Hard Metal Lung Disease Successfully Treated with Inhaled Corticosteroids

Nureki, Shin-ichi; Miyazaki, Eishi; Nishio, Suehiro; Ando, Masayuki; Kumamoto, Toshihide

doi:10.2169/internalmedicine.52.0095

Cited by 13 publications

(6 citation statements)

References 18 publications

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“…44,51,[62][63][64][65] Currently, treatments are limited and no disease-specific therapy or diagnostic tool exists. There has been some success in treating HMLD with corticosteroids or immunosuppressive therapies, 66,67 typically resulting in moderate attenuation of breathing challenges and delayed onset of further symptoms (ie, fibrosis and fluid in the lungs), but in most cases, avoidance of further hard metal exposure is the recommended course of action.…”

Section: Risk Of Wc-co Exposure: Hard Metal Lung Disease (Hmld) Prognmentioning

confidence: 99%

Nanotoxicity: emerging concerns regarding nanomaterial safety and occupational hard metal (WC-Co) nanoparticle exposure

Armstead¹,

Li²

2016

IJN

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Section: Risk Of Wc-co Exposure: Hard Metal Lung Disease (Hmld) Prognmentioning

confidence: 99%

Nanotoxicity: emerging concerns regarding nanomaterial safety and occupational hard metal (WC-Co) nanoparticle exposure

Armstead¹,

Li²

2016

IJN

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“…Occupational exposure during production of hard metal is associated with several adverse health effects implicating cobalt as the causing agent. Those effects include rhinitis, sinusitis, bronchitis ( Balmes, 1987 ; Cugell et al , 1990 ), asthma ( Shirakawa et al , 1989 ; Kusaka et al , 1989 ; Nemery et al , 1990 ), dose-related decreased lung function over time ( Kusaka et al , 1986a ; Rehfisch et al , 2012 ), and hard metal lung disease (HMLD) ( Nemery et al , 1990 ; Ruokonen et al , 1996 ; Nureki et al , 2013 ; Nakamura et al , 2014 ). Allergic dermatitis ( Kusaka et al , 1989 ; Nakamura et al , 2014 ), caused both by direct contact and by skin exposure from deposited air particles ( Gimenez Camarasa, 1967 ; Dooms-Goossens et al , 1986 ) is reported.…”

Section: Introductionmentioning

confidence: 99%

Occupational Exposure to Cobalt and Tungsten in the Swedish Hard Metal Industry: Air Concentrations of Particle Mass, Number, and Surface Area

Klasson

Bryngelsson

Pettersson

et al. 2016

ANNHYG

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Exposure to cobalt in the hard metal industry entails severe adverse health effects, including lung cancer and hard metal fibrosis. The main aim of this study was to determine exposure air concentration levels of cobalt and tungsten for risk assessment and dose–response analysis in our medical investigations in a Swedish hard metal plant. We also present mass-based, particle surface area, and particle number air concentrations from stationary sampling and investigate the possibility of using these data as proxies for exposure measures in our study. Personal exposure full-shift measurements were performed for inhalable and total dust, cobalt, and tungsten, including personal real-time continuous monitoring of dust. Stationary measurements of inhalable and total dust, PM2.5, and PM10 was also performed and cobalt and tungsten levels were determined, as were air concentration of particle number and particle surface area of fine particles. The personal exposure levels of inhalable dust were consistently low (AM 0.15mg m−3, range <0.023–3.0mg m−3) and below the present Swedish occupational exposure limit (OEL) of 10mg m−3. The cobalt levels were low as well (AM 0.0030mg m−3, range 0.000028–0.056mg m−3) and only 6% of the samples exceeded the Swedish OEL of 0.02mg m−3. For continuous personal monitoring of dust exposure, the peaks ranged from 0.001 to 83mg m−3 by work task. Stationary measurements showed lower average levels both for inhalable and total dust and cobalt. The particle number concentration of fine particles (AM 3000 p·cm−3) showed the highest levels at the departments of powder production, pressing and storage, and for the particle surface area concentrations (AM 7.6 µm2·cm−3) similar results were found. Correlating cobalt mass-based exposure measurements to cobalt stationary mass-based, particle area, and particle number concentrations by rank and department showed significant correlations for all measures except for particle number. Linear regression analysis of the same data showed statistically significant regression coefficients only for the mass-based aerosol measures. Similar results were seen for rank correlation in the stationary rig, and linear regression analysis implied significant correlation for mass-based and particle surface area measures. The mass-based air concentration levels of cobalt and tungsten in the hard metal plant in our study were low compared to Swedish OELs. Particle number and particle surface area concentrations were in the same order of magnitude as for other industrial settings. Regression analysis implied the use of stationary determined mass-based and particle surface area aerosol concentration as proxies for various exposure measures in our study.

