Beryllium chronic pulmonary disease

Acute pulmonary disease is due exclusively to inhalation of soluble beryllium salts and is not caused by exposure to the oxide, the metal, or its alloys. The exact forms of beryllium causing the chronic pulmonary disease and the degree of exposure necessary to induce it are not precisely known. It is known that under the completely uncontrolled conditions existing in bery llium extraction plants before the establishment of air-count standards in 1949, when beiyllium air-counts were in milligrams per cubic meter of air rather than micrograms, only about 1% of the exposed workers became ill This would indicate a sensitivity of a limited number of individuals to beryllium. 

Chronic exposure to insoluble beryllium compounds, particularly the oxide, leads to berylliosis (a chronic granulomatous disease), which begins with a cough and chest pains. In most cases, these symptoms soon lead to pulmonary dysfunction. The latency period ranges from months to 25 years. Diagnosis based on clinical, radiographic, and lung function evidence has been found to be difficult. 

Caution Death may result from short exposure to very low concns of the element and its salts. Contact dermatitis, chemical conjunctivitis, corneal burns, non-healing ulceration at site of injury, subcutaneous nodules may occur following exposure. Acute Pneumonitis may result from single exposure to beryllium and occasionally is fatal. Chronic Pulmonary granulomatous disease may appear in 3 months tn 15 years, often after short exposure to low concn. Uncertainty as to complete recovery. Death rate about 25%. See I. Schubert. Beryllium and Barylliosis in Set. Am. 199, no. 2, pp 27-33 (1938). This substance and certain beryllium compounds may reasonably be anticipated to be carcinogens Fourth Annual Report on Carcinogens (NTP... 

Examples Silicosis, asbestosis, pneumonitis, pharyngitis, rhinitis or acute congestion farmer s lung, beryllium disease, tuberculosis, occupational asthma, reactive airways dysfunction S5mdrome (RADS), chronic obstructive pulmonary disease (COPD), hypersensitivity pneumonitis, toxic inhalation injury, such as metal fume fever, chronic obstructive bronchitis, and other pneumoconioses. 

Beryllium-related pulmonary manifestations exist on a continuum from acute inhalational injury to acute pneumonitis, beryllium sensitization, and the chronic form, that has been called berylliosis, chronic berylliosis, and which is now known as chronic beryllium disease (CBD). 

An immunologic basis for chronic beryllium disease has been postulated and a hypersensitivity phenomenon demonstrated. Consistent with the concept of chronic berylliosis as a hypersensitivity pulmonary reaction are the following Persons with berylliosis also show delayed cutaneous hypersensitivity reactions to beryllium compounds their peripheral blood lymphocytes undergo blast transformation and release of macrophage inhibition factor after exposure to beryllium in vitro helper/suppressor T-cell ratios are depressed and there is lack of a dose-response relationship in chronic beryllium cases. Hypersensitization may lead to berylliosis in people with relatively low exposures, whereas nonsensitized individuals with higher exposures may have no effects. 

Aronchick JM, Rossman MD, Miller WT. Chronic beryllium disease diagnosis, radiographic findings, and correlation with pulmonary function tests. Radiology 1987 163(3) 677-682. 

Fig. 10.1. Chest radiograph in a patient with advanced chronic beryllium disease shows abnormality predominating in the upper lobes, consisting of coarse well-defined nodules, which appear to coalesce in areas. Some of the nodules appear calcified. There is moderate upper lobe volume loss with superior hilar retraction and some anatomic distortion. Hilar enlargement is likely due to a combination of adenopathy and pulmonary arterial enlargement due to pulmonary hypertension...

BraunerM, Grenier Pet al (1989) Pulmonary sarcoidosis Evaluation with high resolution CT. Radiology 172 467-471 Brauner M, Lenoir S et al (1992). Pulmonary sarcoidosis CT assessment of lesion reversibility. Radiology 182 349-354 Cullen MR (2005) Screening for chronic beryllium disease one hurdle down, two to go. Am J Respir Crit Care Med 171 3-4... 

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