Qualidade dos registros de ocupação das doenças associadas ao asbesto no sistema de informação sobre mortalidade, Brasil / Quality of occupation records of asbestos-related diseases in the mortality information system, Brazil

Resumo Introdução: Registros de ocupações de trabalhadores em sistemas de informação significam muito mais que um dado sociodemográfico. Na Medicina do Trabalho e na Epidemiologia em Saúde do Trabalhador, são especialmente relevantes por indicarem possíveis fatores de risco ocupacionais. Objetivo: Estimar indicadores de qualidade do registro da ocupação das doenças associadas ao asbesto no Sistema de Informação sobre Mortalidade (SIM), Brasil. Método: Estudo transversal conduzido com registros de óbito de maiores de 16 anos de idade, registrados no SIM, entre 2000-2016, com diagnósticos de doenças tipicamente associadas ao asbesto (DAA): mesotelioma, asbestose e placas pleurais. O registro da "ocupação" foi analisado para a completude e consistência. Resultados: Foram identificados 3.764 registros de óbito, para os quais observou-se 60,3% (n=2.268) de incompletude/inconsistência do registro da ocupação. Dados inválidos da ocupação representaram 40,1% (n=1.508), concentrando-se em registros de aposentados e donas de casa, não reconhecidos como ocupações. A má qualidade do registro de ocupação entre os óbitos por DAA foi superior a 50,0% em todas as regiões do país. Conclusões: A qualidade do registro da ocupação no SIM foi ruim tanto para as DAA quanto outros diagnósticos, especialmente no que se refere a completude e consistência dos dados, em relação à Classificação Brasileira de Ocupações.

Abstract Background: Records from occupations of workers in information systems mean much more than just sociodemographic data. In Occupational Medicine and Occupational Health Epidemiology, they are especially relevant as they indicate possible occupational risk factors. Objective: To estimate quality indicators of the record of occupation of asbestos-related diseases in the Mortality Information System (SIM), Brazil. Method: Cross-sectional study, conducted with death records of people over 16 years of age, registered in SIM, from 2000 to 2016, with diagnoses of asbestos-related diseases (ARD): mesothelioma, asbestosis, and pleural plaques. The "occupation" field was analyzed for completeness and consistency. Results: From a total of 3,764 death records, for which 60.3% (n=2,268) of missed/inconsistent occupation records were observed. Invalid occupation data accounted for 40.1% (n=1,508), mainly filled with "retired" or "housewives", not recognized as formal job titles. The poor occupancy record quality among ARD records was over 50.0% in all regions of the country. Conclusions: The quality of the occupation records in SIM was poor for both ARD and other diagnoses, especially regarding the completeness and consistency of the data, in relation to the Brazilian Classification of Occupations.

Non-occupational Asbestosis: a Potential Risk that should be Considered / Asbestosis no ocupacional: un riesgo potencial que tener en consideración

ABSTRACT The association of occupational exposure with respiratory diseases is well-known. Non-occupational exposure has been recognized for over sixty years. It is necessary to differentiate two types of non-occupational asbestosis: a) Environmental (close or residential exposure). b) Domestic or home exposure. Proximity to a factory that uses asbestos is an important health risk. The environmental levels of this mineral can be dangerous when the clothes worn in the workplace with exposure to asbestos are washed at home. Unaware workers take their clothes home, and their homes could have high levels of asbestos. Contaminated clothing should be left in the workplace. Employees and workers must be educated on the occupational risks and hazards, thus minimizing the risk of developing a disease, especially one that can be prevented.

RESUMEN Es ampliamente conocida la relación entre una ocupación laboral y las enfermedades pulmonares. La exposición no ocupacional se reconoce desde hace más de sesenta años. Es necesario diferenciar dos tipos de exposiciones en asbestosis no ocupacional: a) Ambiental (cercana o residencial). b) Exposición doméstica u hogareña. La vecindad a una fábrica, donde se utiliza amianto, representa un gran riesgo para la salud. Los niveles del mineral en el medio ambiente pueden ser peligrosos cuando la ropa usada en trabajos con amianto se lava en el hogar. Si debido al desconocimiento llevaran su ropa a casa, los hogares de los trabajadores podrían contener altos niveles de amianto. La ropa contaminada debe permanecer en el lugar de trabajo. Los empleadores y los trabajadores deben ser educados sobre los riesgos y los peligros de los riesgos laborales, lo que lleva a minimizar una enfermedad especialmente prevenible.