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“…Among the 18 patients, six cases, including our patient, were treated with corticosteroids (Yokota et al 1996;Enriquez et al 2007;Bezerra et al 2009;Kim et al 2013;Nakamura et al 2014), because the symptoms and/or radiological findings did not show improvement even after avoiding dust exposure before corticosteroid therapy. However, the detailed information of remaining 12 cases were unknown (Schwarz et al 1994;Dunlop et al 2005;Sakamoto et al 2008;Moreira et al 2010;Kaneko et al 2010;Sakai et al 2010;Nureki et al 2013;Mizutani et al 2016). On the other hand, Huang et al (2012) reported that proper prevention of dust exposure (change of workplace, proper wearing of mask, maintenance of better exhaust ventilation and air condition monitoring in the workplace) was effective in patients with HMLD.…”

Section: Discussionmentioning

confidence: 99%

Hard Metal Lung Disease with Favorable Response to Corticosteroid Treatment: A Case Report and Literature Review

Chiba

Kido

Tahara

et al. 2019

Tohoku J. Exp. Med.

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Hard metal lung disease (HMLD) is a pneumoconiosis caused by occupational exposure to hard metals such as tungsten carbide and cobalt, but the treatment strategies for HMLD have not been well established. A 68-year-old Japanese man with occupational history as a grinder of hard metals for 18 years referred to our hospital because of dry cough and dyspnea. A chest computed tomography (CT) on admission revealed centrilobular micronodules, ground-glass opacities, and reticular opacities in the peripheral zone of both lungs. Mineralogic analyses of lung tissues detected components of hard metals, such as tungsten, titanium and iron, and the same metals were also detected in the sample of the dust of his workplace. Thus, the patient was diagnosed as having HMLD based on occupational exposure history and radiologic and mineralogic analyses of the lung. Corticosteroid therapy was initiated, which resulted in partial improvements in his symptoms, radiological and pulmonary functional findings. In a review of the 18 case reports of HMLD treated with corticosteroids, including our case, the majority of patients (77.8%) showed favorable responses to corticosteroid treatment. Furthermore, the presence of fibrotic changes, such as reticular opacity, in radiological examinations was associated with the resistance to corticosteroids. In conclusion, the majority of patients with HMLD are expected to favorable response to corticosteroid treatment, whereas chest CT findings such as fibrotic changes may be predictive of the resistance of corticosteroid treatment. Lastly, proper prevention of hard metal exposure is most important as the first step.

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Hard Metal Lung Disease Successfully Treated with Inhaled Corticosteroids

Cited by 13 publications

References 18 publications

Nanotoxicity: emerging concerns regarding nanomaterial safety and occupational hard metal (WC-Co) nanoparticle exposure

Nanotoxicity: emerging concerns regarding nanomaterial safety and occupational hard metal (WC-Co) nanoparticle exposure

Occupational Exposure to Cobalt and Tungsten in the Swedish Hard Metal Industry: Air Concentrations of Particle Mass, Number, and Surface Area

Hard Metal Lung Disease with Favorable Response to Corticosteroid Treatment: A Case Report and Literature Review

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