Union of Bricklayers and Allied Craftworkers
workers who have worked around silica need to let their doctors know
what possible health problems to watch for. Here is information for
a worker to take a medical checkup. A construction worker may be exposed
to silica dust when cutting or drilling concrete, rock, masonry, or
when sandblasting. Exposure to silica can make a worker short of breath,
increase the risk of getting tuberculosis or lung cancer, or cause
silicosis, which can kill. The International Union of Bricklayers
and Allied Craftworkers has translated this information into French,
Italian, Polish, Portugese and Spanish.
Each year many cases of silicosis are misdiagnosed because physicians
are unaware of their patient's work history and unfamiliar with the signs
associated with this occupational illness. As a result these cases go
unreported. Without proper diagnosis and reporting, workers cannot receive
suitable medical treatment and advice. The physician's alert entitled
"What Physicians Need to Know about Silicosis in Construction, Demolition
and Renovation Workers" was developed to help ensure that all construction
workers at risk of developing silicosis are properly diagnosed, and that
cases of silicosis are documented and reported to the appropriate state
health agencies.The IU now has this alert available in Spanish, French,
Portuguese, Polish and Italian. To receive a copy call the IU at (202)
Please read this letter. Please print out this letter and the physicians
alert document on the next page. Give them both to your doctor for
your medical records.
To All Construction
Workers at Risk of Developing Silicosis:
workers are at risk of being exposed to crystalline silica dust through
their work, or because they work in areas where this dust is being produced.
Crystalline silica is found in brick, concrete products, stone, rock and
abrasives. The dust is released from these materials through dry cutting,
grinding, chipping, blasting and sweeping. Many trades perform these tasks
and are at a high risk of being made ill by the dust many years after
initial exposure. Trades affected include, but are not limited to: masonry
and stone workers, abrasive blasters, laborers, painters, operating engineers,
plasterers, plumbers and truck drivers.
Exposure to crystalline
silica dust can result in serious illnesses - even death. Workers that
breathe in crystalline silica dust are at an increased risk of developing
silicosis (a respiratory lung disease), tuberculosis and lung cancer.
Although most cases of silicosis are found in older workers and retirees,
silicosis related deaths have been documented in workers as young as age
cases of silicosis are misdiagnosed because physicians are unaware of
their patients work history and unfamiliar with the signs associated
with this occupational illness. As a result these cases go unreported.
Without proper diagnosis and reporting, workers cannot receive suitable
medical treatment and advice. In addition, silicosis is a compensatable
disease in some states. Therefore, workers with silicosis may be entitled
to workers compensation depending on the state they are in.
Attached is a physicians
alert entitled What Physicians Need to Know about Silicosis in Construction,
Demolition and Renovation Workers. The New Jersey Department of
Health, with input from CPWR – Center for Construction Research and Training and
the building trades unions, developed this alert as part of a project
funded by the National Institute for Occupational Safety and Health (NIOSH).
It was developed to help ensure that all construction workers at risk
of developing silicosis are properly diagnosed, and that cases of silicosis
are documented and reported to the appropriate state health agencies.
alert will only be effective in improving the diagnosis and documentation
of silicosis and related illnesses if:
- Workers make
their doctor(s) aware of their work history and unique exposure risk.
Workers need to give this alert to their doctor(s), and let them know
how they have been exposed to silica dust - construction materials used
and tasks performed that may have exposed them to silica dust.
- Doctors become
familiar with the information in the attached physicians alert and
emphasize the respiratory system in the workers annual physical
exam. Medical exams should include: a pulmonary function test (PFT) to
look for evidence of respiratory impairment, a baseline PPD skin test
for tuberculosis, and chest x-rays (at the frequency recommended in this
alert or by OSHA in future regulations). It is important that
the chest x-rays be read by a certified class B reader because
silicosis is sometimes confused with sarcoidosis, asbestosis, coal miners
pneumoconiosis, and other pneumoconiosis. Cases of silicosis should then
be reported to the state health department. Doctors should be aware that
there is no medical treatment to reverse silicosis. Corticosteroids are
not useful to reduce the progression of the disease; however, appropriate
treatment for heart failure and tuberculosis should be begun if these
complications exist. In addition, because the risk of silicosis increases
if a person smokes, all individuals should be strongly advised to stop
smoking and offered smoking cessation information and support.
