Silicosis

Silicosis is scarring of the lungs from breathing in silica dust. Silica is an ordinary substance in the earth's crust: it is in sand, sandstone, granite, quartz, concrete, brick and mortar. While the stone is intact it is harmless. What is dangerous is working it: cutting, grinding, drilling and crushing generate dust so fine that it is invisible in the air, stays airborne for hours and travels to the very depths of the lung. There the body tries to clear it, fails, and walls it off with patches of scar tissue instead. Scar does not breathe and does not resolve. Hence the essential fact about this disease: it is irreversible, there is no treatment that returns the lungs to their former state, and all the value lies in protection and in getting away from the dust as early as possible.

Where this dust is found

The risk is not created by the trade itself but by working the material dry and without extraction. Most often that means:

• cutting, grinding and polishing stone, sandstone and granite above all; stonemasonry and restoration work;
• construction and demolition: chasing walls, cutting concrete and tile, drilling, working with brick and mortar;
• making and fitting kitchen worktops;
• abrasive blasting — one of the most dangerous jobs of all when it is done with dry sand;
• mining, quarrying, rock crushing, tunnelling;
• foundry work: moulding sands and knocking out castings;
• ceramics, porcelain, glass, and the manufacture of abrasives and refractories;
• home improvement: an angle grinder on concrete or tile in a closed room with no extraction builds up, within hours, a concentration that would never be tolerated on a properly run site.

The dust travels home on clothing and in hair, so it is not only the worker who breathes it. Work clothes are best not washed together with household laundry.

Engineered stone: the disease in young people within a few years

This deserves a section of its own, because it is a recent story and simply does not appear in reference books from a few years back. It concerns engineered stone worktops — slabs made from crushed quartz bound with resin. They are often chosen as a modern substitute for granite, and to look at they are an unremarkable material. But they contain many times more silica than natural stone, and cutting and grinding them dry produces an extremely fine and aggressive dust.

The consequences have been abrupt. In the fitters who cut these slabs, silicosis appears not after thirty years but after a few, and the people falling ill are in their thirties and forties. The course is also more severe than usual: the disease progresses fast, often to the point where a lung transplant is the only way out. In several countries dry working of these slabs has since been restricted or banned.

The conclusion is simple and practical. If you or someone close to you cuts engineered stone worktops — particularly in a small workshop with no industrial extraction — assume the risk is high, even if you feel perfectly well and have only been doing it a couple of years. Tell the doctor about that job plainly: without that one sentence, the diagnosis in a young person with no bad habits can be hunted for years, and in the wrong direction.

How silicosis announces itself

It usually develops slowly and gives nothing away for a long time. From starting work with the dust to the first symptoms takes ten to twenty years with moderate exposure and five to ten with heavy exposure; with very intense exposure, as in dry blasting or cutting engineered stone, it can be counted in months and in the first few years. There is also the reverse quirk: the scarring carries on after the person has left that job. Having no symptoms does not mean nothing is happening in the lungs.

What appears:

• a cough, dry or productive, that lasts for weeks and has nothing to do with a cold;
• breathlessness. At first only going uphill or upstairs, later on level walking. It is extremely easy to put down to age, weight or smoking;
• weakness, tiring quickly, less stamina;
• chest pain or tightness, wheezing;
• frequent chest infections that drag on.

As it progresses the breathlessness worsens and begins to interfere with daily life, and complications join in: raised pressure in the lung vessels with strain on the right side of the heart, respiratory failure, emphysema, chronic obstructive pulmonary disease. Silicosis is also linked to a raised risk of rheumatoid arthritis, of some autoimmune diseases and of kidney damage.

What the investigations will show

The conversation counts for more here than any machine. The doctor needs to hear where you worked and at what, with which materials, wet or dry, whether there was extraction, whether you were issued a mask and what kind — and also about the side jobs and the home renovation that people normally leave out. Without that, an X-ray showing changes is easily read as something else.

• Chest X-ray — the starting point: silicosis shows characteristic small nodules, more often in the upper zones.
• CT scan shows the same thing far earlier and in more detail, and it is usually the scan that settles matters.
• Spirometry and other breathing tests measure how much function has already been lost and allow the change over time to be tracked.
• Testing for tuberculosis — in silicosis this is needed at diagnosis and regularly thereafter.
• Blood tests are sometimes added, and where the picture is unclear, examination of a sample of lung tissue.

It is worth knowing that in many countries silicosis is on the list of recognised occupational diseases. That means a confirmed diagnosis can open the way to official recognition of the work-related cause, to compensation, and to a move to a dust-free post; the procedure and the bodies involved differ from country to country, so this has to be checked locally.

