The lungs are delicate organs, and the lungs are directly connected to the outside world through the nose and throat. Occupational and environmental exposure to particulate matter and chemicals may damage the airways and even the lung parenchyma and interstitium, causing lung disease due to occupational environmental exposure. I. What is hard metal pneumopathy? Hard metal pneumopathy is an occupational lung disease characterized by respiratory symptoms, lung function impairment, and diffuse interstitial lung changes on imaging and histology due to hard metal dust exposure. II. What are hard metals? Hard metals are polycrystalline man-made synthetic materials that are transformed from powder to solid by the metallurgical process of sintering and are resistant to pressure, wear, heat and corrosion, and are often used in various industries as drills, cutting and grinding planing dies, etc. The first report of this type of disease was in the German literature in 1940. Studies have shown that cobalt is a key etiological factor in hard metal lung disease, with tungsten carbide playing a synergistic role. Sources of cobalt exposure include hard metal fabrication, repair and grinding of hard metal tools and blades, and the manufacture and use of diamond tools containing cobalt. In addition, there are other areas of cobalt exposure such as cobalt-containing pigments, cobalt smelting and extraction, metallurgical industries, petrochemical and plastics industries, chemical reagents and medical treatment. Exposure to cobalt dust in various environments poses a potential threat to the lungs and can lead to asthma in addition to interstitial lung disease. Third, is hard metal lung disease a legal occupational disease in China? In 1980, in Convention No. 121, bronchopulmonary disease caused by hard metal dust was included in the ? International list of occupational diseases. 2010 released the International Labor Organization directory of occupational diseases, hard metal dust-induced bronchopulmonary disease was included in the list of occupational diseases in which the target organ system is respiratory disease. December 23, 2013, the National Health and Family Planning Commission, the Ministry of Human Resources and Social Security, the General Administration of Safety and
The four departments of the National Federation of Trade Unions jointly issued the Classification and Catalogue of Occupational Diseases, and hard metal lung disease was listed as one of the new occupational diseases in China’s statutory occupational diseases. What are the histological features of the lungs in hard metal lung disease? Lung histopathology is characterized by giant cell interstitial pneumonia (GIP), with characteristic changes of multinucleated giant cells in the alveolar septum and alveolar lumen, which have multiple nuclei, visible inclusion bodies, and phagocytic cellular components in the cytoplasm. This is accompanied by a significant interstitial lymphocytic infiltrate. Elemental tungsten is usually detectable in the lung tissue. Due to the plasma solubility of cobalt dust, which does not easily accumulate in the lung tissue, cobalt is detectable in the lung tissue of only about 1/4 of patients. The onset and prognosis of hard metal pneumopathy does not correlate with the dose and duration of hard metal dust exposure, and allergic reactions and individual susceptibility play a role in the onset, similar to allergic pneumonia or chronic beryllium disease. Some patients have histopathological manifestations of allergic pneumonia, suggesting a combination of the two. V. What are the clinical manifestations of hard metal pneumopathy? The course of the disease is heterogeneous, subacute or chronic. There are usually symptoms of mucosal irritation, including sneezing, runny nose, sore throat, and cough. As well as exertional dyspnea, wheezing, and chest pain with weakness and wasting. The symptoms are aggravated by occupational exposure, gradually resolve after disengagement, and worsen again upon re-exposure. Chest CT showed ground glass shadow, grid shadow and lobular central nodular shadow in both upper lungs and along the bronchial distribution. The end-stage resembles the common type of interstitial pneumonia changes. VI. How is hard metal lung disease diagnosed? A thorough and complete occupational history of hard metal dust exposure is a prerequisite for diagnosis. elements. VII. What is the course of the disease? What are the treatment options? In the early stages of the disease, the disease can resolve spontaneously if exposure is stopped. In addition, glucocorticoids can relieve clinical symptoms and improve imaging and lung function. End-stage patients can have lung transplantation. People in industries related to cobalt exposure should be closely monitored and have regular medical examinations for early detection of hard metal lung disease.