While this physicians
alert deals with the proper diagnosis and reporting of silicosis cases,
as noted earlier, it is important to understand this is a disease that
can be prevented. It is the goal of the International Union of Bricklayers
and Allied Craftworkers, as well as all building trades unions to prevent
silicosis by eliminating or reducing the risk of exposure through changes
in work practices and the use of dust control mechanisms. We are working
towards that goal both through the collective bargaining process and better
Until such control
mechanisms and better standards are in place, protect yourself and your
- Not dry-cutting
masonry products or stone: always use water. This is the best way to limit
dust. If you can't use water, use a vacuum with a high efficiency particulate
air (HEPA) filter or another dust control system. If this is not possible,
use a full-face respirator as part of a complete respiratory protection
program that includes proper selection of respiratory cartridges, training
and fit-testing to see if you are able to wear a respirator.
dust that is carried home on clothes and personal belongings such as cars
and tool boxes.
- Not smoking,
because smoking in combination with silica dust exposure increases your
risk of lung cancer.
1 Goodwin, Susan, Undercounting
Silicosis: An Example of Physician failure to Recognize Occupational Disease;
disertation presented at the School of Hygene and Public Health Johns Hopkins
Please read this
physicians alert document and the letter on the previous
page. Print them both out and give a copy of each to your doctor for your
This document should
be filed in the medical records of:
Patients name and social security number
Patients occupation and union affiliation
Demolition, and Renovation Workers Are at Risk of Developing Silicosis
is found in materials, such as those listed below, which are often present
during construction, demolition, and renovation projects. When these materials
are made into a fine dust by tasks listed below, the inhalation and deposition
of these fine particles can produce silicosis over time.
Containing Crystalline Silica:
blasting abrasives, brick, refractory brick, concrete, concrete block,
cement mortar, granite, sandstone, quartzite, slate, gunite, mineral deposits,
rock and stone, sand, fill dirt, topsoil, asphalt containing rock or stone
with Silica Exposure:
Abrasive blasting using sand or other abrasive containing crystalline
Abrasive blasting of concrete.
Demolition of concrete and masonry structures.
Chipping, cutting, sawing, grinding, drilling, jack hammering concrete,
masonry, or mortar.
Crushing, loading, hauling, dumping rock, stone, or sand.
Chipping, hammering, drilling rock.
Dry sweeping or pressurized air blocking of concrete, rock, or sand dust.
High Risk Trades
Many construction, demolition, and renovation occupations are at risk,
including: Abrasive blasters, masonry workers (bricklayers, stone masons),
laborers, operating engineers, painters and plasterers, plumbers, and
that do not work directly with construction materials or tasks involving
silica may be exposed as bystanders if they are in the construction, demolition,
or renovation area when crystalline silica containing materials are being
Silicosis is a diffuse, nodular, interstitial pulmonary fibrosis caused
by a tissue reaction to inhaled crystalline silica dust. It can take the
acute form under conditions of intense exposure but usually takes the
chronic form, requiring several to many years to develop. People who have
silicosis have increased susceptibility to infections such as tuberculosis,
complicating the patients prognosis. There is also increasing evidence
that crystalline silica causes cancer and that the individuals with silicosis
are at increased risk of developing lung cancer.
Except in its acute
form, silicosis begins with a few, if any, symptoms. When clinical symptoms
of silicosis are present, they could include cough and shortness of breath
of increasing severity. On physical examination, breath sounds may be
normal or distant and, with increased severity, there may be signs of
heart failure. Evidence of pathological response to silica exposure exists
well before symptoms occur.
occurring after 10 or more years from first exposure, involve nodular
lesions, (bilateral, multiple, rounded opacities) often more prominent
in the upper lobes. In this simple stage of silicosis, nodules are usually
small (1 centimeter or less). There may be little effect on pulmonary
function at this stage.
silicosis or progressive massive fibrosis (PMF) also usually develops
in the upper lobes but the nodules go on to consolidate and exceed 1 centimeter
and encompass blood vessels and airways. Lung function may be severely
compromised, often with a mixed restrictive/obstructive pattern, but either
pure restriction or obstruction may be seen.
may appear within a few weeks to two years after the onset of massive
exposure. The distinguishing feature of acute silicosis is intraalveolar
deposits, similar to those seen with alveolar proteinosis. In contrast
to the nodular fibrosis seen in the chronic form, diffuse interstitial
fibrosis is not found. Silicosis developing in less than 10 years, the
accelerated form, has been described most often in sandblasters. In these
cases, diffuse fibrosis is likely to develop and may be located throughout
all lobes of the lung.
Simple: mild restrictive and/or obstructive defects, small rounded
opacities on x-ray
Accelerated: diffuse, small rounded opacities on x-ray, more severe
restrictive and/or obstructive defects
Advanced: increased profusion of small opacities and development
of large opacities on x-ray, more severe restrictive and/or obstructive
defects, cor pulmonale
Acute: diffuse perihilar alveolar filling process with ground glass
opacities on x-ray
disease and radiographic findings can continue even after exposure has
The following are
recommended by the New Jersey Department of Health and Senior Services
as a baseline for exposure, then periodically noted:
history to determine years of exposure-update annually. Inquire about
the materials used and tasks performed listed above. In addition, inquire
about employment in non-construction industries with silica exposure-foundries,
quarries, mining, tile, clay, glass, and cement manufacture.
