Original Article 2012 NRITLD, National Research Institute of Tuberculosis and Lung Disease, Iran TANAFFOS ISSN: 1735-0344 Tanaffos 2012; 11(2): 38-41 Silicosis among Stone- Cutter Workers: A Cross-Sectional Study Mashaallah Aghilinejad 1,2, Ali Background: Production process of most factory-made products is harmful to Naserbakht 2, Morteza Naserbakht 2, our health and environment. Silica is the most important stone used in stone Ghavamedin Attari 2, 3 cutting factories. Numerous researches have reported respiratory diseases due to the inhalation of these particles in various occupations. Silicosis is a disease 1 Department of Occupational Medicine, Faculty of with typical radiographic pattern caused as the result of inhalation of silica Medicine, 2 Occupational Medicine Research Center, particles. According to the intensity of exposures and onset of initiation of Tehran University of Medical Sciences (TUMS), clinical symptoms silicosis is classified into three groups of acute, chronic and Tehran, Iran 3 Occupational Hygienist accelerated forms. The present study evaluated silicosis among stone cutter workers. Received: 5 June 2011 Materials and Methods: This cross sectional study was performed on stone Accepted: 25 January 2012 cutter workers in Malayer city (Azandarian) between 2008 and 2009. Correspondence to: Aghilinejad M Respiratory data of our study participants were collected with a respiratory Address: Occupational Medicine Research Center (OMRC) of Tehran University of medical sciences questionnaire and performing spirometry tests and chest radiography. (TUMS) Results: Among our participants, 16 silicosis cases were diagnosed by Email address: [email protected] radiographic changes. Among them, 10 workers had exposure for more than three years and 6 workers were smokers. Eleven workers had an abnormal radiographic pattern on their chest x-rays. Seven workers had obstructive and 4 workers had restrictive spirometric patterns. Conclusion: Prevalence of silicosis was high among our understudy workers and preventive strategies are required to control it. Key words: Silicosis, Stone- cutters, Spirometry, Chest Radiography INTRODUCTION of stone cutters (2, 3). Production of dust increased Silica is the main component of sand. Cutting, significantly due to industrialization (1, 2). More than breaking, crushing, drilling, grinding or abrasive blasting 24,000 deaths occurred annually in China due to silicosis of these materials may produce fine silica dust. Silicosis between 1991 and 1995(4). In the United States, According occurs as the result of deposition of fine respirable dust to recent CDC data, it is estimated that two million (less than 10 micrometers in diameter) in the lungs (1). workers have had occupational exposure to crystalline Silicosis is the most common occupational lung disease silica dust and 59,000 of these workers develop silicosis worldwide, which occurs mostly in developing countries. during their life course (1, 5). In 1713; Ramazzini et al. reported a connection between Classification of silicosis is made according to the asthmatic symptoms and sand-like substances in the lungs disease severity (including radiographic pattern), onset Aghilinejad M, et al. 39 and rapidity of progression and often relates to duration of months to 16 years). Seventy-two (40%) workers had exposure. The classification includes: Chronic simple working experience up to three yrs and 19% mentioned a silicosis (resulting from long-term exposure to relatively working experience less than one year. low concentrations of silica dust and also usually According to chest radiography, silicosis was appearing 10-30 years after first exposure), accelerated diagnosed in sixteen workers (8.9%) and also ten workers silicosis that develops 5–10 years after first exposure to with silicosis mentioned more than three years of working higher concentrations of silica dust and acute silicosis that experience (Figure 1). In general, 40 workers (22.2%) were develops a few weeks to five years after exposure to high smokers and 6 workers with silicosis were smokers with concentrations of repairable silica dust (2, 3, 6). mean smoking history of 5.5 years (5.5 Pack/Year). Seven The present study was performed for assessment of workers had chronic lung disease and only one of them silicosis among stone cutter workers for early detection had history of lung disease. and timely prevention and control of disease. 10 MATERIALS AND METHODS 8 The present analytical cross-sectional study evaluated 6 all workers (180 males) who worked in stone- cutting factories in Malayer-Azandarian (Hamadan province) 4 between 2008 and 2009. Our study was approved by the 2 Ethics Committee of Tehran University of Medical Sciences 0 and Health Services. Data collection was done according to <1 yr 1‐3 yr >3yr clinical examination forms (approved by the Ministry of Figure1. Relative frequency distribution of silicosis cases according to their work Health) and a respiratory status checklist (designed and experience at stone cutting factories in Malayer-Azandarian approved by occupational medicine research center) through interviewing the study participants. Study Furthermore, 35 workers had abnormal spirometric participants explained their chronic pulmonary illness and findings. Eleven workers with silicosis had abnormal their lifestyle. Spirometry was performed for all cases at findings in their spirometry as well. Seven workers had the same time for assessment of lung volumes and obstructive and four had restrictive patterns (Figure 2). capacities. Based on their job description in stone-cutting factories, study participants were referred to a radiologist 7 in Malayer city Hospital to obtain chest radiography. 