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Exposición Personal Al Asbesto PDF
Exposición Personal Al Asbesto PDF
ORIGINAL ARTICLE
Personal exposure to asbestos and respiratory health of heavy
vehicle brake mechanics
Marı́a Fernanda Cely-Garcı́a1, Carlos A. Torres-Duque2,3, Mauricio Durán3, Patricia Parada2, Olga Lucı́a Sarmiento4,
Patrick N. Breysse5 and Juan P. Ramos-Bonilla1
Asbestos brake linings and blocks are currently used in heavy vehicle brake repair shops (BRSs) in Bogotá, Colombia. Some brake
products are sold detached from their supports and without holes, requiring manipulation before installation. The aim of this study
was to assess asbestos exposures and conduct a preliminary evaluation of respiratory health in workers of heavy vehicles in BRSs.
To estimate asbestos exposures, personal and area samples were collected in two heavy vehicle BRSs. Each shop was sampled
during six consecutive days for the entire work shift. Personal samples were collected on 10 workers including riveters, brake
mechanics, and administrative staff. Among workers sampled, riveters had the highest phase contrast microscopy equivalent
(PCME) asbestos concentrations, with 8-h time-weighted average (TWA) personal exposures ranging between 0.003 and
0.157 f/cm3. Respiratory health evaluations were performed on the 10 workers sampled. Three workers (30%) had circumscribed
pleural thickening (pleural plaques), with calcifications in two of them. This finding is strongly suggestive of asbestos exposure.
The results of this study provide preliminary evidence that workers in heavy vehicle BRSs could be at excessive risk of developing
asbestos-related diseases.
Journal of Exposure Science and Environmental Epidemiology (2015) 25, 26–36; doi:10.1038/jes.2014.8; published online 5 February 2014
Keywords: brake mechanics; riveters; chrysotile; Colombia; pleural plaques; pleural thickening
& 2015 Nature America, Inc. Journal of Exposure Science and Environmental Epidemiology (2015), 26 – 36
Asbestos exposure of brake workers
Cely-Garcı́a et al
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hardware version Somaton Sensation 64, and software version Syngo CT
2006A VB20B (Siemens, Erlangen, Germany). Chest X-rays were Table 1. Demographic characteristics and risk factors for workers
interpreted independently by a pulmonologist certified by NIOSH as a sampled.
ILO B reader, and by a radiologist. CT scans were interpreted
independently by two experienced radiologists using previously Sociodemographic characteristics N (%)
Sex
described criteria.30 Any lack of concordance in the interpretation was Male 8 (80)
resolved by consensus. Female 2 (20)
Tuberculin skin tests (TSTs), using monopuncture intradermal technique
(Mantoux): TSTs were performed in workers with evidence of pleural Age
(circumscribed (plaques) or diffuse thickening or calcification) or 26-32 3 (30)
parenchymal abnormalities. Results were interpreted based on the TST 33-44 4 (40)
quantitative value established by ATS.31,32 45-56 3 (30)
Journal of Exposure Science and Environmental Epidemiology (2015), 26 – 36 & 2015 Nature America, Inc.
Asbestos exposure of brake workers
Cely-Garcı́a et al
29
Figure 1. Steps involved in the manipulation process of heavy vehicle brake linings or blocks.
except for 4 short-term personal samples (i.e., samples R1–day 6– below the LOD, a sensitivity analysis was conducted using half the
a, R3–day 2–c, R3–day 4–b, and R4–day 4–e shown in Table 5). To PCM LOD instead of assuming zero. The sensitivity analysis
determine the potential impact of assuming 0 f/cm3 for samples showed that using half the PCM LOD did not result in new TWA
& 2015 Nature America, Inc. Journal of Exposure Science and Environmental Epidemiology (2015), 26 – 36
Asbestos exposure of brake workers
Cely-Garcı́a et al
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Table 2. Description of heavy vehicle brake repair shops (BRSs) sampled.
