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Silicosis

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Respirable crystalline silica (RCS) is found in stone, rocks, sands and clays.Exposure to RCS over a long period can cause fibrosis (hardening or scarring) of the lung tissue with a consequent loss of lung function. In Britain, RCS exposure has a workplace exposure limit (WEL), which contains exposure below a set limit, preventing excessive exposure.

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Exposure to silica (SiO2) is industries and occupations
Stone cutting, glass and cement manufacturing, quarrying.
Progressive even when exposure stops

Epidemiology

Disease is dose-related to exposure levels and time
Needs 10-20 years of exposure usually but some less
Usually chronically progressive over years or decades
Short term high-level exposure can result in an acute silicosis
in UK 14 deaths from silicosis in 2006 and 7 in 2007.

Occupations with exposure to RCS

Quarrying, slate works, foundries, potteries,Stonemasonry
Construction (cutting/breaking stone, concrete or brick)
Industries using silica flour to manufacture goods
Different types of stone contain different amounts of silica

Different types of stone contain different amounts of silica

Type of Stone	Percentage of Silica
sandstone, gritstone, quartzite	more than 70%
concrete, mortar	25% to 70%
shale	40% to 60%
china stone	up to 50%
slate	up to 40%
brick	up to 30%
granite	up to 30%
ironstone	up to 15%
basalt, dolerite	up to 5%
limestone, chalk, marble	up to 2% (but these can contain silica layers)

Clinical

Progressive breathlessness, Cough
Progressive massive fibrosis (PMF)may occur

Investigations

CXR: Multiple well-circumscribed nodular opacities mid and upper lobe. Eggshell calcification of the hilar lymph nodes is characteristic and Reticulonodular shadowing. Can develop Progressive massive fibrosis.
PFTs- restrictive lung defect

Complications

Patients with silicosis are more prone to TB and atypical TB
Higher risk for lung cancer, TB and COPD
Eventually respiratory failure, pulmonary hypertension

Management

Reduce exposure to silica dust but can still progress as highly fibrogenic. Stop smoking
Whole lung lavage may be useful in some cases of acute silicosis
Advanced cases of Chronic silicosis may need lung transplantation

References

Silicosis at HMG

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