6 Afterwards, spirometry results and chest radiographies 5 were evaluated and interpreted by specialists from the 4 occupational medicine research center according to ATS 3 and ILO guidelines, and silicosis was confirmed by chest 2 1 radiography (1, 2, 6). Collected data were analyzed using 0 SPSS version 16 software. NL Restrictive Obstructive RESULTS Figure2. Relative frequency distribution of spirometric patterns among silicosis One-hundred eighty stone-cutter workers participated cases working in stone cutting factories in Malayer-Azandarian in this study. The mean age of participants was 31.98±9.26 (15-59) years; 25% of workers were younger than 25 years Sixteen workers had abnormality in their lung of age and 18% were over the age of 40 yrs. The mean examination as respiratory symptoms, out of which 8 duration of employment was 3.5± 2.87 years (range 6 workers complained of irritating cough, 4 workers Tanaffos 2012; 11(2): 38-41 40 Silicosis among Stone- Cutter Workers complained of cough and dyspnea and 5 workers only some other factors in a way that the higher the complained of exertional dyspnea. concentration of dust in the inspiratory air (as mg/m3) and the more silica particles in the respirable sizes (in this DISCUSSION study silica powder was within this range), the higher the In our study 16 workers (8.9%) had silicosis. In a risk of silicosis (3, 12, 13). Results confirm a large burden of previous study in 2006, rate of silicosis in workers was silicosis among older black workers in the South African reported to be 10% (7). Our study in comparison with the gold mining industry, which is likely to worsen as such mentioned study showed a lower rate and this difference miners spend longer periods in continuous employment in might be due to the higher use of personal protective dusty jobs (14). equipment and shorter work experience in our study Based on the above-mentioned facts our results are samples. consistent with those of other studies. Evidence indicates Gibbs and Du Toit in their study on gold miners of that exposure at the rate of OSHA (Occupational Safety South Africa showed prevalence of silicosis to be 18.3- and Health Administration) and MSHA (Mine Safety and 19.9% which was higher than our mentioned rate (8). Health Administration) standards (0.1 mg/m3) for 100% Out of 16 workers, 8 workers had irritating cough, 5 respirable crystalline silica does not eradicate the risk of workers had cough and dyspnea and only 3 workers silicosis (15). This is also true about our study site because complained of exertional dyspnea. These findings were in the concentration of silica particles was several-folds above accord with the results of similar studies at the same the safe limit. location in 2004 and 2006 (7, 9). In our study, the most There were several limitations in our study. One common symptom was irritating cough (76%) in contrast problem was the impossible evaluation of type of silica to the study conducted in Nigeria which reported the most particles; however, we were able to measure the common symptom in workers with silicosis to be dyspnea concentration of dusts in this research. Another limitation and only 42% complained of cough (10). was the absence of a system to detect and report silicosis Our study results demonstrated that 6 workers with cases regularly and also the inability for early or even late silicosis were smokers. This finding is comparable with the diagnosis of silicosis by physicians of that district. results of a study in Hong Kong on the factors effective on Therefore, the estimated number of diseased cases was far and accompanied by progressive fibrosis in silicosis (4, 11). less than the actual rate. To overcome this problem, it is Also, the spirometric pattern was abnormal in 11 recommended to establish a system by the environmental workers with silicosis, 7 workers had obstructive patterns and occupational health offices at the Ministry of Health (two cases were smokers) while 4 workers had restrictive for protection against silicosis and reporting cases from all pattern (one smoker), in comparison with the previous over the country. We hope to take a step forward in studies that found a significant difference in spirometric eliminating or decreasing the risk of silicosis by patterns between workers with silicosis and healthy undertaking these measures. workers (2, 9). Correlation between lung function tests and chest radiograph was variable among South African gold Acknowledgement miners and those with simple silicosis had lower FEV1 We would like to thank the authorities as well as the values. Pathologic studies demonstrating emphysematous employees of the Malayer health center especially Mr. changes supported these findings. Some studies reported Attari, the responsible agent of occupational health in the risk of silicosis to be correlated with the severity of Azandarian and others who cooperated in performing this exposure, type of silica particles, duration of exposure, and study. 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