- Medical exam emphasizing the respiratory system-annually.
- Chest x-ray to look for evidence of abnormality. Posteroanterior
14 x 17 or 14 x 14, classified according to the
1980 Guidelines for the Use of ILO Classification of Radiographs of Pneumoconiosis
by a certified class B reader, is recommended. The ILO system
has the distinct advantage of a standardized set of comparison x-ray films.
Names of B-readers are available from NIOSH. Information on how to contact
NIOSH is given at the end of section. Recommendations for the frequency
of x-rays are given below. NOTE: the potential for excessive x-rays given
the multiemployer nature of construction and other possible construction
exposures like asbestos for which OSHA may require employers to provide
- Pulmonary Function Tests (PFT) to look for evidence of respiratory
impairment. Should include FEV1 (forced expiratory volume in 1 second),
FVC (forced vital capacity), and DLCO (diffusion capacity of the lungs)
- annually. All PFT should use equipment and follow recommendations issued
by the ATS (American Thoracic Society) and be administered by a technician
who has successfully completed NIOSH-certified training.
- A baseline PPD skin test for tuberculosis because people who
have silicosis have increased susceptibility. Repeat annually if there
is x-ray evidence of silicosis (1/0 or greater profusion category using
the ILO classification) or 25 years or longer exposure.
Frequency of Chest
X-rays for Silicosis
Every 3-5 years with normal x-ray, low exposure, and less than 20 years
exposure. Every 1-3 years with normal x-ray, high exposure, or greater
than 20 years exposure. Annually with x-ray evidence of silicosis (ILO
1/0 or greater or ILO results A, B, or C large opacities), massive exposure,
or positive PPD test. See NOTE in item 3.
Physicians, radiologists, pathologists and other health care professionals
should report cases of silicosis to be the health department in their
state so that it can be determined whether silica exposures are being
controlled at the workplaces where the patient has been employed. Such
reporting is mandatory in many states, including New Jersey. (In New Jersey,
call 800-772-0062 to report cases or for reporting forms.)
If the state has
no occupational health program, cases of concern should be discussed with
NIOSH (National Institute for Occupational Safety and Health) or the local
OSHA (Occupational Safety and Health Administration) office. Information
on how to contact NIOSH and OSHA is given at the end of this bulletin.
elements define a case of silicosis for reporting purposes:
provisional or working diagnosis of silicosis, or chest x-ray or other
imaging technique interpreted as consistent with silicosis, or pathologic
findings consistent with silicosis.
is sometimes confused with sarcoidosis, asbestosis, coal miners
pneumoconiosis, or other pneumoconiosis it is important that all chest
x-rays be reviewed by a B-reader.
There is no known
medical treatment to reverse silicosis, therefore prevention is critically
important. Removal from exposure may decrease the rate of disease progression.
Corticosteroids are not useful to reduce the progression of the disease.
Appropriate treatment for heart failure and tuberculosis should be begun
if these complications exist. All individuals should be strongly advised
to stop smoking and offered smoking cessation information and support.
Regular follow up exams to access progression and possibly to screen for
lung cancer should be scheduled. Individuals who develop silicosis should
be given the option of transfer to silica-free jobs. In order for this
to be a realistic alternative, the individual should be able to maintain
the same rate of pay and benefits without loss of seniority.
For additional information:
Institute of Occupational Safety and Health
phone: 1-800-35-NIOSH (1-800-356-4674) or (513) 533-8328, fax (513) 533-8573,
Internet site www.cdc.gov/niosh/silicpag.html
Request for Assistance in Preventing Silicosis and Deaths in Construction
Workers, DHHS (NIOSH) Publication No. 96-112, May 1996.
Contains details on case definition, case reports, control measures and
List of certified
B-readers by state, approved pulmonary function technician courses, state
health department contacts for reporting purposes.
and Health Administration Local
offices are listed in the government section of the telephone directory,
usually under United States Department of Labor or the state Department
Internet site www.osha.gov
has a directory of all offices.
Or, call the national office for the number of your local office: (202)
Adverse Effects of Crystalline Silica Exposure. American Journal Respiratory
and Critical Care Medicine, 1997; 155: 761-765.
Standardization of Spirometry-1994 update. American Journal Respiratory
and Critical Care Medicine, 1995; 152: 1107-1136.
appears in the eLCOSH website with the permission of the author and/or
copyright holder and may not be reproduced without their consent. eLCOSH
is an information clearinghouse. eLCOSH and its sponsors are not responsible
for the accuracy of information provided on this web site, nor for its
use or misuse.
| CDC | NIOSH
| Site Map | Search
| Links | Help