Tuberculosis and lung cancer: what you cannot wait on

This gets discussed less than it deserves. Silicosis appreciably raises the risk of two serious diseases, and both respond far better when caught early.

Tuberculosis. Lungs damaged by dust defend themselves against it less well, and the rate in people with silicosis is several times the usual. Testing has to be regular, on whatever schedule the doctor sets, not only once someone feels ill.

Lung cancer. Silica dust is recognised as a human carcinogen, so the risk is raised in its own right and is multiplied many times over in smokers. This is the strongest possible reason to stop smoking with this particular diagnosis.

So there is a set of signs that should not wait for the next routine appointment but should take you to a doctor within days:

• coughing up blood, or streaks of blood in the sputum;
• weight loss you cannot account for;
• night sweats and a persistent low-grade temperature;
• a cough that has changed: different in character, worse, or lasting more than three weeks;
• chest pain, or hoarseness that will not clear.

Separately, the situations that call for an ambulance (in Spain, Italy, Portugal, Poland and Ukraine the single number is 112): rapidly worsening breathlessness, being unable to finish a sentence, severe chest pain, blue lips, coughing up a lot of blood, confusion. Sudden severe breathlessness with pain in one side can mean the lung has burst, which does happen where there is scarring.

The disease cannot be reversed — so what is done instead

There is no medicine that dissolves scar tissue. That does not mean there is nothing to be done: length and quality of life depend a very great deal on what is put in place.

• Get away from the dust. This is the only action that affects how fast the disease progresses. Changing site, moving to a different operation, giving up the cash jobs with an angle grinder — anything that reduces the intake of new dust works.
• Stop smoking. Smoking and silicosis add together, and for lung cancer risk they multiply. If you cannot stop on your own, say so to your doctor: effective help exists.
• Keep vaccinations up to date — annually against flu and against pneumococcus, and against other respiratory infections where the doctor advises it. With scarred lungs an ordinary infection runs a harder course.
• Treat what does respond. Narrowed airways are treated with inhaled bronchodilators, a bacterial infection with antibiotics, and low blood oxygen with home oxygen therapy.
• Pulmonary rehabilitation. A supervised programme of breathing and physical exercise noticeably improves exercise tolerance — for what it returns, it is among the best investments of effort in lung disease.
• Follow-up: regular appointments, monitoring of lung function and checks for tuberculosis.
• Lung transplant is discussed in severe cases, more often in younger people; the health requirements are strict and the decision rests with a specialist centre.

Protection: what works and what does not

Silicosis is entirely preventable. The measures are known, and they work in the order set out below: get rid of the dust first, and protect the breathing only as a last resort.

• Wet cutting. Feeding water to the blade or core bit removes most of the dust and costs little. If the tool allows it and the work is being done dry, that is the first thing to change.
• On-tool extraction. Dust capture at the tool itself, an industrial vacuum with a high-efficiency filter, ventilation of the space. An ordinary household vacuum is no use here: it puts the finest dust straight back into the air.
• Do not sweep and do not blow down with compressed air. A broom and a compressor put back into the air what has already settled. Clean up wet, or with a suitable vacuum.
• Separate the work. Cut outdoors or in a separate room wherever possible, and keep unprotected people away from it.
• A mask of the right class. A cloth mask, a surgical mask and a gauze mask give no protection at all against silica dust — they do not retain particles of that size and they do not seal to the face. What is needed is a proper particulate respirator with a high-efficiency filter, and for heavy work such as blasting, an air-fed hood. A respirator only works if it fits tightly: a beard or even stubble cancels the protection out, and the mask itself has to be chosen by size.
• Hygiene. Do not eat, drink or smoke in the dusty area, change out of work clothes at the end of the shift, and do not carry the dust home on them.
• Health surveillance. If periodic lung checks come with the job, do not skip them: they exist precisely to catch changes before symptoms do.

The duty to provide safe conditions and protective equipment lies with the employer. If there is dust but no extraction and no proper respirators, that is grounds for going to the company's safety service or to the labour inspectorate in your country.

Online consultation

A great deal is settled here by talking. An Oladoctor doctor can help you judge whether you have reason to suspect dust damage to the lungs and which investigations it makes sense to start with; explain how to set out your work history so that it is actually taken into account; go through X-rays already taken and the results of breathing tests with you; and tell you which vaccinations and tuberculosis checks belong with this diagnosis and what pulmonary rehabilitation genuinely delivers. If what you describe includes blood in the sputum, weight loss or breathlessness that is worsening quickly, you will be told so at once and directed where to go without delay.

This material is for information only and does not replace medical advice.