Asbestosis no ocupacional: un riesgo potencial a tener en consideración / Non-occupational Asbestosis: a Potential Risk that should be Considered

Es ampliamente conocida la relación entre una ocupación laboral y las enfermedades pulmonares. La exposición no ocupacional se reconoce desde hace más de sesenta años. Es necesario diferenciar dos tipos de exposiciones en asbestosis no ocupacional: a) Ambiental (cercana o residencial). b) Exposición doméstica u hogareña. La vecindad a una fábrica, donde se utiliza amianto, representa un gran riesgo para la salud. Los niveles del mineral en el medio ambiente pueden ser peligrosos cuando la ropa usada en trabajos con amianto se lava en el hogar. Si debido al desconocimiento llevaran su ropa a casa, los hogares de los trabajadores podrían contener altos niveles de amianto. La ropa contaminada debe permanecer en el lugar de trabajo. Los empleadores y los trabajadores deben ser educados sobre los riesgos y los peli gros de los riesgos laborales, lo que lleva a minimizar una enfermedad especialmente prevenible.

The association of occupational exposure with respiratory diseases is well-known. Non-occupational exposure has been recognized for over sixty years. It is necessary to differentiate two types of non-occupational asbestosis: a) Environmental (close or residential exposure). b) Domestic or home exposure. Proximity to a factory that uses asbestos is an important health risk. The environmental levels of this mineral can be dangerous when the clothes worn in the workplace with exposure to asbestos are washed at home. Unaware workers take their clothes home, and their homes could have high levels of asbestos. Contaminated clothing should be left in the workplace. Employees and workers must be educated on the occupational risks and hazards, thus minimizing the risk of developing a disease, especially one that can be pre vented.

Chest high-resolution CT features analysis in predicting the progression of asbestosis / 中华劳动卫生职业病杂志

Objective: To analyze the radiological characteristics of chest high-resolution computed tomography (HRCT) of patients with asbestosis, and to investigate the signs of predicting the disease progression of asbestosis. Methods: A prospective method was used to enroll 68 patients with asbestosis who were regularly followed up from 2013 to 2016. The radiological characteristics of patients with asbestosis were described by the International Classification of HRCT for Occupational and Environmental Respiratory Diseases (ICOERD) , and the differences between patients with and without progression were compared during the observation period. The Cox proportional hazards regression model was used to analyze the chest HRCT radiological signs predicting the progression of asbestosis. Results: The study included 68 patients with asbestosis aged (65.5±7.8) years old, of which 64.7% (44/68) were female, 29.4% (20/68) had a history of smoking. There was no significant difference in age, sex, smoking and asbestos exposure between patients with progressive asbestosis (20.6%, 14/68) and patients without progressive asbestosis (79.4%, 54/68) (P>0.05) . Chest HRCT of patients with asbestosis showed irregular and/or linear opacities, of which 5.9% (4/68) were accompanied by honeycombing. Irregular and/or linear opacities were mainly lower lung preponderant, often accompanied with ground glass opacity and mosaic perfusion. 98.5% (67/68) had pleural abnormalities, of which 39.7% (27/68) had diffuse pleural thickening with parenchymal bands and/or rounded atelectasis. The analysis of multivariable Cox proportional hazard regression showed that the risk of the progression of asbestosis was increased with higher irregular and/or linears opacities cores (HR=1.184, 95%CI: 1.012-1.384, P=0.034) and the appearance of honeycombing (HR=6.488, 95%CI: 1.447-29.097, P=0.015) . Conclusion: The irregular and/or linear opacities scores and honeycombing on chest HRCT are independent influencing factors for predicting the disease progression of asbestosis.

Mesotelioma en paciente colombiano con sobrevida mayor a tres años: presentación de caso / Mesothelioma in a Colombian Patient over three years: Case Presentation / Mesotelioma em paciente colombiano com sobrevivência superior a três anos: apresentação de caso

Resumen Introducción: el mesotelioma epitelioide es un tumor que se desarrolla en las capas embrionarias mesoteliales; es de etiología desconocida, pero se relaciona con la exposición al asbesto, con una presentación clínica inespecífica y con un pronóstico de sobrevida corto después del diagnóstico. Presentación del caso: hombre de profesión mecánico automotor, con tos sin expectoración, disnea, hipertermia y emaciación posterior a la extracción quirúrgica de lipomas que afectaban el tórax, quien posteriormente fue diagnosticado con mesotelioma epitelioide maligno con ubicación en la pleura del hemitórax derecho y fue tratado con toracotomía, quimioterapia con los medicamentos pemetrexed y cisplatino y sesiones de radioterapia, que mostraron un aumento en la sobrevida 3 tres años. Conclusión: este caso permitió identificar que el uso de la pleurodesis química con quimioterapia como tratamiento podría ser responsable del aumento de la esperanza de vida y la calidad de esta en los pacientes que padecen este tipo de tumor.

