Current global perspectives on silicosis—Convergence of old and newly emergent hazards

Abstract

Silicosis not a disease of the past. It is an irreversible, fibrotic lung disease specifically caused by exposure to respirable crystalline silica (RCS) dust. Over 20,000 incident cases of silicosis were identified in 2017 and millions of workers continue to be exposed to RCS. Identified case numbers are however a substantial underestimation due to deficiencies in reporting systems and occupational respiratory health surveillance programmes in many countries. Insecure workers, immigrants and workers in small businesses are at particular risk of more intense RCS exposure. Much of the focus of research and prevention activities has been on the mining sector. Hazardous RCS exposure however occurs in a wide range of occupational setting which receive less attention, in particular the construction industry. Recent outbreaks of silicosis associated with the fabrication of domestic kitchen benchtops from high‐silica content artificial stone have been particularly notable because of the young age of affected workers, short duration of RCS exposure and often rapid disease progression. Developments in nanotechnology and hydraulic fracking provide further examples of how rapid changes in technology and industrial processes require governments to maintain constant vigilance to identify and control potential sources of RCS exposure. Despite countries around the world dealing with similar issues related to RCS exposure, there is an absence of sustained global public health response including lack of consensus of an occupational exposure limit that would provide protection to workers. Although there are complex challenges, global elimination of silicosis must remain the goal.

Occupational Lung Health: A global problem requiring local awareness

“…In low‐income countries, the effects of adverse workplace conditions are much more of a daily issue faced by clinicians and their patients than in middle‐ and high‐income countries, where often these concerns are out of mind. Two occupational diseases highlighted in this issue of Respirology demonstrate that no country is immune to inadequate control of occupational hazards: the impact of COVID‐19 on healthcare workers (HCW) and a surge in cases of silicosis caused by the production of fashionable artificial stone (AS) kitchen benchtops 1,3 …”

“…Recently, over 20,000 incident cases of silicosis have been identified per year, a number that is likely to be a vast underestimation 8 . Although silicosis has re‐emerged in some high‐income countries related to high silica content AS, the review Current global perspectives on silicosis demonstrates that this occupational disease has never gone away and global elimination efforts have fallen far short of expectations 1 . As is often the case with occupational health and safety, insecure workers, immigrants and workers in small businesses are at particular risk.…”

“…This inaugural Occupational Lung Health special issue of Respirology highlights the importance of a healthy work environment and the often severe consequences to workers when occupational hazards are not identified and controlled. This issue provides detailed reviews of one of the earliest recognized occupational lung diseases which continues to be a major global public health issue (silicosis), 1 a disease that is common but poorly recognized (occupational chronic obstructive pulmonary disease) 2 and the most recent major risk to workers' respiratory health (the COVID-19 pandemic). 3 In the field of respiratory medicine, we witness the effects of hazardous exposures on our patients' respiratory health on a daily basis.…”

“…Two occupational diseases highlighted in this issue of Respirology demonstrate that no country is immune to inadequate control of occupational hazards: the impact of COVID-19 on healthcare workers (HCW) and a surge in cases of silicosis caused by the production of fashionable artificial stone (AS) kitchen benchtops. 1,3 Smallwood et al present a comprehensive review of COVID-19 infection and the broader impacts of the pandemic on healthcare workers, the first new global occupational disease in decades. 3 The pandemic has had a major impact on HCWs who have tirelessly provided care for patients with COVID-19 throughout the pandemic.…”

Do we still live under a silica rock?

“…Among the pneumoconioses, silicosis has become the most common type of pneumoconiosis recently (6,7). Silicosis is one of the fibrotic types of pneumoconioses caused by free silicon dioxide or silica.…”