PCME concentrations above the occupational standard. For TWA personal concentrations of other workers were grouped together
concentrations that exceeded the standard of 0.1 f/cm3, the results in one category (i.e., other workers). Other workers were exposed
show a negligible impact of this assumption on the TWA to 8 h TWA PCME asbestos concentrations in compliance with
concentrations. For TWA concentrations below 0.1 f/cm3, using both the Colombian and the US OSHA standards.
half the PCM LOD to estimate 8 h TWA concentrations could lead For area samples, most of the PCM concentrations were below
to larger TWA estimations; however, in these cases, the the LOD, including samples collected close to the manipulation
concentrations were so small that the actual concentration equipment. PCM concentrations for area samples (i.e., including
change was negligible as well. The sensitivity analysis described manipulation area, office facilities, and warehouse) ranged from
above is included in Supplementary Table S3. o0.003 to 0.020 f/cm3. The highest PCM area concentration was
Three of the samples collected on R1 and one sample collected collected at the manipulation area of BRS2.
on R3 were overloaded (i.e., see footnote ‘‘c’’ in Table 3). Two All blank filters were analyzed by both PCM and TEM and had
methods were used in these cases to estimate TWA concentra- no fibers detected. Background samples had PCM concentrations
tions. One method assumed that the concentration in overloaded below the LOD and were not analyzed by TEM. Four samples were
sampling windows was 0 f/cm3 (i.e., this assumption was applied considered suspect because of flow drift above 5%. Flow drift for
in all the TWA estimations showed in all the tables). The other these samples ranged between 5.03% and 8.8%. Two of these
method assumed that the concentration in overloaded sampling samples were area samples and the other two were personal
windows was the average concentration of the remaining samples of riveter 1 (R1–day 4, Table 3) and worker 5 (W5). This is
sampling windows of that work shift. A sensitivity analysis of important because the sample of R1 was used in the TWA
these assumptions is presented in Table 4. estimation of one of the non-compliance days of this worker. The
As expected, assuming 0 f/cm3 underestimates TWA concentra- suspect sample of this day was collected over 106 min, and the
tions. However, sample R3–day 1, which was the only sample in PCME concentration of this sample was 0.058 f/cm3.
compliance among the four samples analyzed in Table 4, did not During sampling days, air temperature was B20 1C in both the
change from compliance to non-compliance of the regulatory manipulation area and office facilities in BRS1, and relative humidity
standards after using a different assumption. was B53% and B57% in each microenvironment, respectively. In
Table 5 describes the manipulation activities performed by BRS2, air temperature was B22 1C at the manipulation area and
riveters, and the short-term asbestos concentrations associated B21 1C at the office facility, and relative humidity was B50% and
with these activities. The largest TEM and PCME short-term B52% in each microenvironment, respectively.
asbestos concentrations were associated with complete manip-
ulation activities (i.e., manipulation that included beveling and
grinding, on top of unriveting, drilling, countersinking, and Respiratory Health Evaluation of Workers Sampled
riveting). Manipulation activities that performed all but beveling Table 7 summarizes the results of the respiratory evaluation of the
and grinding (i.e., unriveting, drilling, countersinking, and riveting) 10 workers. All chest X-rays were normal. CT scans were abnormal
were associated with the second highest short-term concentra- in 4 of 10 subjects; some of them had more than one abnormality.
tions, followed by exposures during cleaning activities. For short- Of the three subjects with pleural calcifications (R2, W3, and W4),
term samples that exceeded 30 min, the TWA was estimated using two had circumscribed pleural thickening (plaques). In these three
the entire sampling time. All short-term exposures were in subjects, the TST was negative. We found two mild abnormalities
compliance with the US OSHA STEL (1 f/cm3). However, several in PFT, but the four subjects with abnormal CT scan had normal
PCME 30 min asbestos concentrations were 450% of the US PFT.
OSHA STEL, and some 30 min samples had TEM concentrations of Table 8 shows detail information of smoking status and imaging
41 f/cm3 (i.e., recognizing that TEM concentrations cannot be results for each worker sampled. Two subjects had mild alteration
used to determine regulatory compliance). of pulmonary function; W2 had obstructive defect, and R4 had
A summary of the results of PCME personal samples for both 8 h decreased diffusing capacity (i.e., detailed information regarding
TWA and 30 min samples for each type of worker is presented in pulmonary function results is presented in Supplementary Table
Table 6. As riveters were the workers with the highest exposures, S4). All the subjects with CT abnormalities had normal PFT. Based
Journal of Exposure Science and Environmental Epidemiology (2015), 26 – 36 & 2015 Nature America, Inc.
Asbestos exposure of brake workers
Cely-Garcı́a et al
31
Table 3. Phase contrast microscopy equivalent (PCME) TWA personal samples for riveters.
Worker–day Sampling Actual sampling PCME TWA only US OSHA STANDARD COLOMBIAN STANDARD
windows used in time (total using actual (0.1 f/cm3 for 8 h TWA) (0.083 f/cm3 for 9 h TWA)
calculations sampling time) sampling time
(total sampling (min) (f/cm3)
windows)
Time assumed PCME Time assumed PCME
with 0 f/cm3 to concentration with 0 f/cm3 to concentration
complete 8 h for 8-hr TWA complete 9 h for 9-hr TWA
TWA (min) (f/cm3) TWA (min) (f/cm3)
Table 4. Comparison of TWA phase contrast microscopy equivalent (PCME) asbestos concentrations using two estimation approaches for
overloaded samples.