Abstract Introduction: Epithelioid mesothelioma is a tumor that develops in the mesothelial embryonic layers; it is of an unknown etiology, but it is related to asbestos exposure with a nonspecific clinical presentation and a short survival prognosis after diagnosis. Case presentation: An automotive mechanic patient presents with cough without expectoration, dyspnea, hyperthermia, and emaciation following surgical removal of lipomas. This affected the chest and the patient was subsequently diagnosed with malignant epithelioid mesothelioma located in the pleura of the right hemithorax. The patient was treated with thoracotomy, chemotherapy with the drugs pemetrexed and cisplatin, and radiation therapy sessions which resulted in an increased survival rate at 4 years. Conclusion: This case report identifies the use of chemical pleurodesis in combination with chemotherapy as an effective treatment for increasing the life expectancy and quality of life in patients suffering from this type of tumor.

Resumo Introdução: o mesotelioma epitelióide é um tumor que se desenvolve nas camadas embrionárias mesote-liais; é de causa desconhecida, mas está relacionado com a exposição ao amianto e possui uma manifestação clínica inespecífica e com prognóstico de sobrevivência curto após o diagnóstico. Apresentação do caso: o paciente é um mecânico automotivo, que apresentou tosse seca, dispneia, hipertermia e emagrecimento posterior a extração cirúrgica de lipomas que afetavam o tórax sendo posteriormente diagnosticado com mesotelioma epitelióide maligno localizado na pleura do hemitórax direito e foi tratado com toracotomia, quimioterapia com os medicamentos pemetrexed e cisplatino além de sessões de radioterapia, mostrando um aumento de expectativa de vida para 4 anos. Conclusão: este estudo de caso permite identificar que o uso da pleurodese química com quimioterapia como tratamento poderia ser a responsável pelo aumento da expectativa e qualidade de vida em pacientes acometidos por este tipo de tumor.

Evaluation of respiratory dysfunction in patients with asbestos lung based on pulmonary function indexes utilizing CT / 国际生物医学工程杂志

Objective To evaluate the changes and characteristics of respiratory function and pulmonary function in patients with asbestosis by multi-slice spiral CT imaging.Methods 61 asbestosis patents and 30 healthy subjects were enrolled and divided into normal re spiratory function group,mild injury group and moderate/severe injury group according to forced vital capacity and forced expiratory volume in one second.The lungs were scanned at the end of inspiratory and expiratory phase,and the lung volume,lung density and small airway index were measured.Results There were significant differences in lung volume (inspiratory and expiratory volume,volume difference,and volume ratio) among the normal group,the mild injury group and the moderate/severe injury group (all P＜0.05).There were statistically significant differences in the mean lung density (lung density at the end of inspiratory and expiratory phase,lung density difference,lung density ratio) among the three groups (all P＜0.05).There were significant differences in the small airway indexes (tracheal wall thickness ratio at the end of inspiratory and expiratory phase,bronchial wall area ratio) among the three groups (all P＜0.05).Conclusions CT lung function imaging techniques can be used to assess the degree of respiratory dysfunction in asbestosis patients.With the development of pulmonary respiratory dysfunction,the total lung volume decreased,the amount of lungs gradually increased,emphysema gradually increased,and the thickness of small airway wall and alveolar fibrous hypertrophy gradually increased.

Exploratory analysis on burden of disease attributable to asbestosis from 2006 to 2015 / 中华劳动卫生职业病杂志

Objective@#To analyze the levels and trends of the burden of disease attributable to asbestosis from 2006 to 2015.@*Methods@#Theincidence of asbestosis from 2006 to 2015 was used for calculation, with data of disability weight and remission rate from Global burden of disease study 2015 (GBD 2015) and DisMoD-MR 2.1 software for the calculation of duration and age of year onset. The reference template of GBD was adopted to calculate disability adjusted life year (DALY) , year of life lost (YLL) and year of lived with disability (YLD) value in order to analyze the level and changing trend of burden of disease attributable to asbestosis.@*Results@#A total YLD attributable to asbestosis during 2006 and 2015 in China was 39632. The YLD burden of female was more severe than male, which accounted for 20361 in female and 19271 in male. In 2015, DALY attributable to asbestosis decreased from 8623.76 in 2006 to 6436. Among that, in 2015, YLD was 6436 and YLL was 73.76. 2006 had a highest level of DALY and 2008 had the lowest level of DALY, which accounted for 8623.76 in 2006 and 1558 in 2008. DALY during 2008 and 2015 had a fluctuant increase, and both male and female had such trend.@*Conclusion@#The level of burden of disease attributable to asbestosis is higher in male than in female during 2006 and 2015. Between 2006 and 2015, burden of disease attributable to asbestosis has a fluctuant increase trend.

