silicosis

Silicosis: description

Silicosis is a scarred change in the lung tissue. It arises when fumes of quartz are inhaled and settles in the lungs. Quartz is the main constituent of the earth’s crust. It is also found in conjunction with other substances such as magnesium, iron or aluminum. These so-called silicate salts do not cause silicosis, but can also cause minor lung scarring.

Mixed dust silicosis

In some professions, fumed silica is increasingly exposed. Silicosis is therefore one of the occupational diseases. The decisive factor is how long and to what extent a person was exposed to the dust. Especially with ore and coal miners Mischstaublungen are more common. In some mixed pneumonia diseases both quartz and iron dust can be found. In addition, other minerals that are rich in silica, such as talc, are a source of danger.

Forms of silicosis

Doctors distinguish different forms of silicosis. The quartz dust is divided into a chronic, an accelerated and an acute variant. In chronic silicosis, typical symptoms develop only at least 20 years after the first fumed silica inhalation.

In accelerated silicosis, these signs begin after two to five years. Acute silicosis is already evident after six months to two years. It mainly occurs when a great deal of fumed silica has been inhaled in no time at all. Under certain circumstances, it can also lead to scarred remodeling processes in the liver and kidney.

Silicosis: symptoms

Depending on the form, the signs of silicosis can occur within a few months or decades. In general, the shorter the time between exposure to fumed silica and the onset of the first symptoms, the more severe the symptoms.

Acute silicosis

This form of silicosis is getting worse. Patients are getting increasingly bad. The skin, especially the oral mucosa, lips and fingers discolored bluish (cyanosis), as less and less oxygen can be absorbed into the blood via the lungs. Those affected lose weight and feel dull and choppy. There are also chest pains and coughing.

Chronic silicosis

Over time, lung tissue hardens due to scarred remodeling processes. The scarred lung is less stretchy and can not develop so easily. Symptoms such as dry cough and shortness of breath occur late. First and foremost, sufferers get less air, especially when they make an effort.

In the later course of a silicosis, some sufferers complain of a dark expectoration. It arises when the quartz dust-containing, scarred tissue dies, is softened and coughed off. Here too, the lack of oxygen at the ends of the fingers, mouth and mucous membranes is apparent.

Silicosis: causes and risk factors

Silicosis occurs when fumes of quartz are inhaled and settle in the lung tissue, especially in the alveoli. The inspired particles must have a specific size of about 0.5 to five microns so as not to be trapped by the upper respiratory tract (e.g., nose). In addition, a certain dust content in the air is decisive for the formation of silicosis. A cause for the different forms is unknown.

Particularly endangered are ore and coal miners, tunnel builders, cast cleaners (cleaning and smoothing of castings), sandblasters, oven masons, dental technicians and persons who extract, process or produce metal, glass, stone, clay and glass ceramics. Work such as grinding, pouring or scouring releases more fumed silica into the ambient air, thereby considerably increasing the risk of developing silicosis.

The fumed silica activates cells of the defense system in the lung tissue. White blood cells and phagocytes migrate into the tissue and try in vain to break down the fumed silica. The tissue becomes inflamed and the lung tissue is scarred.

Silicosis: examinations and diagnosis

Silicosis is diagnosed if the exposure to fumed silica in the workplace is ensured and typical changes in the X-ray image are detected. If you have a complaint, you should contact a medical or occupational physician. In a first conversation, the doctor tries to determine the risk of silicosis. He asks, among other things, the following questions:

• Which complaints do you have and since when do they exist?
• Do you have a sputum when coughing?
• What is your profession? How long have you been working in this profession?
• What profession did you practice before your current employment?
• Do you breathe dust?
• Have you taken any particulate matter measurements at your workplace?
• Are there protective measures at your workplace such as wearing a protective mask or goggles?

After the doctor’s talk follows an examination of the body. The doctor mainly listens to the lungs and taps them with his finger. By inflammation – especially in acute silicosis – accumulates more fluid in the lung tissue. This makes it possible to hear sounds reminiscent of blubber bubbles. They arise when the respiratory air flows through accumulations of fluid (mucus, secretions) in the respiratory tract. Further investigations that may be useful in the diagnosis are:

• blood collection
• X-ray photograph
• CT
• Lung function test
• lung biopsy

Silicosis: treatment

As part of a silicosis lung fibrosis progresses slowly. There is no such thing as a healing therapy. Cortisone shows little effect. Additional infections of the respiratory tract by bacteria or fungi are treated with antibiotics or antimycotics, so that the lung function is not additionally restricted. In the advanced stage, those affected often need a separate oxygen supply and possibly a respirator. Due to the lack of therapeutic options, prevention is a top priority.

Silicosis: Disease course and prognosis

The prognosis of silicosis depends mainly on the onset of symptoms. An acute silicosis usually ends with death. Blame is the rapidly progressing respiratory weakness. Chronic silicosis, on the other hand, usually breaks out only decades after exposure to quartz dust. As a result, pulmonary fibrosis rarely shortens the lives of those affected. However, silicosis usually worsens over time. The quartz dust is particularly susceptible to infections from the outside. Therefore, they must be treated as quickly as possible to avoid additional breathing difficulties.

Silicosis and tuberculosis

Silicosis can cause complications. Silicosis patients are about 30 times more likely to be ill with tuberculosis (TB). If physicians can show both silicosis and active tuberculosis, they speak of silico-tuberculosis. If the person has an earlier TB infection, it can be reactivated by the quartz dust particles.

Chronic obstructive bronchitis and pulmonary emphysema

In addition, quartz dust can lead to further illnesses that make breathing difficult. Among hard coal miners, chronic inflammation of the respiratory tract is common. The respiratory tracts can no longer sufficiently rid themselves of fumed silica. This triggers inflammation, resulting in increased mucus production. The trachea narrows (chronic obstructive bronchitis). Those affected can no longer exhale the air properly. Therefore, some lung areas remain “over-inflated”.

Cor pulmonale

Due to the hardened lung tissue in a silicosis, the blood can no longer flow easily through the blood vessels. As a result, it jams back to the heart. Due to the congestion, the heart is limited in its function, which eventually leads to heart failure. Doctors speak of a cor pulmonale. Signs include water retention in the legs, prominent jugular veins, and impaired liver function, as the blood can not drain from there to the right heart. Sudden cardiac arrhythmias can even lead to death.

Further sequelae

In addition, silicosis patients are twice as likely to develop lung cancer as the general population. Also, the risk of connective tissue disease of the whole body is increased. It is a combination of silicosis and chronic arthritis (chronic polyarthritis, rheumatoid arthritis). This disease also occurs more frequently in hard coal miners.

Occupational disease silicosis

Silicosis usually occurs through occupational exposure and is therefore considered an occupational disease. Once diagnosed, occupational and medical measures are taken to relieve symptoms. If sick people have permanent physical disabilities despite these measures and can no longer work, a pension will be paid.

In 2013, out of 1497 suspected cases, 768 silicosis was recognized as an occupational disease. Chronic obstructive bronchitis and pulmonary emphysema of underground coal miners can also be confirmed as an occupational disease, even if silicosis is not yet present.

To prevent silicosis, protective measures must be observed. Wet drilling and well-ventilated mining tunnels with a developed extraction system reduce the amount of quartz dust in the air. The latter also plays a major role in the processing industry (for example, ceramics, glass). In any case, it is crucial to wear protective masks against fine dust. As with all risk assessments, it is advisable to take part in occupational medical examinations. Only then can one silicosis be recognized early and treated.