What are the effects of beryllium on the lungs, specifically in relation to Berylliosis (Chronic Beryllium Disease)?

From the Guidelines

Beryllium exposure is a known risk factor for lung disease, and individuals with a history of beryllium exposure should be considered for lung cancer screening, as it can cause chronic beryllium disease (CBD) and increase the risk of lung cancer. The effects of beryllium on the lung can be severe, with chronic beryllium disease (CBD) being a significant concern 1. CBD is an inflammatory disorder that develops in approximately 2-6% of exposed individuals, leading to the formation of granulomas (clusters of inflammatory cells) in the lungs. Early symptoms include shortness of breath, dry cough, fatigue, weight loss, and chest pain 1.

Key Points to Consider

• Beryllium exposure can cause chronic beryllium disease (CBD), an inflammatory disorder that can lead to pulmonary fibrosis and reduced lung function 1.
• Acute beryllium exposure at high concentrations can cause chemical pneumonitis, a severe inflammatory reaction in the lungs 1.
• Prevention is critical through proper workplace controls and respiratory protection for those working with beryllium-containing materials 1.
• Treatment for CBD typically involves corticosteroids like prednisone to suppress inflammation, along with oxygen therapy and bronchodilators as needed 1.
• Beryllium is identified as a carcinogen targeting the lungs, and individuals with a history of beryllium exposure should be considered for lung cancer screening 1.

Recommendations

• Individuals with a history of beryllium exposure should undergo lung cancer screening, as recommended by the NCCN guidelines 1.
• Early detection through beryllium lymphocyte proliferation testing (BeLPT) and removal from further exposure are essential steps in managing CBD and preventing progression 1.
• A multidisciplinary approach for nodule management, including thoracic radiology, pulmonary medicine, and thoracic surgery, is recommended for individuals with a history of beryllium exposure 1.

From the Research

Effects of Beryllium on the Lung

• Beryllium exposure can lead to sensitization (BeS) and chronic beryllium disease (CBD), a systemic granulomatous lung disorder caused by a specific delayed immune response to beryllium 2, 3.
• The beryllium lymphocyte proliferation test is the cornerstone of both medical surveillance and the diagnosis of BeS and CBD, with a confirmed abnormal test result without evidence of lung disease being diagnostic of BeS, and BeS with evidence of a granulomatous inflammatory response in the lung being diagnostic of CBD 2.
• The determinants of progression from BeS to CBD are uncertain, but higher exposures and the presence of a genetic variant in the HLA-DP β chain appear to increase the risk 2, 3, 4.
• Longitudinal data suggest that BeH progresses to CBD, and together with a comprehensive history, the BeLPT may help identify berylliosis in patients erroneously diagnosed with sarcoidosis 4.
• Beryllium lung disease is a chronic granulomatous disorder in which a beryllium-specific immune response plays a central role, with pathologic changes on biopsy, lymphocytic alveolitis on BAL, and positive BAL lymphocyte transformation tests (LTT) in response to beryllium sulfate 5.
• The beryllium bronchoalveolar lavage lymphocyte proliferation test (BeBALLPT) can contribute evidence of BeS and beryllium-induced lung inflammation, with a positive test being closely linked to the presence of granulomata on lung biopsy 6.

Diagnosis and Management

• Medical surveillance in workplaces that use beryllium-containing materials can identify individuals with BeS and at-risk groups of workers, which can help prioritize efforts to reduce inhalational and dermal exposures 2.
• Periodic evaluation of affected individuals can detect disease progression (from BeS to CBD, or from mild CBD to more severe CBD) 2.
• Corticosteroid therapy is typically administered when a patient with CBD exhibits evidence of significant lung function abnormality or decline 2.
• The current Occupational Safety & Health Administration permissible exposure limit of 2 microg/m3 has failed to protect workers from BeS/CBD, and further reductions in exposure levels are needed to help minimize the incidence of CBD 3.