Differences of CT pulmonary function indexes in asbestosis patients engaged in different types of work / 国际生物医学工程杂志

Objective To evaluate the changes and characteristics of pulmonary function in asbestosis patients engaged in different types of work by multi-slice spiral CT imaging.Methods Total 30 asbestosis patients were equally divided into three groups,who engaged in the work of raw asbestos processing,fiber combing and pressure molding,respectively.The pulmonary volume,pulmonary density and pulmonary small airway indexes were measured by a whole lung scanning at maximum inspiratory and maximum expiratory efforts.The pulmonary volume indexes include maximum inspiratory volume,maximum expiratory volume,pulmonary volume difference and pulmonary volume ratio.The mean pulmonary density indexes include the mean pulmonary densities after inspiratory and expiratory activities,pulmonary density difference and pulmonary density ratio.The small airway indexes include the diameter ratios of the wall after inspiratory and expiratory activities and the percentage of bronchial wall area after inspiratory activity.Results The differences of the gender,age,stage,and contact history of the patients are not statistically significant for all the groups (all P＞0.05).The differences of the mean pulmonary densities after expiratory activity,the left and right pulmonary densities after expiratory activities,pulmonary density ratio,diameter ratios of the wall after inspiratory and expiratory activities,and the percentage of bronchial wall area after inspiratory activity are statistically significant among the three groups (all P＜0.05).Further pairwise comparison showed that the differences of between the combing group and the raw material processing group in the above indexes are statistically significant (all P＜0.05),while not statistically significant between the molding group and the raw material processing group (all P＞0.05).The differences among the three groups in other indexes are not statistically significant (all P＞0.05).Conclusions The emphysema with fibrous thickening in the alveolar septum and small airway wall is more severe in the workers who engaged in asbestos fiber combing comparing with in raw asbestos processing and asbestos pressure molding.Therefore,the medical protection of these groups of patients should be strengthened.

Differences of CT pulmonary function indexes in asbestosis patients engaged in different types of work / 国际生物医学工程杂志

Objective To evaluate the changes and characteristics of pulmonary function in asbestosis patients engaged in different types of work by multi-slice spiral CT imaging.Methods Total 30 asbestosis patients were equally divided into three groups,who engaged in the work of raw asbestos processing,fiber combing and pressure molding,respectively.The pulmonary volume,pulmonary density and pulmonary small airway indexes were measured by a whole lung scanning at maximum inspiratory and maximum expiratory efforts.The pulmonary volume indexes include maximum inspiratory volume,maximum expiratory volume,pulmonary volume difference and pulmonary volume ratio.The mean pulmonary density indexes include the mean pulmonary densities after inspiratory and expiratory activities,pulmonary density difference and pulmonary density ratio.The small airway indexes include the diameter ratios of the wall after inspiratory and expiratory activities and the percentage of bronchial wall area after inspiratory activity.Results The differences of the gender,age,stage,and contact history of the patients are not statistically significant for all the groups (all P＞0.05).The differences of the mean pulmonary densities after expiratory activity,the left and right pulmonary densities after expiratory activities,pulmonary density ratio,diameter ratios of the wall after inspiratory and expiratory activities,and the percentage of bronchial wall area after inspiratory activity are statistically significant among the three groups (all P＜0.05).Further pairwise comparison showed that the differences of between the combing group and the raw material processing group in the above indexes are statistically significant (all P＜0.05),while not statistically significant between the molding group and the raw material processing group (all P＞0.05).The differences among the three groups in other indexes are not statistically significant (all P＞0.05).Conclusions The emphysema with fibrous thickening in the alveolar septum and small airway wall is more severe in the workers who engaged in asbestos fiber combing comparing with in raw asbestos processing and asbestos pressure molding.Therefore,the medical protection of these groups of patients should be strengthened.

Asbesto: la epidemia silenciosa

Aunque el hombre usa el asbesto desde hace 4500 años, recién a principios del siglo pasado se asoció su uso con la aparición de enfermedad. Se revisan los dos mecanismos por los cuales tras llegar las fibras de asbesto al pulmón se diseminan a todo el organismo. Se presentan brevemente las enfermedades relacionadas a su uso y el largo período de latencia que media desde su exposición. Se revisa la historia de la legislación antiasbesto y el impacto que su aplicación ha tenido en la disminución de las tasas de mesotelioma pleural. Se hace hincapié en la necesidad de impulsar la aplicación de estas leyes en todos los países del mundo.

Although mankind has been using asbestos for 4500 years or more, it was not until the beginning of the XX century that its use was associated with the occurrence of disease. We review the two mechanisms through which once asbestos fibers reach the lungs they may disseminate all over the body. We briefly review the diseases related to asbestos use and the long latency period from exposure to the development of disease. We also review the history of regulations against asbestos and the impact of their implementation on the reduction of pleural mesothelioma rates. We emphasize on the need of enforcing these regulations in countries all over the world.

