March 27, 2000
I have been asked to describe the toxicity of beryllium. I am an occupational medicine specialist, trained in work related toxic exposures. I practice here in Lorain County and am an assistant professor at Case Western Reserve University School of Medicine.
I remember well the story of beryllium toxicity from my medical school education. Beryllium disease was first described in the 1930's and 1940's in workers, mainly women, exposed to beryllium-containing phosphors in the fluorescent lamp industry. Cases were initially mistaken for both tuberculosis and sarcoidosis. It was due to diligent detective work by medical investigators, such as Dr. Harriet Hardy, that the true cause of these workers' illnesses- beryllium- was uncovered.
Beryllium has been a difficult substance for the medical field to completely understand and conquer. At high exposure levels, beryllium dust or fumes acts similarly to other severe metal and chemical irritants. Fumes and dust from heating and grinding of beryllium metal can cause skin rash, irritation of the eyes, nose and throat, chest pain and bronchitis. Repeated high exposures will lead to chronic lung disease, emphysema and death.
These serious health effects were preventable by dramatically lowering beryllium air levels in the workplace. Process redesign and engineering controls were put in place to enclose systems, and workers were required to wear protective clothing and respirators while working with beryllium. The Occupational Safety and Health Administration (OSHA) instituted air level regulations for beryllium. These regulations state that workers must not be exposed to more than 2 micrograms per meter cubed of beryllium in the air over an eight hour day. Acute beryllium disease is now rarely seen today.
However, the toxicity of beryllium does not occur solely at those high levels. There is a much more subtle lung disease caused by beryllium at much lower air levels. Chronic beryllium disease (CBD), also known as berylliosis, can occur at low air levels of beryllium that do not cause eye, nose and lung irritation. This illness may not begin until ten years or more after exposure. The symptoms include shortness of breath, cough, fatigue, weight loss, chest pain and joint pains. Patients with CBD can develop skin ulcerations, swollen lymph glands, enlargement of the liver and spleen, and heart failure. Their lungs become more and more damaged, sometimes slowly, sometimes quickly, leading to permanent lung scarring and emphysema. The lungs can become so scarred that there is literally no lung tissue left with which to breathe.
CBD is a terrible, often fatal, illness that appears to attack not only the lungs but also many other areas of the body. Medical research to find effective treatment for this disease has been very disappointing thus far. We have not found a cure for CBD. Patients with CBD are frequently forced to take lifelong corticosteroid therapy just in an attempt to halt the progression of the disease. Cortisteroid medication such as prednisone, has it's own serious side effects, such as marked weight gain, thinning of the bones and a weakened immune system. Some patients with CBD must also be on an oxygen machine for up to 24 hours a day. Thirty percent of those with CBD will die from their disease.
How does beryllium cause this devastating illness? We know that beryllium as a dust or fume is inhaled into the lungs. Some of this beryllium is then absorbed through the lungs into the blood stream and travels throughout the body, where it deposits in bone, liver and kidneys. After doing it's damage, much of the beryllium is then extracted through the kidneys. People who develop CBD appear to have longterm hypersensitivity reaction to the beryllium. This reaction continues even after the beryllium exposure stops, leading to the many serious medical complications noted previously. Medical studies are continuing to research why beryllium workers develop this hypersensitivity. Although it is not clear how many workers become sensitized, studies indicate that between 1-3% of beryllium workers develop CBD.
Another critical research question concerns the level of exposure that can cause CBD. No clear threshold of exposure has been determined. CBD has occurred not only in beryllium processing workers but also in guards and secretaries at these plants and in family members of beryllium workers. As recently as 1991, CBD was diagnosed in a family member of a worker who brought beryllium dust home on his clothes. According to the Federal Agency for Toxic Substance and Disease Registry (ATSDR), "low, seemingly trivial exposure to beryllium may be important in causing beryllium disease".
The question of low level exposure is also important when considering the cancer-causing risk of beryllium. Although acute and chronic beryllium disease was recognized in the early to mid 1990's, it wasn't until more recently that beryllium was suspected of causing lung cancer. The National Institute of Occupational Safety and Health (NIOSH) completed several studies in the early 1990's analyzing lung cancer cases in all seven beryllium plants studied. NIOSH estimates that patients with CBD have more than a two times increased risk of lung cancer compared to the general population.
In summary, beryllium is clearly one of the most toxic metals in industry. One can make an apt comparison between beryllium and better known toxins, such as lead and asbestos. All of these substances have been extremely useful and versatile tools in the industrial revolution of the last century. However, they have left so much suffering and death in their wake. Medical science has been unable to find cures to the devastating illness caused by lead, asbestos, and beryllium. Instead, the public health consensus for exposure to beryllium -- just as it is for asbestos and lead -- is prevention. My recommendation to you is to do everything you can prevent beryllium exposure to the citizens and workers of Lorain.