Worker–day Calculation assuming 0 f/cm3 Calculation assuming TWA concentration of the remaining
for overloaded samples sampling windows for overloaded samples
Actual PCME TWA PCME PCME Sampling time PCME TWA for PCME PCME
sampling for actual concentration concentration including time new sampling concentration concentration
time (min) sampling for 8 h TWA for 9 h TWA of overloaded time (f/cm3) for 8 h TWA for 9 h TWA
time (f/cm3) (f/cm3) (f/cm3) sample (min) (f/cm3) (f/cm3)
& 2015 Nature America, Inc. Journal of Exposure Science and Environmental Epidemiology (2015), 26 – 36
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Table 5. Short-term transmission electron microscopy (TEM) and phase contrast microscopy equivalent (PCME) asbestos concentrations and related
activities.
Worker–day– Sampling Chrysotile TEM asbestos PCME asbestos PCME TWA 30 min Activities
sample time (min) fibers counted concentration concentration asbestos concentration
(TEM f/F ratio) (f/cm3) (f/cm3) (f/cm3)
Journal of Exposure Science and Environmental Epidemiology (2015), 26 – 36 & 2015 Nature America, Inc.
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Table 5. (Continued )
Worker–day– Sampling Chrysotile TEM asbestos PCME asbestos PCME TWA 30 min Activities
sample time (min) fibers counted concentration concentration asbestos concentration
(TEM f/F ratio) (f/cm3) (f/cm3) (f/cm3)
R4–day 2–a 31 70 (0.99) 1.215 0.459 0.459 Worker used electric circular saw on asbestos-
containing blocks.
R4–day 2–b 24 19 (1) 0.425 0.251 0.201 Manipulation activitiesa of 2 asbestos-
containing linings.
R4–day 2–c 31 24 (1) 0.428 0.222 0.222 Manipulation activitiesa of 4 asbestos-
containing linings.
R4–day 3–a 30 19 (1) 0.352 0.141 0.141 Manipulation activitiesa of 4 non-asbestos-
containing linings.
R4–day 4–a 34 19 (1) 0.297 0.112 0.112 Manipulation activitiesa of 4 asbestos-
containing blocks.
R4–day 4–b 35 26 (1) 0.410 0.236 0.236 Cleaning activities of brake system. Unriveting
old liningse.
R4–day 4–c 30 32 (1) 0.565 0.287 0.287 Manipulation activitiesa of 4 asbestos-
containing blocks.
R4–day 4–d 30 20 (1) 0.343 0.072 0.072 Manipulation activitiesa of 4 asbestos-
containing blocks.
f
R4–day 4–e 29 — — — — Brake mechanic’s activities. Unriveting old
linings.e
R4–day 4–f 30 0 (0) o0.018 0.000 0.000 Manipulation activitiesa of 2 asbestos-
containing linings. Worker drilled the edges to
get the proper size of these linings.
R4–day 5–a 30 9 (1) 0.168 0.181 0.181 Manipulation activitiesa of 2 asbestos-
containing linings.
R4–day 5–b 30 25 (1) 0.447 0.151 0.151 Manipulation activitiesa of 2 asbestos-
containing linings.
R1, riveter 1; R2, riveter 2; R3, riveter 3; R4, riveter 4.
a
Manipulation activities include: unriveting old lining or block, drilling, countersinking, and riveting new lining or block.
b
Filter loaded with particulate that may affect analytical result.
c
Complete manipulation activities include: unriveting old lining or block, drilling, countersinking, riveting, beveling, and grinding new lining or block.
d
Small linings are used for emergency brakes.
e
Asbestos presence in brake products cannot be determined.
f
Samples were not analyzed by TEM because PCM concentrations were oLOD.
g
PCM fiber concentration was oLOD, but sample was analyzed by TEM.
workers non-exposed to asbestos was not established. However, Thus, riveters could be at excessive risk of developing asbestos-
our results can be contextualized in relation with the prevalence related diseases. This is aggravated because of the high
of pleural plaques in the general population reported in the prevalence of smoking observed in this group of workers.
