providing the first useful interventions (smoking cessation, best therapeutic management, etc.). Once patients are diagnosed with occupational COPD, there is a wide international variation in access to specialist occupational medicine and public health services, along with limitations in workplace and income support. Therefore, a strong collaboration between primary care physicians, respiratory physicians and occupational medicine specialists is desirable to help manage COPD patients' health and social issues.
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Affiliation(s)
- Nicola Murgia
- Section of Occupational Medicine, Respiratory Diseases and Toxicology, University of Perugia, Perugia, Italy
| | - Angela Gambelunghe
- Section of Occupational Medicine, Respiratory Diseases and Toxicology, University of Perugia, Perugia, Italy
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Characterisation of dust emissions from machined engineered stones to understand the hazard for accelerated silicosis. Sci Rep 2022; 12:4351. [PMID: 35288630 PMCID: PMC8921240 DOI: 10.1038/s41598-022-08378-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 03/04/2022] [Indexed: 12/22/2022] Open
Abstract
Engineered stones are novel construction materials associated with a recent upsurge in silicosis cases among workers in the stonemason industry. In order to understand the hazard for the short latency of lung disease among stonemasons, we simulated real-time dust exposure scenario by dry-machining engineered stones in controlled conditions, capturing and analysing the respirable dust generated for physical and chemical characteristics. Natural granite and marble were included for comparison. Cutting engineered stones generated high concentrations of very fine particles (< 1 µm) with > 80% respirable crystalline silica content, in the form of quartz and cristobalite. Engineered stones also contained 8–20% resin and 1–8% by weight metal elements. In comparison, natural stones had far lower respirable crystalline silica (4- 30%) and much higher metal content, 29–37%. Natural stone dust emissions also had a smaller surface area than engineered stone, as well as lower surface charge. This study highlighted the physical and chemical variability within engineered stone types as well as between engineered and natural stones. This information will ultimately help understand the unique hazard posed by engineered stone fabrication work and help guide the development of specific engineering control measures targeting lower exposure to respirable crystalline silica.
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Jones RM. Artificial Stone Silicosis: Need for Improved Controls. Ann Work Expo Health 2022; 66:137-138. [PMID: 35037027 DOI: 10.1093/annweh/wxab118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 01/07/2022] [Indexed: 11/12/2022] Open
Abstract
Silicosis is emerging as a rapidly progressing occupational disease among young workers who fabricate and install artificial stone. Artificial stone is a composite material characterized by high levels of crystalline silica. Recent research has demonstrated high levels of crystalline silica exposures, particularly during dry cutting and finishing tasks, and an association between exposure intensity and duration and adverse respiratory outcomes. Occupational hygienists must move forward with development and implementation of control strategies, with consideration for the conditions of artificial stone work that may make control implementation challenging.
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Affiliation(s)
- Rachael M Jones
- Department of Family and Preventive Medicine, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA
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