A pathology textbook chapter on occupational, environmental and drug-induced lung disease, covering the pneumoconioses, metal-related lung diseases such as berylliosis, hard-metal disease and toxic metal fume injury, and how pathologists identify inhaled materials.
Authors
- Corrin, B., & Nicholson, A. G. (2011). , Pathology of the Lungs (3rd ed.), 327–399.
What was issued?
This is Chapter 7 of the reference textbook Pathology of the Lungs (third edition, 2011) by the lung pathologists Bryan Corrin and Andrew G. Nicholson. The chapter has three parts. The first, on occupational disease, covers the pneumoconioses (lung diseases caused by inhaled mineral dust, such as silicosis, coal pneumoconiosis and asbestosis), metal-related lung diseases (aluminium, rare earths, hard metal and beryllium), welding, toxic fumes and gases, occupational asthma and occupational fevers. The second, on environmental lung disease, covers radon, pressure injuries, drowning, air pollution, tobacco smoke, smoke inhalation, ingested toxins and recreational drugs. The third, on iatrogenic lung disease, covers adverse drug reactions and complications of medical procedures. The chapter explains how inhaled particles are deposited and cleared, how the lung reacts to different dusts and fumes, and how pathologists identify the responsible material in tissue, for example with polarising microscopy and electron microprobe analysis.
Who is affected?
The occupational sections describe workers exposed to dusts and metal fumes: miners, quarry workers, foundry and abrasive workers, aluminium smelters and powder workers, hard-metal and diamond-polishing workers, workers in beryllium processing and alloy machining, and welders. The chapter also describes "neighbourhood" cases of berylliosis in people living downwind of beryllium plants, and cases in relatives exposed through contaminated work clothes. The environmental and iatrogenic sections concern the general population, including people exposed to air pollution, tobacco smoke or radon, and patients who have adverse reactions to drugs or complications from medical procedures.
Most important findings
The chapter explains that dust particles about 1–5 µm in diameter settle in the alveoli, and that the lung's response depends on the material. Crystalline silica is highly fibrogenic, while iron, tin, barium and carbon are largely inert. Several metals cause specific diseases. Stamped aluminium powder made with mineral-oil lubricants has caused rapidly progressive fibrosis of the upper lobes, whereas granular aluminium powders are inert. Hard metal, a tungsten carbide alloy containing cobalt, causes asthma and an interstitial fibrosis with characteristic giant cells (giant cell interstitial pneumonia), and cobalt is considered the harmful component. Chronic berylliosis is an allergic, granulomatous disease that looks identical to sarcoidosis under the microscope; very little beryllium is needed to cause it, and it is linked to the HLA-DPβ1 Glu69 genotype. The fumes of cadmium, chromium, cobalt, mercury, nickel carbonyl, aluminium and beryllium can cause tracheobronchitis, bronchiolitis, diffuse alveolar damage and pulmonary fibrosis. Metal fume fever, a self-limiting illness most often linked to welding zinc-coated surfaces, is caused chiefly by zinc, copper and magnesium fumes. The chapter warns that persistent symptoms should raise suspicion of acute cadmium poisoning or another toxic metal fume disease. Welders may also inhale hexavalent chromium compounds and develop lung cancer.
Key implications
For heavy metal safety, the chapter shows that inhalation is a distinct and important route of metal exposure, separate from diet. Its effects depend on the metal, its chemical and physical form (dust, fume, powder or alloy), and the individual's susceptibility. Cadmium, chromium, cobalt, nickel, beryllium and aluminium are mainly occupational inhalation hazards whose lung effects are recognised and diagnosed by pathologists. Because some of these diseases, such as berylliosis and hard-metal disease, can mimic sarcoidosis or idiopathic pulmonary fibrosis, the authors stress that a full occupational history matters, and they recommend that any patient thought to have sarcoidosis who has worked with or near metals be offered a beryllium lymphocyte transformation test. The chapter is a pathology reference, not a study of metals in food or consumer products.
Citation
Corrin, B., & Nicholson, A. G. (2011). Occupational, environmental and iatrogenic lung disease. In Pathology of the Lungs (3rd ed., pp. 327–399). Churchill Livingstone. https://doi.org/10.1016/B978-0-7020-3369-8.00007-0