Radiologic Diagnosis of Asbestosis in Korea

Asbestosis is the most important change noted in the lung parenchyma after environmental and occupational exposure to asbestos fibers. It is characterized by diffuse interstitial pulmonary fibrosis. In Korea, the incidence of asbestosis will continue to increase for many years to come and the government enacted the Asbestos Damage Relief Law in 2011 to provide compensation to those suffering from asbestos-related diseases. Radiologic evaluation is necessary for diagnosis of asbestosis, and radiologists play a key role in this process. Therefore, it is important for radiologists to be aware of the various imaging features of asbestosis.

Las enfermedades pulmonares intersticiales difusas en el ámbito laboral / Diffuse interstitial lung diseasesin the workplace

La enfermedad pulmonar intersticial difusa (EPID) se refiere a un grupo heterogéneo de condiciones pulmonares caracterizadas clínicamente por disnea y empeoramiento de la función pulmonar y radiológicamente por una infiltración intersticial evidente que afecta predominantemente las bases pulmonares. No existe una clasificación estándar o internacional sobre la misma, pero muchos autores tienden a clasificarla en uno de los dos siguientes grupos: los de causa conocida, secundarios a enfermedades de causa desconocida y los idiopáticos (que son 7 identidades clínicas claramente descritas). Como se ha visto, una de las causas dilucidadas de esta condición se asocia directamente con materiales irritantes como agentes y sustancias químicas tales como: el asbesto, silicón, y carbón utilizadas comúnmente en distintos ámbitos laborales, por lo que aquellas personas que se vieran continuamente expuestas a estos tienen un riesgo aumentado de desarrollar dicha patología. Las EPID son alteraciones que, a pesar de medidas, precauciones y regulaciones impuestas en distintas organizaciones de la promoción de la salud continúan siendo una de las principales enfermedades adquiridas en ámbitos laborales y además es de suma importancia clínica dado que estos pacientes pueden tener un rápido deterioro de función pulmonar. Este factor, sumado al hecho que su fisiopatología, incidencia e historia natural no han logrado ser suficientemente esclarecidos, constituyen la base que soporta la revisión que se ha propuesto realizar. Finalmente, es importante destacar que puede existir un largo tiempo entre la exposición a los agentes causales de la enfermedad y el inicio de las manifestaciones clínicas, por lo que se han documentado pacientes con estos diagnósticos aún años o hasta décadas después de que ocurrió la exposición, por lo que una adecuada regulación (por ejemplo, vacaciones profilácticas) y prevención a la misma podría evitar las consecuencias...

Diffuse interstitial lung disease (ILD) refers to a heterogeneous group of lung conditions characterized clinically by dyspnea, worsening of lung function and radiologically by an evident interstitial infiltration predominantly affecting the lung bases. There is no standard classification on it, but many authors tend to separate it into one of two groups: those with known cause, secondary to diseases of unknown cause and those idiopathic (with 7 clinical identities described). It is known that the condition is also directly associated with irritating materials, agents and chemicals such as asbestos, silicon, and carbon commonly used in industrial fields, so that people continouslly working with these have an increased risk of developing this disease. Despite measures, precautions and regulations imposed by various organizations of health promotion, ILD remains one of the major diseases acquired in work environments and it is of great clinical importance since these patients may have a rapid impaired lung function. This factor, besides the fact that its pathophysiology , incidence and natural history have failed to be sufficiently understood , constitute the base supporting the following review. Finally, we must know that there may be a long time between exposure to the causative agents of disease and the onset of clinical manifestations so that patients could present the diagnoses years or even decades after exposure. Hence derives the importance of proper regulations (eg, prophylactic holidays) and prevention to avoid the possible consequences...

Risk assessment of gastric cancer associated with asbestosis: a case report

BACKGROUND: The International Agency for Research on Cancer classifies asbestos as belonging to Carcinogen Group 2A for gastric cancer. We herein report a case of gastric cancer associated with asbestosis and describe the work-related and risk assessments of asbestos exposure for gastric cancer. CASE PRESENTATION: The 66-year-old male patient in our case worked in asbestos spinning factories. His level of cumulated asbestos fiber exposure was estimated to be 38.0-71.0 f-yr/cc. Thus, the Excess Life Cancer Risk for lung cancer associated with asbestos exposure was 9,648x10-5, almost 9,600 times the value recommended by the United States of America Environmental Protection Agency (1 x 10-5). The relative risk of developing lung cancer for this patient was more than 25 f-yr/cc, a well-known criterion for doubling the risk of lung cancer. CONCLUSION: The patient's exposure to high-dose asbestos was sufficient to increase his risk of gastric cancer because as the risk of lung cancer increased, the risk of gastric cancer was due to increase as well. Therefore, occupational asbestos fiber exposure might be associated with gastric cancer in this case.

