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Vol. 55. Issue 7.
Pages 394-395 (July 2019)
Vol. 55. Issue 7.
Pages 394-395 (July 2019)
Letter to the Editor
DOI: 10.1016/j.arbr.2019.01.002
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Silicosis Caused by Artificial Quartz Conglomerates: Keys to Controlling an Emerging Disease
Silicosis por aglomerados artificiales de cuarzo: claves para controlar una enfermedad emergente
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Aránzazu Pérez-Alonsoa,
Corresponding author
, Juan Antonio Córdoba-Doñab, Antonio León-Jiménezc,d
a Servicio de Medicina Preventiva y Salud Laboral, Hospital Universitario de Puerto Real, Puerto Real, Cádiz, Spain
b Servicio de Salud Pública, Delegación Territorial de la Consejería de Salud, Cádiz, Spain
c Servicio de Neumología, Hospital Universitario Puerta del Mar, Cádiz, Spain
d Servicio de Neumología, Hospital Universitario Puerto Real, Puerto Real, Cádiz, Spain
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Table 1. Clinical and occupational characteristics of workers.
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To the Editor,

The interesting editorial by Martínez-González1 on changes in the clinical and epidemiological profile of pneumoconiosis caused by exposure to silica in our country highlights a novel source of exposure: the emergence in the 1990s of artificial quartz agglomerates (AQA) for the construction of kitchen worktops and surfaces.

In the Spanish province of Cadiz between 2009 and 2012, we detected a cluster of cases in small family decorative stone-working businesses in local industrial parks, where exposed workers specializing in the machine-working of AQA were employed in poor working conditions. In our experience, this emerging silicosis affects young men after intense exposure over short periods of time.2,3

Despite awareness of the danger of this exposure, deficiencies in health and safety measures continue to be detected. As an example, we present the clinical and occupational characteristics (Table 1) of a new cluster of 7 cases diagnosed with simple chronic silicosis at the end of 2015, originating in a decorative stone-working company in Seville employing 11 workers. Mean age at diagnosis was 34.9 years, mean employment history in the company was 11.6 years, and the prevalence of silicosis was 63.6%. Dry polishing, cutting and finishing were carried out in the workshop and in homes, and these finishing activities continued to be performed using dry techniques, despite introducing machinery with water intake in 2011. It is interesting to note the family relationships between 4 of those affected.

Table 1.

Clinical and occupational characteristics of workers.

Series  Age at diagnosis (years)  Working history (years)  Position  Diagnostic test  Spirometric pattern DLCO  mMRC dyspnea  Personal history  Toxic habits  Affected relative 
Case 1  30  10  Workshop, home  HRCT  Normal  Grade 1  Asthma, rhinoconjunctivitis  Active smoker  No 
Case 2  33  16  Workshop  HRCT  Mild obstructive  Grade 1  Asthma, pericarditis  No  Father (case 3). 
Case 3  54  10  Home  HRCT  Normal  Grade 1  Not significant  Active smoker  Son (case 2). 
Case 4  39  13  Home  HRCT  Mild reduction in DLCO  Grade 2  Phthisis bulbi right eye, mild hearing loss right ear  Active smoker  Brother (case 5). 
Case 5  31  14  Workshop  HRCT  Normal  Grade 1  Not significant  Active smoker  Brother (case 4). 
Case 6  30  12  Workshop  HRCT  Normal  Grade 1  Psoriasis  No  No 
Case 7  27  Workshop, home  Transbronchial biopsy  Normal  Grade 1  Not significant  No  No 

DLCO: diffusing capacity of carbon monoxide; mMRC: Modified Medical Research Council dyspnea scale; HRCT: high-resolution computed tomography.

Six of the silicosis cases were diagnosed using high-resolution computed tomography (HRCT), and the seventh was diagnosed by transbronchial biopsy after a history of occupational exposure was collected. No standard chest X-rays were performed in examinations conducted before diagnosis. In our practice, the health monitoring of exposed workers must include a standard chest X-ray, although HRCT is useful if the radiological findings are unclear, and for monitoring slow-progressing disease.4 However, confirmatory diagnostic criteria in the management of radiological tests must be fulfilled.

With regard to prevention, doubts have been raised as to the effectiveness of daily exposure limits. In 2015, the National Institute for Health and Safety at Work decreased the limit for free crystalline silica exposure from 0.1mg/m3 to 0.05mg/m3, but the institutions involved must be aware that this reduction in daily exposure limits must also be accompanied by greater rigor in the implementation of both preventive measures and inspections.

Due to the seriousness of the situation in Andalusia (between 2007 and 2015, 126 cases of occupational disease due to silicosis in workers exposed to AQA were reported), a comprehensive pioneer program for this new form of silicosis was proposed in 2017, that is still pending evaluation.5

Although the economic crisis resulted in a decline in the construction sector and consequently in the manufacture and installation of AQA worktops, a resurgence of this economic activity has been observed, so surveillance and monitoring of this emergent form of silicosis must be stepped up, in order to ensure safe and healthy workplaces and to protect workers and their families after diagnosis.

Conflicts of interest

The authors declare no conflicts of interest.

References
[1]
C. Martínez-González.
Cambio en el perfil de las enfermedades por la exposición a la inhalación de sílice.
Arch Bronconeumol, 54 (2018), pp. 5-6
[2]
A. Pérez-Alonso, J.A. Córdoba-Doña, J.L. Millares-Lorenzo, E. Figueroa-Murillo, C. García-Vadillo, J. Romero-Morillo.
Outbreak of silicosis in Spanish quartz conglomerate workers.
Int J Occup Environ Health, 20 (2014), pp. 26-32
[3]
A. Pérez-Alonso, J.A. Córdoba-Doña, C. García-Vadillo.
Aportaciones de la tomografía axial computarizada de alta resolución en la detección precoz de silicosis.
Arch Bronconeumol, 51 (2015), pp. 528-529
[4]
T. Tamura, N. Suganuma, K.G. Hering, T. Vehmas, H. Itoh, M. Akira, et al.
Relationships (I) of international classification of high-resolution computed tomography for occupational and environmental respiratory diseases with the ILO international classification of radiographs of pneumoconioses for parenchymal abnormalities.
Ind Health, 53 (2015), pp. 260-270
[5]
J.F. Álvarez Zarallo, J.P. Cabrera Eisman, J.A. Córdoba Doña, F. García Ruiz, F.J. Leal Reina, A. Rabadán Asensio.
Programa Integral de Silicosis de Andalucía en el manipulado de aglomerados de cuarzo PL Sevilla.
Consejería de Salud, Consejería de Empleo, Empresa y Comercio, (2017),

Please cite this article as: Pérez-Alonso A, Córdoba-Doña JA, León-Jiménez A. Silicosis por aglomerados artificiales de cuarzo: claves para controlar una enfermedad emergente. Arch Bronconeumol. 2019;55:394–395.

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