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KQH 073
KQH 073
doi:10.1093/occmed/kqh073
IN-DEPTH REVIEW
(20–40 years), one can realistically expect cases to During the last 30 years, the prevalence of CWP
continue to present well into the twenty-first century [3]. has fallen consistently in the USA. In active under-
Although in the UK it has been estimated that the ground miners included in the National Institute for
mesothelioma rates would decline by only the second Occupational Safety and Health (NIOSH) Coal Workers’
decade of the twenty-first century [20], there is some X-ray Surveillance Program [19], rates fell from >10% in
evidence [21,22] that the rates may be dropping already. the early 1970s to <2% in the late 1990s (consistent with
Despite many years of clinical research, there is still no the estimated current rate in South Africa of 2.6%) [30].
effective therapy for malignant mesothelioma; untreated Similar trends have been noted in Europe [3,8].
the median survival time is 9 months. Chemotherapy, Nevertheless, dust levels in coal mines are still high. A
· mine
the balance of evidence points overwhelmingly to coal
dust being a cause of impaired lung function;
suggested that the level be lowered to 0.01 mg/m3
[46,47].
· the best estimate
this can be disabling; Although the major determinant of silicosis is the lung
· volume in 1 s) in ofrelation
the loss of FEV (forced expiratory
1
to exposure of coal miners is
dust burden, there is accumulating evidence that other
variables such as freshly fractured silica, admixtures of
0.76 ml/g h/m3; and other minerals, e.g. clay components which can coat the
· the combined effects of coal mine dust and smoking on
FEV1 appear to be additive.
surface of the silica [29] and peak exposures also may be
important [36]. Individual susceptibility to the disease
determined using biomarkers may also play a role [48].
Tuberculosis
Silicosis The association between silicosis and tuberculosis has
long been recognized. Rates for active tuberculosis in
silicotic subjects range from 2- to 30-fold more than those
Risk and prevalence
in the same workforce without silicosis [52]. Factors
Silicosis continues to be a major disease world wide, even which influence the development of tuberculosis include
in developed countries, affecting workers in mining and the severity of silicosis, the prevalence of tuberculosis in
other occupations, including construction and foundries the population from which the work force was drawn, as
[3,19]. This avoidable disease remains a significant cause well as their age, general health and HIV status [2,52].
of morbidity and mortality [42]. Furthermore, reported Exposure to silica, without silicosis, may also predispose
cases are a gross underestimate of the total cases of individuals to tuberculosis [52,53]. Although M.
silicosis [43], and in some settings, the prevalence of tuberculosis is the usual organism, NTM account for a
silicosis is rising [44]. large proportion of the mycobacterial disease in some
Although silica dust is one of the most documented populations [42,54]. The prevalence of HIV infection in
workplace exposures, there is controversy over the precise developing countries has and will increase the burden of
quantitative relationship between dust inhalation and the tuberculosis in miners exposed to silica dust. A recent
development of disease. Scientific evidence is increasingly study [55] of the effect of HIV infection on silicosis and
demonstrating that exposure over a working lifetime to tuberculosis incidence in black South African gold
the commonly used standard of 0.1 mg/mg3 will result in mineworkers found that HIV infection increased the
a significant burden of radiological silicosis and also incidence of tuberculosis by five times and silicosis
death from silicosis and lung cancer [45]. The evidence is increased the incidence of tuberculosis by three times.
insufficient to indicate whether or not halving this level to The co-existence of HIV and silicosis increased the
0.05 mg/m3 would be protective and hence it has been incidence of tuberculosis multiplicatively by fifteen times.
308 OCCUPATIONAL MEDICINE
Potential (IRDGP) of South African Coals. SIM 020604 prediction and early detection of pneumoconiosis.
Report. Johannesburg: Safety in Mines Research Advisory SIM030803 SIMRAC Report. Johannesburg: Safety in
Committee (SIMRAC), 2003. Mines Research Advisory Committee (SIMRAC), 2004.
36. Buchanan D, Miller BG, Soutar CA. Quantitative relations 49. Mossman BT, Churg A. Mechanisms in the pathogenesis
between exposure to respirable quartz and risk of silicosis. of asbestosis and silicosis. Am J Respir Crit Care Med
Occup Environ Med 2003;60:159–164. 1998;157:1666–1680.
37. Carta P, Aru G, Barbieri MT, et al. Dust exposure, 50. Checkoway H, Hughes JM, Weill H, et al. Crystalline silica
respiratory symptoms, and longitudinal decline of lung exposure, radiological silicosis, and lung cancer mortality
function in young coal miners. Occup Environ Med in diatomaceous earth industry workers. Thorax
1996;53:312–319.