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Artificial Stone Silicosis

Rapid Progression Following Exposure Cessation

      Background

      Silicosis is rapidly emerging in high-income countries in relation to the replacement of natural stone with artificial stone, especially in the manufacturing and installation of kitchen and bathroom countertops. Progression of this form of silicosis following the cessation of exposure is unknown.

      Research Question

      The objective of this study was to determine the radiologic progression and lung function in individuals with artificial stone silicosis.

      Study Design and Methods

      Between 2009 and 2018, a total of 106 patients were diagnosed with artificial stone silicosis in the Bay of Cádiz area (southern Spain), 14.15% by using biopsy results and the remainder according to chest radiography and high-resolution CT imaging. Follow-up consisted of respiratory function tests and radiographic studies. All patients stopped working in the stone industry following diagnosis.

      Results

      All patients were men; their mean ± SD age at diagnosis was 36.2 ± 7.0 years, and the mean duration of exposure was 12.0 ± 4.3 years. At diagnosis, 99 patients were considered to have simple silicosis (93.4%) and seven to have progressive massive fibrosis (PMF) (6.6%). After a mean follow-up of 4.01 ± 2.1 years, disease in 56% of patients had progressed two or more International Labour Office subcategories, and the number of patients with PMF had increased to 40 (37.7%). Regarding lung function, there was a decrease in FVC and FEV1, with an average decrease of 86.8 and 83.4 mL per year, respectively; in 25% of patients, the annual decrease was > 157 mL in FVC and > 133 mL in FEV1. Multivariable analysis showed that lower FVC at diagnosis and longer duration of exposure to silica were associated with progression to PMF.

      Interpretation

      Artificial stone silicosis rapidly progresses to PMF even following exposure cessation, and a significant percentage of patients experience a very rapid decrease in lung function.

      Key Words

      Abbreviations:

      AS (artificial stone), CXR (chest radiography), Dlco (diffusing capacity of the lung for carbon monoxide), ILO (International Labour Office), HRCT (high-resolution CT), PMF (progressive massive fibrosis)
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      Linked Article

      • Artificial Stone Silicosis: Removal From Exposure Is Not Enough
        CHESTVol. 158Issue 3
        • Preview
          In a recently published article in CHEST, León-Jiménez and colleagues1 have reported the first follow-up study of workers with advanced silicosis from exposure to respirable dust generated during the manufacture and installation of artificial stone (AS) countertops and other fixtures. Their cohort, originally described in 2014,2 now has had 4 years of follow-up. They demonstrated that silicosis from this exposure is aggressive and exhibits rapid progression in a high proportion of affected individuals.
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