Transcript Slide 1

SILICOSIS
Penyaji :
Dr. Sinatra Gunawan, MK3, SpOk
Referensi :
Amer Rassam MD1, Gerry San Pedro
MD2, Daniel Banks MD1.
Department of Internal Medicine
LSUHSC-Shreveport
Silicosis
General
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The most prevalent and oldest known OLD in
the world
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Exposure to crystalline silica (quartz)
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Most commonly, latency 20-30 years
Mining, glassmaking, ceramics, sandblasting,
foundries, and brick yards
In the USA, > 2 million workers are at risk
Silicosis
Forms of Silicosis
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*Chronic or pure nodular silicosis - 35% quartz
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Acute silicosis – silico-proteinosis - fatal
Complicated nodular silicosis (PMF) < 5%
Accelerated silicosis – 50% quartz – after 5
years of exposure – smaller nodules in the
middle zones of the lung
Silicosis
Pathogenesis
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Progresses even in absence of further exposure
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Inflammatory response mediated by alveolar
macrophages
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TNF released by macrophages may be an essential
component of the inflammatory response
Rapid progression: R/O TB
Workers with nodules < 5 mm have long-term
survival similar to that of the general population
Silicosis
Simple Nodular Silicosis
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Small fibrocalcific nodules in upper lung
Hilar lymphadenopathy (eggshell calcification)
Increased susceptibility to TB
Yearly PPDs are recommended
D.D.: TB, CWP, Berylliosis
Silicosis
Complicated Nodular Silicosis (PMF)
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Large nodules > 1 cm tend to coalesce
Increased susceptibility to TB
No specific treatment
Decline in FVC & FEV1 in Silicosis
4
3.7
3.6
FVC
3.4
3.3
3
3
2.6
Liters
FEV1
2.5
2.7
2.4
2.3
2
1.8
2
1
0
10/95
11/95
4/96
6/96
10/96
3/97
From: Occupational Lung Disease “An International Perspective”
Daniel E. Banks and John E. Parker. 1998
Silicosis
Remember !

Yearly PPDs are recommended in patients
with silicosis
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A + PPD in these patients should receive
prophylaxis no matter what the patient age or
duration of + PPD

If symptoms are rapidly worsening, think of
TB
Accelerated Silicosis with PMF
From: Occupational Lung Disease “An International Perspective”
Daniel E. Banks and John E. Parker. 1998
Diffuse Nodular Silicosis & Egg-shell calcification
From: Occupational Lung Disease “An International Perspective”
Daniel E. Banks and John E. Parker. 1998
Massive Conglomerate Silicosis (Angel’s Wings)
From: Occupational Lung Disease “An International Perspective”
Daniel E. Banks and John E. Parker. 1998
Egg-shell Calcification – Pathognomonic for Silicosis
From: Occupational Lung Disease “An International Perspective”
Daniel E. Banks and John E. Parker. 1998
Progressive Massive Fibrosis - Silicotuberculosis
From: Occupational Lung Disease “An International Perspective”
Daniel E. Banks and John E. Parker. 1998
SILICA
Why Target Crystalline Silica Exposure?
• Widespread Occurrence and use – Maritime
– Agriculture
– Construction
– General Industry
• Number of Related Deaths
• Number of exposed workers
• Health Effects
SILICA
Occurrence of Crystalline Silica
• Silicon Dioxide is basic
component of sand,
quartz, & granite
• Quartz is second most
common mineral in
earth’s crust
• Airborne silica is
produced by, among
other activities:
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Sandblasting
Rock Drilling
Roof Bolting
Foundry Work
Stone Cutting
Drilling
Quarrying
Tunneling
SILICA
Industries with Silica Exposure
• Electronics
• Foundries
• Ceramics, clay &
pottery, stone, glass
• Construction
• Agriculture
• Maritime
• Mining
• Railroad ( setting &
laying track)
• Slate & flint
quarrying & flint
crushing
• Use & manufacture
of abrasives
• Manufacture of soap
& detergents
SILICA
Number of Silica Related Deaths.
• Total US deaths 1968-1990 where silica is
reported on death certificate : 13,744 people.
• Deaths where silicosis is reported as
underlying cause of death : 6,322 people.
• 68% of silica related deaths reported in 12
states.
• 10% of silica-related deaths reported from
construction industry.
SILICA
Health Effects
• Pulmonary fibrosis (silicosis)
– Acute silicosis (1 to 3 years)
– Accelerated silicosis (3 to 10 years)
– Chronic silicosis (5 to 25 years)
• Possible Lung Cancer
SILICA
Inspection Targeting
• Wherever possible, inspections will be focused
to particular establishments where known
exposures to crystalline have occurred or there
are known cases of silicosis
• Process
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Identify establishments
Select sites by use of random number tables
Numbers of Inspections determined by regions
Sites with effective control programs are exited
after program review
SILICA
Elements of an effective, On-going Control
Program for Crystalline Silica
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Personal Monitoring
Medical Surveillance
Training
Availability of monitoring/Surveillance data
to workers
• Respiratory Protection Program
• Hygiene facilities & clothing change areas
SILICA
Elements of Control Program (continued)
• Recordkeeping
• Exposures below PEL or a current
program with interim protection
• Housekeeping
• In construction : A Safety & Health
Program
• Regulated areas to limit exposures
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