What is beryllium?
Beryllium is a metal that is used in the manufacturing of dozens of items, including cars, computers, golf clubs, and electrical equipment. Beryllium is light, non-magnetic, and a good conductor of heat and electricity, which is why it is used so widely.
What is beryllium disease?
Beryllium-induced lung disease can occur when beryllium dust or fumes are inhaled. There are 2 types of beryllium disease, acute and chronic:
- Acute beryllium disease is very rare today. Current workplace safety regulations prevent the massive quantities of beryllium that cause acute beryllium disease from being released into the air.
- Chronic beryllium disease (CBD, berylliosis) is associated with inhaling beryllium powder or fumes (although inhaling beryllium does not always lead to CBD). An exposed person usually gets sensitized to beryllium prior to progressing to CBD. Sensitization is similar to an allergy; when allergic or sensitized, the body reacts negatively to that particular substance. Beryllium sensitivity (BeS) and CBD can develop soon after exposure or many (30-40) years later. Of those working around beryllium, about 10% get sensitized to it and about half of those progress to develop CBD.
There is no health threat associated with contact with solid beryllium; however, both the solid and powder forms can cause irritation if they come in contact with broken skin.
Symptoms and Causes
What are the symptoms of beryllium disease?
In the early stages of the disease, little or no symptoms are experienced by the individual. When a person begins to develop CBD, inflammation (swelling) occurs in the lungs because they are reacting to a foreign object. The lungs' typical response to the beryllium exposure is to develop collections of cells known as granulomas that may eventually cause scarring within the lungs. This scarring, in turn, reduces the lungs' ability to function. Over time, the inflammation response continues, and eventually symptoms may appear, including:
Diagnosis and Tests
How is beryllium disease diagnosed?
Early in the disease, the person who has CBD has no symptoms, so the disease can be difficult to diagnose. Your doctor may look for certain signs that may indicate CBD, including unusual breath sounds in your lungs, swollen lymph nodes, and an enlarged liver. These signs develop in late stages of the disease.
Beryllium-exposed individuals should have regular health examinations, including chest X-rays and breathing tests. It is also recommended that all beryllium-exposed individuals be tested for beryllium sensitivity (BeS) with a blood test called beryllium lymphocyte proliferation test (BeLPT). This test measures your white blood cells' reaction to beryllium.
If you have an abnormal chest X-ray, breathing test, or BeLPT, your doctor may want to consider a bronchoscopy. During a bronchoscopy, a slender tube with a camera on the end is inserted into the lungs to allow the doctor to obtain samples (washings) to look for evidence of BeS in the lung, and biopsies to look for granulomas and other changes caused by beryllium disease.
Management and Treatment
How is beryllium disease treated?
There is no cure for chronic beryllium disease (CBD), but the symptoms can be treated.
All individuals diagnosed with beryllium sensitivity (BeS) or CBD are advised to avoid further beryllium exposure. Corticosteroids, which decrease inflammation, are the most frequent treatment for CBD.
The most common corticosteroid used for CBD is prednisone. Although there is no standard dosage for CBD, most doctors begin with 40 mg taken either daily or every other day. Since everyone responds differently to this treatment, your doctor will monitor your response to the drug and adjust the dosage as needed.
For patients who don't improve with steroids, the doctor may prescribe the drug methotrexate.
How can beryllium poisoning be prevented?
Avoiding exposure to beryllium is the most effective way to prevent chronic beryllium disease (CBD). The employer and all employees must make an effort to minimize and avoid exposure. The employer must follow standards set by the Occupational Safety and Health Administration (OSHA), including:
- Adequate ventilation of workspaces.
- Minimal use of beryllium over other, equivalent metals.
- Isolation of procedures using beryllium.
- Safe use of high-efficiency particulate air (HEPA) vacuums for cleaning.
- The use of personal protective devices, including face masks and respirators.
The employee must always completely clean his or her workspace and avoid eating, drinking, smoking, and applying make-up when working with beryllium dust or fumes.
Although there is a permissible exposure limit (PEL) set by OSHA for CBD-causing beryllium forms, this standard may still be too high. Inquire with your employer about the company's specific PEL.
If you work with beryllium, there are a number of actions you can take to avoid exposing your family:
- Remove street clothes and put on a uniform before entering the work area.
- Before leaving work, leave the uniform in a hamper with a lid at the workplace.
- Shower before leaving work.
- Clean work shoes before leaving the work area and don't wear them home.
Can genetic testing identify who is at higher risk of developing beryllium sensitivity (BeS) or chronic beryllium disease (CBD)?
Genetic testing may be able to identify individuals with a higher risk of developing BeS and/or progression to CBD. However, more studies are needed before beginning the widespread use of those tests. Currently, the decision to perform genetic testing should be done on a case-by-case basis, after careful discussion with a genetic counselor and the doctor.
Outlook / Prognosis
What is the outlook for someone who has beryllium disease?
The natural history of chronic beryllium disease (CBD) is currently incompletely understood. While some people may have granulomas in their lungs without experiencing untoward effects or symptoms, others develop respiratory (breathing) impairment that can be progressive over time or stable with treatment, while others develop progressive disease that may lead to disability and death.
There is no way to predict the course of a specific individual. This is why it is important to be evaluated and followed by a physician experienced in treating CBD.
What complications could occur from beryllium disease?
Lung cancer rates are significantly higher in people exposed to beryllium. Strain placed on the heart when the respiratory system is damaged can lead to an enlarged heart and heart disease over time. Side effects of medications may also be experienced by individuals needing and receiving corticosteroids (eg, weight gain, high blood pressure, high blood sugar levels, osteoporosis) or other medications.