Siliocosis & Asbestosis
The commonest form of pneumoconiosis is due to the inhalation of free silica.
Free silica (SiO²) or chrystalline silica occurs in three common forms in industry: quartz, tridymite and cristobalite. A cryptocrystalline variety occurs in which the ‘free silica’ is bound to an amorphous silica (non-crystalline). It includes tripolite, flint and chert. Diatomine is the most common form of amorphous silica capable of producing lung disease. Some of these forms can be altered by heat to the more dangerous crystalline varieties such as tridymite and cristobalite.
Industrial exposure occurs in mining, quarrying, stone cutting, sand blasting, some foundries, boiler scaling, in the manufacture of glass and ceramics and, for diatomite, in the manufacture of fluid filters. Particles of free silica less than 5 mm in diameter when inhaled are likely to enter the lungs and there become engulfed by scavenging cells (macrophages) in the walls of the tiniest bronchioles. The macrophages themselves are destroyed and liberate a fluid causing a localised fibrous nodule which will obliterate the air sacs. The nodules are scattered mainly in the upper halves of the lungs. They gradually enlarge to form a compressed mass of nodules. Sometimes a single large mass of tissue may occur, known as progressive massive fibrosis. If much of the lung is affected the remaining healthy tissue is likely to become over distended during inhalation.
There are no symptoms in the early stage. Later the initial complaint is of a dry morning cough. Next occurs some breathlessness, at first noticeable on exercise but, as destruction of the lung tissue proceeds, breathlessness worsens until it is present at rest. The interval between exposure and the onset of symptoms varies from a few months in some susceptible individuals to, more usually, many years, depending on the concentration of respirable free silica and the exposure time at work. Silicosis is the one form of pneumoconiosis that predisposes tuberculosis, when additional symptoms of fever, loss of weight, bloody sputum may occur. In the presence of gross lung destruction the blood circulation from the heart to the lung may be embarrassed and result in heart failure.
This depends on a history of exposure and, in the early stages, a chest X-ray showing tiny radio opaque nodules and, later, a history of cough and breathlessness and sound in the chest detectable with a stethoscope. Lung function tests may be helpful, but usually not until the late stages.
Where exposure to free silica is a recognised hazard, a pre-employment medical is advised, which should enquire into previous history of dust exposure, of respiratory symptoms, with examination of the chest, lung function testing and chest X-ray. The medical should be repeated periodically as circumstances may demand.
Reduction of the dust to the lowest level practicable and where necessary by the provision of personal respiratory protective equipment.
There are three important types of asbestos, blue (crocidolite), brown (amosite) and white (chrysotile). Asbestosis is a reaction of the lung to the presence of asbestos fibres which, having reached the bronchioles and air sacs, cause a fibrous thickening in the network distribution, mainly in the lower parts of the lung. There follows a loss of elasticity in the lung tissue, (relative to the concentration of fibres inhaled and the duration of exposure) resulting in breathing difficulty.
Among those at risk are persons engaged in milling the ore, the manufacture of asbestos products, lagging, asbestos spraying, building, demolition, and laundering of asbestos worker’s overalls.
Symptoms develop slowly after a period of exposure which can vary from a few to many years. In some cases exposure may have begun so long ago that it cannot be recalled. Breathlessness occurs first and progresses as the lung loses its elasticity. There may be little or no cough and chest pain seldom occurs. The individual becomes weak and distressed on effort and, eventually, even at rest. Unless periodic medicals are introduced the diagnosis will not be made until symptoms appear. Early diagnosis is essential in order to prevent further exposure and an exacerbation of the condition. Asbestosis predisposes to cancer of the bronchus, a risk increased by cigarette smoking. The chest should be x-rayed every two years and special lung function tests are helpful. Diagnosis depends on history of exposure, chest X-ray, lung function testing, symptoms and physical signs.