Alveolar crystal burden in stone workers with artificial stone silicosis

Abstract

Background and objective An epidemic of silicosis has emerged due to a failure to control risks associated with exposure to high‐silica content respirable dust generated while working with artificial stone products. Methods for quantification of alveolar crystal burden are needed to advance our understanding of the pathobiology of silica‐related lung injury as well as assisting in the diagnosis, clinical management and prognostication of affected workers. The objective of this study was to develop and validate novel methods to quantify alveolar crystal burden in bronchoalveolar lavage (BAL) fluid from patients with artificial stone silicosis. Methods New methods to quantify and analyse alveolar crystal in BAL from patients with artificial stone silicosis were developed. Crystals were isolated and counted by microscopy and alveolar crystal burden was calculated using a standard curve generated by titration of respirable α‐Quartz. The utility of the assay was then assessed in 23 patients with artificial stone silicosis. Results Alveolar crystal burden was greater in patients with silicosis (0.44 picograms [pg]/cell [0.08–3.49]) compared to patients with other respiratory diagnoses (0.057 pg/cell [0.01–0.34]; p < 0.001). Alveolar crystal burden was positively correlated with years of silica exposure (ρ = 0.49, p = 0.02) and with decline in diffusing capacity of the lungs for carbon monoxide (ρ = −0.50, p = 0.02). Conclusion Alveolar crystal burden quantification differentiates patients with silicosis from patients with other respiratory disorders. Furthermore, crystal burden is correlated with the rate of decline in lung function in patients with artificial stone silicosis.

Concept of health surveillance programme for workers exposed to respirable crystalline silica at present and in the past

“…Some of the introduced modifications can also consider the latest research results. In recent papers the authors discuss the use of some other diagnostic tools and new methods for early silicosis detection, like high resolution computed tomography (HRCT), ultra-low dose computed tomography (ULD-CT), alveolar crystal burden quantification in bronchoalveolar lavage (BAL), biomarkers present in serum or exhaled breath condensate (EBC) [27][28][29][30].…”

Understanding the pathogenesis of engineered stone‐associated silicosis: The effect of particle chemistry on the lung cell response

“…In fact, the presence of metals such as Al was detected in the bronchoalveolar lavage (BAL) fluid from patients with engineered stone-associated silicosis. 20 There is also a growing concern regarding the potential impact of inhaling the organic compounds liberated by processing ES, potentially from the binding resin which represents up to 14%, by weight, of ES. 15,21 Recently, we showed that ES processing generates volatile organic compounds (VOCs) such as styrene and phthalic anhydride, both of which have been linked to lung disease.…”

“…In addition to high levels of crystalline silica, ES emissions contain a range of metal elements (8%–10% by weight) 16–19 with known toxicological and pro‐inflammatory profiles. In fact, the presence of metals such as Al was detected in the bronchoalveolar lavage (BAL) fluid from patients with engineered stone‐associated silicosis 20 . There is also a growing concern regarding the potential impact of inhaling the organic compounds liberated by processing ES, potentially from the binding resin which represents up to 14%, by weight, of ES 15,21 .…”

Occupational Lung Health: A global problem requiring local awareness

“…Apte et al investigate alveolar silica crystal burden in bronchoalveolar lavage (BAL) fluid from patients with AS silicosis. 12 Crystal burden was positively correlated with years of silica exposure and with a decline in diffusing capacity of the lungs. Apte et al note a correlation between crystal burden and the rate of decline in lung function in patients with AS silicosis.…”

“…Apte et al investigate alveolar silica crystal burden in bronchoalveolar lavage (BAL) fluid from patients with AS silicosis 12 . Crystal burden was positively correlated with years of silica exposure and with a decline in diffusing capacity of the lungs.…”