Aluminosis is a lung disease that belongs to the group of pneumoconioses and is also recognized as an occupational disease when individuals have been exposed to aluminum oxide dust or smoke for prolonged periods in the course of their occupation. Inhaled aluminum oxide particles react directly with the cell membranes of the alveoli and are deposited in and on the membranes. Gradual remodeling of the lung parenchyma to nonfunctional collagen-hyaline tissue occurs, resulting in restrictive ventilatory dysfunction.
What is aluminosis?
In aluminosis, aluminum oxide reacts with and settles in the membranes of the alveoli. From a pathologic-anatomic perspective, aluminosis – also known as aluminum dust lung – is a special form of pneumoconiosis. Individuals who have been exposed to aluminum oxide dust or aluminum oxide smoke for years experience a gradual conversion of their functional lung tissue into functionless collagen-hyaline tissue. Aluminum dust is therefore classified as a malignant dust. The aluminum oxide reacts with the membranes of the alveoli and settles in them. The septa of the alveoli thicken and lose functionality, while the lumen of the alveoli typically narrows. In advanced aluminosis, the functionality of the lung parenchyma suffers. This leads to a greater or lesser degree of functional limitation, also known as restrictive ventilatory dysfunction. What distinguishes aluminosis from other forms of pneumoconiosis is not only the inhaled aluminum. Aluminosis mainly consists of the aluminum chemically reacting with the membranes of the alveoli. As a result, there is a change in the membrane composition and its functionality. Aluminosis is usually recognized as a compensable occupational disease in individuals who can prove that they have been exposed to certain concentrations of aluminum oxide dust at their workplace over a long period of time.
Causes
As with most other pneumoconioses, the primary cause of aluminosis is exposure and contamination of the respiratory air that exceeds a certain level. In this context, a high peak exposure reached here and there plays a lesser role than, for example, a more or less continuous exposure of the respiratory air to alumina dust or alumina smoke in the workplace. In the case of many dusts, which are merely deposited in the alveoli and can be partially phagocytosed and transported away, the process of pneumoconiosis is theoretically reversible. This is not the case with aluminosis. The alumina particles react with the septa, the cell membranes between the individual alveoli, causing thickening of the cell walls associated with partial to complete loss of function.
Symptoms, complaints, and signs
The fatal thing about aluminosis is the long waiting period, which can be as long as two decades. This means that, depending on the contamination of the air breathed in the workplace, it remains asymptomatic for many years and therefore usually goes unnoticed at first. The remodeling of the lung functional tissue and the associated loss of the ability to exchange gases proceed very slowly. The first noticeable signs and symptoms of aluminosis can be the onset of shortness of breath, bronchitis that becomes chronic, and a constant dry cough that can last for years. The risk of developing pneumonia also increases significantly. As tissue remodeling in the lungs progresses, shortness of breath and symptoms of low blood oxygen saturation increase.
Diagnosis and progression
If aluminosis is suspected, a comprehensive history and research on possible dust exposure at work and other additional exposures to dust in one’s personal life is important. The course of symptoms and complaints also provides an initial indication of the severity of possible aluminosis. The history is followed by auscultation of the chest cavity using a stethoscope. Further indications that are important for an exact diagnosis are provided by the lung function test, spiroergometry and X-ray examination. The X-ray image of the lungs reveals, for example, remodeled tissue and, above all, possible water retention in the lungs. A blood gas analysis also provides valuable information. In particular, oxygen saturation and carbon dioxide content are measured, which is elevated due to increasing aluminosis.In rare cases, a lung biopsy is necessary for an exact diagnosis, in which lung tissue is removed in a surgical procedure for further examination. The further course of aluminosis depends on the extent to which tissue remodeling in the lungs has already progressed. This also includes the possibility of protecting the diseased person from further exposure to aluminum dusts. Already remodeled functional lung tissue is irreversible. Fibrous lung tissue cannot be converted back into functional tissue capable of gas exchange. With continued exposure to dust, the course of aluminosis is severe and the prognosis unfavorable.
When should you see a doctor?
