Editorial
Changes in the Profile of Diseases Caused by the Inhalation of Silica
Cambio en el perfil de las enfermedades por exposición a la inhalación de sílice
Cristina Martínez-González
Servicio de Neumología, Área de Gestión del Pulmón, Hospital Universitario Central de Asturias, Facultad de Medicina, Oviedo, Spain
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By the end of the 20th century, the prevalence and severity of pneumoconiosis caused by coal had reduced significantly, due to the progressive replacement of coal by other fuels, the implementation of preventive measures in the mining industry, early diagnosis of these diseases, and the progressive introduction of medical and legal coverage.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">1</span></a> In 1995, the International Labor Organization, together with the World Health Organization, set up the “Global Program for the Elimination of Silicosis”, with the aim of eliminating this disease as a worldwide occupational health hazard by 2030. This initiative prompted programs for the control and prevention of silicosis in many countries, including Brazil, Chile, China, Indonesia, Malaysia, Mexico, Poland, South Africa, Thailand, Turkey, Ukraine, and Vietnam. Although adherence to these recommendations has reduced the incidence of this disease,<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">2</span></a> it is not yet fully controlled or eliminated. Silicosis persists, particularly in the more impoverished regions, due to factors such as ineffective techniques for the prevention of workplace exposure to respirable dust containing silica, and the persistence of other risk factors, such as high rates of tuberculosis.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">3</span></a> Moreover, silicosis continues to be a cause of morbidity and mortality in both developed and developing countries.<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">4,5</span></a> In industrialized countries, unlike developing countries, healthcare and institutional systems are in place to register changes in the profile of diseases caused by exposure to silica that can be addressed from different perspectives:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1.</span><p id="par0010" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Sources of exposure</span>: in 1999, at the peak of the construction boom, Spain was the world's highest producer of granite and slate, and in 2004, 24<span class="elsevierStyleHsp" style=""></span>000 workers were employed in this sector. The extraction and exploitation of these rocks was the greatest source of silica exposure during the years prior to the economic crisis. In the 1990s, quartz conglomerates, composed of crystalline silica, mainly quartz and smaller amounts of cristobalite, dyes, and acrylic resins, were introduced. The range of colors and resistant properties of these materials led to their widespread use in kitchens and bathrooms, and exposure to silica increased across the country. Another new source of silica exposure is hydraulic fracturing (fracking) for gas and oil production. Significant exposure also continues in foundries, sand-blasting industries, and the production of abrasives and ceramics, and during the quarrying of sand and gravel (limestone, clay, sand, quartz, quartzite, etc.) and its use in concrete and road-building.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2.</span><p id="par0015" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Exposed workers</span>: exposure to silica is no longer mainly restricted to miners with well-paid, stable jobs in large companies located in certain geographic areas. The current profile now comprises workers in small companies scattered all over the country. Successive periods of growth and subsequent economic crisis have contributed to a deterioration in working conditions and health monitoring.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3.</span><p id="par0020" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Preventive measures:</span> several epidemiological studies have called into question the effectiveness of the accepted limits of respirable dust set down in the regulations.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">6</span></a> Similarly, in the early years of quartz conglomerate production, adequate health and safety measures for workers handling these materials were only introduced after the appearance of alarming cases of silicosis.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">7</span></a></p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">4.</span><p id="par0025" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Diagnostic process:</span> a history of more than 10 years’ exposure, along with a characteristic radiological and functional presentation in the absence of other symptoms, has been sufficient for medical experts to give a diagnosis with a high degree of certainty.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">8</span></a> Changes in occupational exposure, the development of severe, atypical forms of the disease in young individuals, and management by physicians unfamiliar with silicosis have led to the indiscriminate use of high-resolution computed tomography. This technique can help identify very early radiological patterns, but the data are still insufficient for evaluating the pathological and prognostic relevance of these findings.