CT Findings in People Who Were Environmentally Exposed to Asbestos in Korea

Asbestos related pleuropulmonary disease has been emerging health problem for recent years. It can cause variable clinical symptoms and radiological abnormalities. However, there has been no report for their characteristics in subjects who were environmentally exposed to asbestos. We reviewed the CT images of 35 people who were environmentally exposed to asbestos in Chungnam province, Korea. The study result showed high incidence of pleural plaque and pulmonary fibrosis on chest CT (94% and 77%, respectively). The common CT findings of lung parenchymal lesions were as follows: centrilobular opacities (94%), subpleural dot-like or branching opacities (80%), interlobular septal thickening (57%), intralobular interstitial thickening (46%), parenchymal bands (43%) and subpleural curvilinear line (29%). There were no significant differences in the prevalence of pulmonary fibrosis and pleural plaques according to sex, age and duration of exposure. In conclusion, pleural plaque and pulmonary fibrosis are common asbestos-related CT finding in the exposed people. Asbestos related lung parenchymal CT findings in the participants with environmental exposure show similar to those observed in the occupational exposure.

Asbestose / Asbestosis

Este artigo procura fazer uma revisão bibliográfica sobre asbestose recordando o que existe na literatura em relação ao tema, enfatizando principalmente o quadro clínico, os aspectos diagnósticos, o tratamento e as complicações. O estudo deste assunto é de fundamental importância para diferentes especialistas, incluindo pneumologistas, clínicos gerais, cirurgiões torácicos e médicos do Trabalho, pois dependendo do início de instalação, do grau de exposição ocupacional, da localização e do grau de comprometimento, a asbestose pode levar a diversos graus de manifestações clínicas, implicando, por vezes, em diagnósticos tardios ou mesmo incorretos, retardando a detecção do mesotelioma pleural e câncer de pulmão, que são suas principais complicações...

Asbesto en Colombia: un enemigo silencioso / Asbestos in Colombia: A silent enemy

El asbesto es un grupo de minerales no metálicos fibrosos, compuestos de silicatos de doble cadena que poseen gran resistencia a la tensión y la degradación química y conductividad térmica baja. A pesar de la evidencia experimental y poblacional de que dichos minerales son agentes cancerígenos y de su reconocimiento como tales por la Organización Mundial de la Salud, aún se los sigue usando en muchos países, Colombia incluida, a costa de la salud de los trabajadores, lo que se ha convertido en un problema mundial por el desarrollo de enfermedades asociadas a estos minerales en individuos expuestos. En este artículo se hace una revisión sobre el asbesto, las enfermedades asociadas a él y la normatividad mundial y colombiana frente al mismo; además, se plantea la conveniencia de evaluar la utilidad de la monitorización genética como complemento para el seguimiento de los individuos expuestos, que permita mejorar la vigilancia en nuestro país del desarrollo de cáncer de pulmón, mesotelioma y otras enfermedades asociadas con el asbesto.

Asbestos is a group of fibrous non-metallic minerals, composed of double chain silicates, that shows high resistance to tension and chemical degradation and low thermal conductivity. Despite being recognized as carcinogenic agents by the World Health Organization (WHO), based on experimental evidences and population studies, asbestos are still used in many countries at the expense of the health of workers. This has become a worldwide problem associated with the increase of asbestos-related diseases in exposed persons. In this article, we review asbestos and their associated diseases; the use, exposure and existing regulations on asbestos both in Colombia and in other countries. Finally, we raise the possibility of evaluating the usefulness of genetic monitoring in addition to following-up exposed individuals. This would enable a better surveillance in our country with respect to lung cancer, mesothelioma and other asbestos-related diseases.

Lung Function Profiles among Individuals with Nonmalignant Asbestos-related Disorders

BACKGROUND: Inhalation of asbestos fibers can lead to adverse health effects on the lungs. This study describes lung function profiles among individuals with nonmalignant asbestos-related disorders (ARDs). METHODS: The study population was from the Workers' Compensation (Dust Diseases) Board of New South Wales, Sydney, Australia. Lung function measurements were conducted in males with asbestosis (n = 26), diffuse pleural thickening (DPT; n = 129), asbestosis and DPT (n = 14), pleural plaques only (n = 160) and also apparently healthy individuals with a history of asbestos exposure (n = 248). Standardized spirometric and single-breath diffusing capacity for carbon monoxide (DLCO) measurements were used. RESULTS: Mean age [standard deviation (SD)] was 66.7 (10.3) years for all participants. Current and ex-smokers among all participants comprised about 9.0% and 54.8%, respectively. Median pack-years (SD) of smoking for ex- and current-smokers were 22.7 (19.9). Overall 222 participants (38.6%) and 139 participants (24.2%) had forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) measurements < 80% predicted, and 217 participants (37.7%) had FEV1/FVC results < 70%. A total of 249 individuals (43.8%) had DLco values < 80% predicted and only 75 (13.2%) had DLco/VA results < 80% predicted. A total of 147 participants (25.6%) had peak expiratory flow (PEF) measurements < 80% predicted. The presence of ARDs lowered the lung function measurements compared to those of healthy individuals exposed to asbestos. CONCLUSION: Lung function measurement differs in individuals with different ARDs. Monitoring of lung function among asbestos-exposed populations is a simple means of facilitating earlier interventions.