Since aluminosis causes respiratory disorders, this disease must be treated by a doctor in any case. Without treatment, there is usually shortness of breath and decreased saturation of the blood with oxygen. This can result in damage to the internal organs, which is usually irreversible. Therefore, if shortness of breath develops and is accompanied by a cough, a visit to a doctor is necessary. Pneumonia can also be a symptom of aluminosis. In most cases, this is treated by a doctor. It is not uncommon for patients to also notice decreased blood flow or cold extremities. These symptoms may also indicate the disease and should be treated by a medical professional. Whether direct treatment of aluminosis is possible cannot be generally predicted. If the individual is unsure whether aluminosis is present, either a pulmonologist or a general practitioner can be consulted. The treatment itself is then usually performed by a pulmonologist.
Treatment and therapy
The most important initial measure when aluminosis is detected is to protect the ill person from further exposure to alumina dust or alumina smoke and also from other dusts. If the disease is accompanied by acute inflammatory processes, treatment with cortisone and, in rare cases, antibiotics, some of which are controversial, may be indicated. Aluminosis may worsen even years after exposure to alumina dust has stopped. Because there is no known effective drug treatment that could effectively halt the progression of the disease, the only therapeutic option may be lung transplantation. However, aluminosis is in sharp decline due to strict regulations on workplace respiratory exposures. There are hardly any new cases of the disease.
Outlook and prognosis
As a rule, aluminosis cannot be diagnosed early because the complaints and symptoms do not manifest themselves in the patient until after about twenty years. Thus, early treatment is unfortunately not possible either. In most cases, aluminosis has a very negative effect on the breathing of the affected person. Shortness of breath and gasping for breath occur. Furthermore, the affected person can also suffer from shortness of breath, which is sometimes associated with panic attacks. The quality of life of the affected person decreases significantly due to aluminosis. Furthermore, pneumonia often occurs and the concentration of oxygen in the blood is reduced. Due to the undersupply of oxygen, the internal organs are also damaged, and the brain can also be affected. The life expectancy of the affected person is reduced by aluminosis. A causal treatment of this disease is not possible. Existing inflammation can be resolved with the help of antibiotics. However, in some cases, transplantation of the lungs is necessary to prevent the affected person from dying. Similarly, the patient is usually unable to perform his or her previous occupation due to the disease.
Prevention
The most important preventive measure to prevent aluminosis is to avoid prolonged exposure to polluted air. This requires individuals in the aluminum processing industry to be aware of the level of exposure in their individual workplace. If limit values are exceeded, an immediate reduction in exposure must be demanded. In addition, it is advisable for persons at risk to have a lung function test carried out regularly at intervals of a few years in order to be able to draw consequences at the first signs of aluminosis.
Aftercare
Direct follow-up is usually not possible for aluminosis. In most cases, only the symptoms of aluminosis can also be treated symptomatically, with no causal treatment possible. Possibly the life expectancy of the patient is also reduced by this disease. The affected person must immediately stop the trigger for the disease when diagnosed with aluminosis. This may also involve changing occupations so that the dust or fumes from alumina are no longer inhaled. This is the only way to prevent further deterioration of the general condition of the affected person. Further treatment usually involves the use of medications and antibiotics. The patient should ensure that these are taken regularly and that they do not interact with other medications, so that complications do not arise. Antibiotics should not be taken together with alcohol. In severe cases of aluminosis, however, transplantation of a lung is necessary to completely cure the affected person. After such a procedure, the patient must always rest and take it easy. Smoking or physical activity must be avoided in any case. Furthermore, in some cases, contact with other sufferers of aluminosis can have a positive effect on the course of the disease.
What you can do yourself
After aluminosis has been diagnosed, the most important measure is to prevent the affected person from further contact with aluminum oxide dust, aluminum oxide smoke, and other harmful influences. Accompanying this, the sufferer must in any case have a medical examination and, if necessary, start therapy directly. Usually, medications such as cortisone or antibiotics are prescribed for the treatment of aluminosis. Drug therapy can best be supported by the affected person through a healthy lifestyle and close monitoring of the physical reaction to the prescribed drugs. It is also important to have regular examinations by a physician, as aluminosis can become noticeable months or years after the initial exposure. Depending on the underlying cause of the condition, it may be necessary to change jobs in parallel with these measures. If the complaints are due to an accident, trauma therapy is also useful in some cases. Which measures are indicated in detail should be decided by the affected person in discussion with the responsible physician. In any case, contact with the toxins must be avoided.
