High levels of indium exposure relate to progressive emphysematous changes: a 9-year longitudinal surveillance of indium workers.
BACKGROUND
During the last decade it has been clarified that the inhalation of indium compounds can evoke alveolar proteinosis, cholesterol granuloma, pulmonary fibrosis and emphysema. In this study, we aimed to elucidate the characteristics and time course of pulmonary disorders among indium workers using comprehensive pulmonary examinations at an indium-processing factory.


METHODS
Data for 84 male workers who underwent the examinations for nine consecutive years from 2002 to 2010 were analysed regarding their symptoms, serum indium concentration (sIn), serum markers of interstitial pneumonia, pulmonary function test parameters and high-resolution CT (HRCT) findings of the lungs.


RESULTS
In association with improvements in the work environment and work practice, the sIn levels decreased with significant reductions in the KL-6 and surfactant protein D (SP-D) levels. Regarding the HRCT findings, the interstitial lesions regressed partially, whereas emphysematous lesions increased progressively in the workers with high sIn values. FEV1/FVC decreased with the years and the rate of decrease was significantly greater in those with high sIn. The biological half-life of sIn was estimated to be 8.09 years.


CONCLUSIONS
The present findings suggest that the sIn, SP-D, KL-6 levels and radiological interstitial changes can be reduced in indium workers by alleviating exposure to indium, whereas emphysematous lesions can progress among those with a history of heavy exposure.
Department of Medicine, Nikko Memorial Hospital, Hitachi, Japan Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan.
Atsuko
A
Amata
Department of Medicine, Nikko Memorial Hospital, Hitachi, Japan.
Tatsuya
T
Chonan
Department of Preventive Medicine and Public Health, School of Medicine, Keio University, Tokyo, Japan.
Kazuyuki
K
Omae
Department of Medicine, Nikko Memorial Hospital, Hitachi, Japan.
Hiroshi
H
Nodera
Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan.
Jiro
J
Terada
Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan.
Koichiro
K
Tatsumi
D000328:Adult; D003430:Cross-Sectional Studies; D018450:Disease Progression; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007204:Indium / Q000009:adverse effects*; D007564:Japan / Q000453:epidemiology; D008297:Male; D009784:Occupational Diseases / Q000139:chemically induced / Q000175:diagnosis / Q000453:epidemiology*; D016273:Occupational Exposure / Q000009:adverse effects*; D011656:Pulmonary Emphysema / Q000139:chemically induced / Q000175:diagnosis / Q000453:epidemiology*; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D013997:Time Factors
D007204:Indium
Alveolar proteinosis; Emphysema; Interstitial Fibrosis; Occupational Lung Disease