SILICOSIS

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SILICOSIS

• Penyaji
• Dr. Sinatra Gunawan, MK3, SpOk
• Referensi
• Amer Rassam MD1, Gerry San Pedro MD2, Daniel
  Banks MD1.
• Department of Internal Medicine
• LSUHSC-Shreveport

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Silicosis
General

• The most prevalent and oldest known OLD in the
  world
• Exposure to crystalline silica (quartz)
• Mining, glassmaking, ceramics, sandblasting,
  foundries, and brick yards
• Most commonly, latency 20-30 years
• In the USA, gt 2 million workers are at risk

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Silicosis
Forms of Silicosis

• Chronic or pure nodular silicosis - 35 quartz
• Complicated nodular silicosis (PMF) lt 5
• Accelerated silicosis 50 quartz after 5
  years of exposure smaller nodules in the middle
  zones of the lung
• Acute silicosis silico-proteinosis - fatal

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Silicosis
Pathogenesis

• Progresses even in absence of further exposure
• Rapid progression R/O TB
• Workers with nodules lt 5 mm have long-term
  survival similar to that of the general
  population
• Inflammatory response mediated by alveolar
  macrophages
• TNF released by macrophages may be an essential
  component of the inflammatory response

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Silicosis
Simple Nodular Silicosis

• Small fibrocalcific nodules in upper lung
• Hilar lymphadenopathy (eggshell calcification)
• Increased susceptibility to TB
• Yearly PPDs are recommended
• D.D. TB, CWP, Berylliosis

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Silicosis
Complicated Nodular Silicosis (PMF)

• Large nodules gt 1 cm tend to coalesce
• Increased susceptibility to TB
• No specific treatment

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Decline in FVC FEV1 in Silicosis
Liters
11/95
4/96
6/96
3/97
10/95
10/96
From Occupational Lung Disease An International
Perspective Daniel E. Banks and John E. Parker.
1998
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Silicosis
Remember !

• Yearly PPDs are recommended in patients with
  silicosis
• 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

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Accelerated Silicosis with PMF
From Occupational Lung Disease An International
Perspective Daniel E. Banks and John E. Parker.
1998
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Diffuse Nodular Silicosis Egg-shell
calcification
From Occupational Lung Disease An International
Perspective Daniel E. Banks and John E. Parker.
1998
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Massive Conglomerate Silicosis (Angels Wings)
From Occupational Lung Disease An International
Perspective Daniel E. Banks and John E. Parker.
1998
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Egg-shell Calcification Pathognomonic for
Silicosis
From Occupational Lung Disease An International
Perspective Daniel E. Banks and John E. Parker.
1998
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Progressive Massive Fibrosis - Silicotuberculosis
From Occupational Lung Disease An International
Perspective Daniel E. Banks and John E. Parker.
1998
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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

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SILICA

• Occurrence of Crystalline Silica

• Silicon Dioxide is basic component of sand,
  quartz, granite
• Quartz is second most common mineral in earths
  crust

• Airborne silica is produced by, among other
  activities
• Sandblasting
• Rock Drilling
• Roof Bolting
• Foundry Work
• Stone Cutting
• Drilling
• Quarrying
• Tunneling

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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

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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.

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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

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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
• 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

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SILICA

• Elements of an effective, On-going Control
  Program for Crystalline Silica

• Personal Monitoring
• Medical Surveillance
• Training
• Availability of monitoring/Surveillance data to
  workers
• Respiratory Protection Program
• Hygiene facilities clothing change areas

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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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BERLANJUT KE PAK bag-3D