literature that ranges from 0.02% to 7.5%,18–20 and in men can go Smoking has a synergistic effect with asbestos exposure in the
up to 12.8%.20 These values are below the percentage found in risk of developing lung cancer.35
the current study. Furthermore, because tuberculosis can cause Manipulation activities are required because brake products are
pleural thickening and plaques, TSTs were performed in all the commercialized detached from their supports and in most cases
workers who had imaging evidence of pleural plaques. The three without holes. Grinding and beveling, which were some of the
workers with pleural calcifications had a negative TST result. manipulation activities identified in the current study, have been
Although this finding does not completely rule out tuberculosis, it identified in previous studies as opportunities of exposure
is strongly suggestive that the pleural plaques could be related because of the release of asbestos fibers.6,36
with asbestos exposure. Moreover, no other causes of pleural A study similar in design to the current study conducted on
diseases were identified in the clinical evaluation. Recognizing passenger vehicle BRSs13 found that all the workers were exposed
that the sample size of workers evaluated is small (n ¼ 10), this to concentrations in compliance with the US OSHA PEL and US
finding is important because of the high apparent prevalence OSHA STEL. Recognizing that the sample size in both studies in
(30%) of pleural calcifications, and because these workers were terms of the number of BRSs and workers sampled is small, the
exclusively exposed to chrysotile. Furthermore, imaging results suggest that riveters who work in heavy vehicle BRSs
evaluation included both chest X-ray and CT scans, and some appear to be at higher risk for overexposure compared with
studies have shown that CT scans are better for the detection of workers in passenger vehicle BRSs.
pleural plaques.18,33,34 Several samples collected in the BRSs Our findings differ from the results of several studies conducted
where these mechanics currently work exceeded both the US in high-income countries that have concluded that brake
OSHA and Colombian occupational standards. To the best of our mechanics are not at excessive risk of developing asbestos-related
knowledge, this is the first study to analyze simultaneously diseases.7–11 However, brake mechanics in high-income countries
asbestos exposures and respiratory health of brake mechanics and do not routinely manipulate asbestos-containing brake products
riveters of heavy vehicle BRSs in low- and middle-income to the extent observed in this study.
countries. High exposure concentrations in BRSs were reported in a study
This study documented that riveters working in the conducted in Iran. Brake mechanics analyzed worked in both
heavy vehicle BRSs sampled have to perform manipulation passenger vehicle and heavy vehicle shops, and were exposed to
activities of asbestos-containing brake products, and in some a mean PCM concentration of 0.46 f/cm3.12 PCM concentrations
cases this manipulation resulted in asbestos exposures not reported in the Iran study were higher compared with the results
in compliance with the US OSHA and Colombian standards. of the current study. Unfortunately, the Iran study did not estimate
In other cases, the exposures exceeded the US OSHA action level. PCME concentrations.
& 2015 Nature America, Inc. Journal of Exposure Science and Environmental Epidemiology (2015), 26 – 36
Asbestos exposure of brake workers
Cely-Garcı́a et al
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Table 6. Phase contrast microscopy equivalent (PCME) personal statistics summary for both brake repair shops (BRS) sampled.
Although short-term personal samples of the current study pulmonary function loss was higher on asbestos-exposed workers
were in compliance with the US OSHA STEL, some TEM short-term who also smoke.37 As smoking is common in the workers sampled,
personal concentrations were 41 f/cm3. The higher TEM concen- including riveters, these workers should be followed-up closely.
trations provide additional support to the conclusion that brake Imaging evaluations showed that 3 workers (30%) had pleural
mechanics could be at excessive risk of developing asbestos- thickening with calcifications that are considered markers of
related diseases. asbestos exposure,34,35,40 and can occur in 20–60% of occupation-
Interestingly, some short-term personal samples collected ally exposed workers.35 A fourth worker also had these CT features,
during the manipulation of non-asbestos-containing brake pro- but was positive in the TST that can confound this finding. Similar
ducts detected the presence of asbestos fibers (i.e., R1–day 2–b pleural abnormalities have been recently described in a study of
and R1–day 4–b; Table 5). This result could have two potential 103 French brake mechanics that reported 5 cases (4.9%) with
explanations: first, labels were incorrect and the brake products pleural thickening.33 However, none of the workers evaluated in the
did in fact have asbestos fibers; second, as the manipulation current study had interstitial compromise (i.e., asbestosis), as
equipment was covered with dust and fibers from previous reported in the French study. Brake mechanics in the French
manipulation activities, the manipulation process may have study were exposed to chrysotile, similar to the workers sampled in
resuspended fibers exposing the worker. A similar event was the current study. Both studies used CT scans that are the most
observed in passenger vehicle BRSs.13 accurate method to detect pleural thickening.33,34 Recognizing that
The elevated personal asbestos concentrations identified for R1 there is an important difference in sample size between the two
occurred despite the fact that a local ventilation system was studies (i.e., the current study only evaluated 10 workers), the
constantly operated during the manipulation activities. Thus, a prevalence of pleural thickening in Bogotá is higher than the results
false expectation of safety may have been created for this worker. obtained in the French study.33 Manipulation activities performed
It was strongly recommended that the ventilation design and by the riveters of Bogotá, and the use of non-appropriate
performance be revaluated and that major improvements should respiratory protection, could help explain this difference.
