Six cases of silicosis: implications for health surveillance of stonemasons.
BACKGROUND
Silicosis is one of the oldest occupational lung diseases, but it continues to cause significant morbidity and mortality worldwide.


OBJECTIVE
To report cases of silicosis presenting to two specialist respiratory clinics.


METHODS
A retrospective analysis of prospectively collected data of cases of silicosis in workers referred to specialist respiratory clinics.


RESULTS
Over the course of 6 years, six cases were identified. The patients were all male with an age range between 24 and 39 years. The duration of silica exposure ranged between 7 and 20 years (mean 13 years). Four cases were entirely asymptomatic at presentation, and two cases described minimal shortness of breath on exertion. Pulmonary function tests were normal in three cases, and a mild restrictive ventilatory defect was documented in the other cases. All had a low apparent predicted probability of pneumoconiosis based on health questionnaires, spirometry and duration of silica exposure. The initial chest X-ray was abnormal in all six cases with radiological evidence of silicosis (International Labour Office profusion category ≥1/1) on imaging, and all had evidence of silicosis on high-resolution computed tomography (HRCT). Three patients had already progressed to progressive massive fibrosis on HRCT scanning at the time of referral to specialist respiratory services.


CONCLUSIONS
The appearances of these six cases of silicosis in young, asymptomatic construction workers emphasizes the importance of enforcing effective exposure control and comprehensive surveillance programmes. Our observations highlight the importance of having a low threshold for early radiological screening to promote early and effective detection of this disease.
Lung Injury Group, Centre for Inflammation Research, Queen's Medical Research Centre, University of Edinburgh, Edinburgh, UK, Lung Fibrosis Clinic, Respiratory Medicine Unit, Royal Infirmary of Edinburgh, Edinburgh, UK, lisanicol@doctors.org.uk.
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Nicol
Lung Injury Group, Centre for Inflammation Research, Queen's Medical Research Centre, University of Edinburgh, Edinburgh, UK, Lung Fibrosis Clinic, Respiratory Medicine Unit, Royal Infirmary of Edinburgh, Edinburgh, UK.
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McFarlane
Lung Injury Group, Centre for Inflammation Research, Queen's Medical Research Centre, University of Edinburgh, Edinburgh, UK, Lung Fibrosis Clinic, Respiratory Medicine Unit, Royal Infirmary of Edinburgh, Edinburgh, UK.
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Hirani
Respiratory Medicine Unit, Western General Hospital, Edinburgh, UK.
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Reid
D000328:Adult; D006801:Humans; D008168:Lung / Q000503:physiopathology; D008297:Male; D009784:Occupational Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology; D016273:Occupational Exposure / Q000706:statistics & numerical data*; D011859:Radiography; D012189:Retrospective Studies; D012829:Silicosis / Q000453:epidemiology* / Q000209:etiology; D006113:United Kingdom / Q000453:epidemiology
Health surveillance; occupational health care delivery; occupational respiratory disease; pneumoconioses; silicosis.