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">9</span></a> New endoscopic techniques and the development of mineralogical analysis of tissue samples have led to the characterization of new presentations.</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">5.</span><p id="par0030" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Effects of crystalline silica inhalation:</span> the main pathogenic effect of the sustained inhalation of silica is the development of silicosis. Different entities among the spectrum of diseases caused by silica or coal dust can be detected with the latest diagnostic procedures, and include cases of diffuse interstitial fibrosis with a very similar radiological pattern to the usual interstitial pneumonia associated with idiopathic pulmonary fibrosis,<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">10</span></a> granulomas similar to sarcoidosis, as well as the conventional silicosis nodules and forms of desquamative interstitial pneumonia.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">11</span></a> In exposed individuals, particularly smokers, who develop lung cancer or chronic obstructive pulmonary disease, some effort is required to recognize the carcinogenic effect of silica<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">12</span></a> and its effect on the rapid decline in lung function<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">13</span></a> (much weaker than smoking), and to assess the individual causal attribution of either deleterious substance.</p></li></ul></p><p id="par0035" class="elsevierStylePara elsevierViewall">Silicosis is an old disease which, to paraphrase the Italian writer Lampedusa, is changing in order to stay the same. To bring about real change, the most urgent measures required are the following: the incorporation of standardized reading of high-resolution computed tomography images,<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">14</span></a> standardization of diagnostic procedures based on longitudinal studies which show the significance of early findings, research focused on the use of antifibrotics already used in idiopathic pulmonary fibrosis, a search for new therapeutic targets based on knowledge of the inflammasome,<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">15</span></a> generalized use of new methods for the detection of latent tuberculosis infection, and the rigorous application of preventive measures in all the industrial sectors mentioned above. It is also essential to pass on the accumulated body of knowledge to young pulmonologists and to stimulate their interest in preventable diseases that remain a problem in our environment.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Martínez-González C. Cambio en el perfil de las enfermedades por exposición a la inhalación de sílice. Arch Bronconeumol. 2018;54:5–6.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:15 [ 0 => array:3 [ "identificador" => "bib0080" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "King coal" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "A. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 4 | 5 | 9 |
| 2024 October | 37 | 21 | 58 |
| 2024 September | 48 | 26 | 74 |
| 2024 August | 62 | 38 | 100 |
| 2024 July | 35 | 25 | 60 |
| 2024 June | 49 | 31 | 80 |
| 2024 May | 71 | 42 | 113 |
| 2024 April | 36 | 29 | 65 |
| 2024 March | 44 | 23 | 67 |
| 2024 February | 34 | 23 | 57 |
| 2023 March | 11 | 5 | 16 |
| 2023 February | 37 | 32 | 69 |
| 2023 January | 24 | 30 | 54 |
| 2022 December | 70 | 35 | 105 |
| 2022 November | 76 | 34 | 110 |
| 2022 October | 66 | 44 | 110 |
| 2022 September | 36 | 38 | 74 |
| 2022 August | 36 | 74 | 110 |
| 2022 July | 39 | 77 | 116 |
| 2022 June | 39 | 40 | 79 |
| 2022 May | 36 | 39 | 75 |
| 2022 April | 31 | 32 | 63 |
| 2022 March | 40 | 41 | 81 |
| 2022 February | 43 | 32 | 75 |
| 2022 January | 33 | 49 | 82 |
| 2021 December | 32 | 45 | 77 |
| 2021 November | 39 | 41 | 80 |
| 2021 October | 36 | 52 | 88 |
| 2021 September | 28 | 45 | 73 |
| 2021 August | 22 | 31 | 53 |
| 2021 July | 24 | 28 | 52 |
| 2021 June | 33 | 36 | 69 |
| 2021 May | 39 | 31 | 70 |
| 2021 April | 68 | 67 | 135 |
| 2021 March | 37 | 27 | 64 |
| 2021 February | 23 | 15 | 38 |
| 2021 January | 25 | 19 | 44 |
| 2020 December | 24 | 21 | 45 |
| 2020 November | 16 | 10 | 26 |
| 2020 October | 39 | 21 | 60 |
| 2020 September | 17 | 5 | 22 |
| 2020 August | 27 | 19 | 46 |
| 2020 July | 23 | 25 | 48 |
| 2020 June | 18 | 8 | 26 |
| 2020 May | 28 | 8 | 36 |
| 2020 April | 39 | 26 | 65 |
| 2020 March | 25 | 13 | 38 |
| 2020 February | 30 | 19 | 49 |
| 2020 January | 26 | 14 | 40 |
| 2019 December | 28 | 17 | 45 |
| 2019 November | 29 | 19 | 48 |
| 2019 October | 25 | 9 | 34 |
| 2019 September | 20 | 5 | 25 |
| 2019 August | 40 | 14 | 54 |
| 2019 July | 41 | 24 | 65 |
| 2019 June | 26 | 10 | 36 |
| 2019 May | 34 | 16 | 50 |
| 2019 April | 35 | 15 | 50 |
| 2019 March | 36 | 26 | 62 |
| 2019 February | 37 | 25 | 62 |
| 2019 January | 42 | 47 | 89 |
| 2018 December | 44 | 23 | 67 |
| 2018 November | 71 | 34 | 105 |
| 2018 October | 189 | 31 | 220 |
| 2018 September | 61 | 11 | 72 |
| 2018 May | 2 | 1 | 3 |
| 2018 April | 34 | 15 | 49 |
| 2018 January | 1 | 1 | 2 |
| 2017 December | 0 | 1 | 1 |
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