Enfermedad pulmonar por amianto en trabajadores de acería / Pulmonary disease due to asbestos in steel industry workers

Las enfermedades relacionadas al amianto se producen por la inhalación de fibras de asbestos en su variedad crisotilo o amianto blanco. A pesar de que en la Argentina la prohibición data del año 2003, existen numerosas industrias donde se sigue trabajando con este mineral, entre ellas las metalúrgicas y acerías. Actualmente se conoce la alta patogenicidad de este material, por lo que en muchos países existen programas de seguimiento de los trabajadores expuestos. Se describen las características generales y manifestaciones clínicas pulmonares de 27 pacientes que trabajaron en una gran acería de América del Sur. El diagnóstico de amiantopatías se realizó mediante historia clínica laboral, antecedente de exposición al amianto, estudios complementarios de función pulmonar e imágenes del tórax. Se analizaron la fuente de exposición (laboral, doméstica y ambiental), tiempo de exposición y período de latencia en los pacientes de los cuales se detectó enfermedad relacionada. Los antecedentes de tabaquismo fueron tenidos en cuenta para el análisis. En 22 pacientes se presentaron patologías benignas (81.4%), 16 de ellos tenían lesiones exclusivamente pleurales y otros 6 asbestosis. Las patologías malignas se presentaron en 5 pacientes (18.5%), en 4 fueron mesoteliomas y en uno carcinoma pulmonar. El problema de la exposición al amianto tiene vigencia actual. De ahí la necesidad de un programa de vigilancia en trabajadores expuestos al amianto actualmente o en el pasado, para detectar, notificar, registrar e investigar las características de estas patologías.

Asbestos-related diseases are caused by the inhalation of asbestos fibers in their variety chrysotile or white asbestos. Although the ban in Argentina dates from 2003, there are numerous industries where work continues with this mineral, including iron and steel industries. It is currently known the high pathogenicity of this material, so that in many countries there are programs to monitoring the exposed workers. Here we describe the general characteristics and pulmonary manifestations in 27 patients who had worked in a very huge steel factory in South America. The diagnosis of asbestos-related diseases was made by a medical-occupational record, history of asbestos exposure, additional studies of lung function and chest images. Then the sources of exposure (occupational, domestic and environmental), exposure time and latency period were analyzed, in those patients in whom a related disease was detected. Smoking history was also taken into account. Twenty-two patients had benigns pathologies (81.4%), sixteen of them with lesions localyzed in pleura, and other six pulmonary asbestosis. The malignant pathologies occurred in five patients (18.5%), in four of them mesothelioma and in other one lung cancer. The problem of asbestos exposure has contemporary relevance. Hence the need for a surveillance program in workers exposed to asbestos in the past or currently, to detect, report, record and investigate the characteristics of these pathologies.

Clinical Year-in-Review of Occupational Lung Disease / 결핵및호흡기질환

Occupational lung disease (OLD) is a group of lung diseases caused and/or aggravated by organic and inorganic inhaled dust, fumes, and mist. OLD can develop under various occupational situations. Therefore, occupational history should be considered when evaluating respiratory symptoms. Once OLD is developed, it may not be treated and may even progress after exposure to the causative agents has stopped. The best ways to treat OLD are prevention and early detection by controlling the working environment and conducting regular surveillance of workers. Common OLDs in Korea are coal worker's pneumoconiosis, asbestos-related diseases, and occupational asthma. Recent aspects of these common OLDs in Korea will be described based on recently published studies.