be implemented. As chrysotile was the only type of asbestos found, and workers
Although asbestos concentrations were high, only four samples sampled did not have other occupational history of asbestos
were overloaded. This highlights the importance of designing a exposure, this study provides additional information regarding
proper sampling strategy in heavily polluted occupational personal exposures of workers exclusively exposed to chrysotile.4,16,41
environments. Although the number of overloaded samples was This study, combined with the results presented in a previous
small, their impact on exposure underestimation can be study of our research group,13 could help inform current efforts to
important. Because of this, strategies to include overloaded reconstruct historical asbestos exposures of brake mechanics.
samples in TWA estimations have to be considered, as it was Nevertheless, additional efforts are needed to characterize asbestos
discussed in the Results section of this study. exposures, not only for brake mechanics, but also for other
Administrative staff spend most of their work shifts at the office occupations that use and manipulate asbestos-containing products.
facilities and the warehouse that are microenvironments where no This study has a number of weaknesses. The principal limitation
manipulation activities are performed. Although they were exposed is the small sample size in terms of numbers of shops and workers
to asbestos fibers, all administrative workers and brake mechanics sampled. The small sample size may limit the generalizability of
who do not manipulate brake products had personal asbestos the data. We have visited a number of other BRSs in Bogotá
exposures in compliance with the standards. The maximum 8 h TWA (Colombia) and the shops sampled are typical of the city in terms
PCME concentration for non-riveter workers was 0.017 f/cm3. of size, manipulation activities, and amount of work. Although the
Asbestos-related diseases were not diagnosed in any of the number of shops and workers sampled is small, their exposure
workers evaluated in this study. Reports of pulmonary diseases on characterization is extensive, with a total of 235 samples collected
brake repair workers exclusively exposed to chrysotile asbestos are during the assessment campaigns. In addition, these results are
scarce.4,33,37,38 Furthermore, some authors report that brake important because very few assessments of BRSs in developing
mechanics are not at excessive risk of developing asbestos- countries have been published. As a result, this paper is a
related diseases.36,39 Previous studies have shown that asbestos- significant contribution to the literature, highlighting the impor-
exposed brake mechanics can have functional abnormalities tant public health problem of asbestos and brake repairs in low-
including restrictive impairment with decreased forced vital and middle-income countries.
capacity and total lung capacity.37 This was not the case for the In conclusion, this study identified the deplorable working
workers sampled in the current study. Erdinc¸ et al.37 reported that conditions of a group of heavy vehicle brake mechanics,
Journal of Exposure Science and Environmental Epidemiology (2015), 26 – 36 & 2015 Nature America, Inc.
Asbestos exposure of brake workers
Cely-Garcı́a et al
35
ACKNOWLEDGEMENTS
Table 7. Respiratory health evaluation of workers sampled.
We thank the owners, administrative staff, brake mechanics, and riveters from the
BRSs sampled. We also thank the Research Vice-presidency, the School of
Previous cardiorespiratory diseases reported by workers N (%)
Engineering, and the Department of Civil and Environmental Engineering from
Previous respiratory diseasesa 1 (10) Universidad de Los Andes for their financial support. The collaboration received from
Previous CHDb 1 (10) the staff of Fundación Neumológica Colombiana and the Radiology Department in
Respiratory health resultsc Fundación Cardioinfantil in Bogotá is also greatly appreciated. Finally, we thank
Pulmonary function tests Forensic Analytical Laboratories for the analysis of the samples. All the equipment
Normal 8 (80) used to assess exposure was acquired with the financial support of the Department
Obstructive defect 1 (10) of Civil and Environmental Engineering from Universidad de Los Andes. Laboratory
Decreased diffusing capacity 1 (10) analysis and respiratory health evaluations were performed with the financial support
Chest X-ray of the Research Vice-presidency, the School of Engineering, and the Department of
Normal 10 (10) Civil and Environmental Engineering from Universidad de Los Andes.
CT scan
Normal 6 (60)
Abnormal (two workers had more than one 4 (40)
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