Efeitos respiratórios da exposição ao talco industrial em ex-trabalhadores de mineração / Efectos respiratorios de la exposición al talco industrial en extrabajadores de minería / Respiratory effects from industrial talc exposure among former mining workers

OBJETIVO: Avaliar efeitos respiratórios tardios da inalação ocupacional de talco contaminado por asbesto. MÉTODOS: Análise de série de casos de 29 ex-trabalhadores de mineração de talco contaminado com asbestos provenientes de Carandaí, MG, atendidos no Centro de Referência Estadual de Saúde do Trabalhador de Minas Gerais em 2004-2005. Os ex-trabalhadores foram submetidos a anamnese clínico-ocupacional, radiografia de tórax e espirometria. Foi criado um escore de exposição que, multiplicado pela duração, originou um índice de exposição cumulativa ao talco. Para verificar a associação do índice de exposição cumulativa com a presença de alterações radiológicas, sugestivas de pneumoconiose e/ou alterações pleurais, foi ajustado um modelo de regressão logística exata. RESULTADOS: Todos os ex-trabalhadores eram homens, com média de idade de 48,2 anos. Nas radiografias de tórax foram encontradas alterações pleurais em três deles, opacidades parenquimatosas compatíveis com pneumoconiose em um e suspeita em seis. Alterações espirométricas ocorreram em três. A regressão logística apontou odds ratio de 1,059 (IC 95 por cento: 1,012;1,125) para o índice acumulado, ou seja, cada unidade no índice resulta em um aumento de 5,9 por cento na chance de apresentar alteração radiológica compatível ou suspeita de pneumoconiose. Em relação à mediana do tempo estimado de latência entre o início da exposição até o diagnóstico das placas pleurais, ocorreu diferença significativa (p = 0,013) entre os casos (27,0 anos) e não casos (14,3 anos). CONCLUSÕES: Os achados apontam a necessidade de controle clínico nos trabalhadores que foram expostos a asbesto, particularmente devido aos efeitos tardios da exposição a esse mineral.

OBJECTIVE: To evaluate late respiratory effects from occupational inhalation of talc contaminated with asbestos. METHODS: This was a case series study on 29 former talc mining workers with asbestos contamination, in the municipality of Carandaí, Southeastern Brazil, who were attended at the State Workers' Health Reference Center in 2004 and 2005. Their clinical and occupational histories were obtained and they underwent spirometry and chest radiography. An exposure score was created; multiplying this by duration produced a cumulative talc exposure index. To confirm the association between the cumulative exposure index and the presence of radiological abnormalities suggestive of pneumoconiosis and/or pleural abnormalities, an exact logistic regression model was fitted to this. RESULTS: All the former workers were males, with an average age of 48.2 years. Chest radiographs showed pleural abnormalities in three of them; parenchymatous opacity compatible with pneumoconiosis in one; and suspected pneumoconiosis in six. Spirometric abnormalities were found in three workers. Logistic regression showed an odds ratio of 1.059 (95 percent CI: 1.012; 1.125) for the cumulative exposure index, i.e. each unit increase in the index resulted in an increase of 5.9 percent in the chance of presenting radiological abnormalities compatible with or suspicious of pneumoconiosis. With regard to the median estimated latency period between the start of exposure and the diagnosing of pleural plaque, there was a significant difference (p = 0.013) between the cases (27.0 years) and non-cases (14.3 years). CONCLUSIONS: These findings indicate the need for clinical control among workers who have been exposed to asbestos, particularly because of the late effects from exposure to this mineral.

OBJETIVO: Evaluar efectos respiratorios tardíos de la inhalación ocupacional de talco contaminado por asbesto. MÉTODOS: Análisis de serie de casos de 29 extrabajadores de minería de talco contaminado con asbestos provenientes de Carandaí, sureste de Brasil, atendidos en el Centro de Referencia Estatal de Salud del Trabajador de Minas Gerais en 2004-2005. Los extrabajadores fueron sometidos a anamnesis clínico-ocupacional, radiografía de tórax y espirometría. Fue creado un escore de exposición que multiplicado por la duración, originó un índice de exposición acumulativa al talco. Para testar la asociación del índice de exposición acumulativa con la presencia de alteraciones radiológicas, sugestivas de neumoconiosis e/o alteraciones pleurales, fue ajustado un modelo de regresión logística exacta. RESULTADOS: Todos los extrabajadores eran hombres, con promedio de edad de 48,2 años. En las radiografías de tórax fueron encontradas alteraciones pleurales en tres de ellos, opacidades parenquimatosas compatibles con neumoconiosis en uno y sospecha en seis. Alteraciones espirométricas ocurrieron en tres. La regresión logística indicó odds ratio de 1,059 (IC 95 por ciento:1,012;1,125) para el índice acumulado, es decir, cada unidad en el índice resulta en un aumento de 5,9 por ciento en el chance de presentar alteración radiológica compatible o con sospecha de neumoconiosis. Con relación a la mediana del tiempo estimado de latencia entre el inicio de la exposición y el diagnóstico de las placas pleurales, ocurrió diferencia significativa (p=0,013) entre los casos (27,0 años) y no casos (14,3 años). CONCLUSIONES: Los resultados muestran la necesidad de control clínico en los trabajadores que fueron expuestos a asbesto, particularmente debido a los efectos tardíos de la exposición a este mineral.