Document 5bkqYpg27y31MKa69GGzgeOeR

FILE NAME Power Generation POW DATE 1979 DOC POW029 DOCUMENT DESCRIPTION Medical Study of Power Plant Workers ASBESTOS RISK AMONG TIME WORKERS IN AN GENERATING POWER STATION A. Hirsch L. Di Menza A. Carre A. Harf S. Perdrizet J. Cooreman J. Bignon Service de Pneumologie Centre Hospitalier Intercommunal 94010 Cr^'teilFrance M^'decinedu Travail EDG 94400 Seine France Serviced'Explorations Fonctionnelles Respiratoires - - + H^pitalMondor '; ; 94010 Cr^'teilFrance INSERM U 123 Centre de Recherche du V^'sinet 78110 Le V^'sinetFrance The significant association of pleural fibrosis and mesothelioma with slight and transient exposure to asbestos has led to investigations undertaken to determine whether persons working time in generating power stations might be at risk. In such stations there are many areas with elevated temperatures which in the past have been insulated with containing materials The asbestos fibers could be inhaled by the workers during lagging operations particularly during the dismantling and stripping ofold lagging material early 1965 medical officers in an generating power station in - London warned of the serious potential problem of asbestos exposure for workers of that until medical findings company 1975 however that areport of the - given by Bonnel et al at the XIIIth International Congress Occupational _ Health They showed that of 77 laggers and laggermates whose exposures ranged -.., from 8 to 18 years there had been 45 cases of asbestosis including three workers with - = -': _ bronchogenic carcinoma eight cases of mesothelioma 13 workers with pleural + these were plaques Although findings made only in laggers it clear that other . ~- in ' workers involved maintenance work at power stations are also risk although at lower conducted volunteers a For this reason a survey has been conducted among volunteers from the time -. staff of French generating power station te lah Mediol Eas | - Materials and Methods | groups simultaneously Two of subjects were studied 55 male workers from the a time staff of the generating power station EDF Vitry with an average period of employment of 24.2 years and a minimum of 3 years and 53 males le - working in an automobile factory in the same area Renault Choisy Roi who had no previous asbestos exposure and served as the control group - - sot The 108 workers from both groups were examined during the period June 6 to November 7 1977 according to the following procedure Supported in part by Contract 77.3.221.5 with the National Institute of Health and Medical Research INSERM 137 DEPO EX 26-26- DATE 0330-0137 1.75 '1979. NEPONENT NEPONENT REPORTER ; a 5 wos : ot mo: _ a a . y : : z 5 138 . Annals New York Academy of Sciences ' TABLE 1 CHARACTERISTICS OF EXPOSED AND CONTROL WORKERS Characteristic Mean age years Range years 45 . 45-49 50-54 55 Females Smoking habits . Nonsmokers _ smokers - + -. |. ; Smokers Exposed n = 55 49.6 . 75005 75005 28 75005 r . - 12 825 - 825 , . oO Control n = 53 49.9 6705e 6705e 26 6705e 6705e 11 17 so 26 p NS NS NS NS NS NS . NS NS NS for A standardized questionnaire on past history of pulmonary disease on current | symptoms relating to the upper and lower respiratory system antdo the gastrointesti- .- nal tract and on occupational domestic environmental histories detection of . past exposure to asbestos ". Te : _ Posteroanterior PA and left lateral L chest rays read blindly by two experienced physicians according to the ILO 1971 classification re ; TABLE2 - a CYTOLOGIC Clincial FuncTIONAL AND DATA FOR EXPOSED and CONTROL WORKERS Exposed 7 a Control Data 0 55 - n = 53 Pa Number Percent Number Percent p Clinical Chronic bronchitis 11 Shortness of breath at exercise 31 Thoracic pain 19 Voice hoarsening 8 Intestinal transit abnormalities 22 Dyspepsia 1 Gastralgia 15 Abdominal pain 3 Functional 20 56 34 14.6 40 1.8 27.3 5.4 10 22 9 S 16 2 21 6 18 42 17 9.4 29.6 3.8 38.9 11.1 . NS NS 0.03 NS NS NS NS NS Normal Obstructive abnormalities FEV1 FVC < 80 predicted Restrictive abnormalities FVC < 80 predicted Mixed Not reliable Cytologic Ferruginous bodies Bronchoalveolar cells 39 79 38 88 NS 6 12 N 4 NS 406 8 121 2 NS 406 121 24 NS 406 121 NS 18 32.7 Sw 5.6 0.001 39 74 Sw 57.6 0.08 Pulmonary funct capacity FVC one curve maximum ex FVC consecutive Three consecutive screening and two in bodies by light micro Air was sampled Analysis of the asbe TEM for identifi fibers Statistical studies ' RAY Ray Data Parenchymal opacities Small opacities Size - AO - Profusion -, Irregular Opacities Size Profusion Pleural abnormalities Diaphragm rectitud Pleural thickening > 5mm Pleural calcification 1971 ILO Clas Age and sex as ir and control Renault . was a total of 43 ciga cigarette consumptio years and 26 t P NS NS NS NS NS . NS . , Hirsch et al Asbestos Risk 139 Pulmonary function tests in each subject one measurement of forced vital capacity FVC one of forced expiratory volume in 1 sec FEV and a volume curve maximum expiratory flow rate at 25 of forced vital capacity MEFR 25 FVC Three consecutive sputum samples were collected one in 60 alcohol for cytologic screening and two in 10 formaldehyde for detection and numeration of ferruginous bodies by light microscopy Air was sampled both inside and outside the various workplaces of the two plants Analysis of the asbestos fibers was performed by transmission electron microscopy TEM for identification and quantitation of TEM chrysotile amphibole fibers . : Statistical studies were performed by use of standard tests square TABLE 3 RAY FINDings for EXPOSED AND CONTROL WORKERS es for gastrointesti- of | blindly by two ol 3 Percent Pp Ray Data Parenchymal opacities Small opacities Size Profusion . Irregular Opacities : Size ae _ ~ Number Percent Number Percent P p 18 33.5 6617 30.2 NS No lw^o 5.6 6617 11.3 NS -- No lw^o 6617 NS 0/0 No lw^o 18.1 6617 14.2 NS 1/1 No lw^o 14.8 = 20.6 NS 1/2 No lw^o 3.7 2 3.8 NS .2 . 1 1.9 NS 2/2 1 1.8 "4 1.9 NS : et ; Coe - : . S 31 57.4 37 69.8 NS an a 16 29.6 7 .13.2 NS . NS wo -Profusion oo . NS - 17 0.03 ne - . 0/0 1/1 - 1/2 14 25.4 19 35.2 14.8 2 - 14 19 26.4 35.8 11.3 .. NS = NS NS 29.6 NS sO ; 3.8 38.9 NS NS Ce sof * 11,1 NS oe 11,1 abnormalities 2/2 ne _ Pleural abnormalities : . 23 . Diaphragm rectitude - to 23 . Pleural thickening . a _ a * 5mm 7. - 15 5.6 - 2. 3.8 | NS 41.8 . 27.3 17 * . 9 - 17 0.005 -. ee - 7 _ . _ 13 0.06 : i = - 4 | : coats 4 NS ; 1971 ILO Classification ' 7 24 24 5.6 57.6 NS NS 0.001 0.08 RESULTS . . Age and sex as indicated in TABLE , were identical both groups exposed EDF and control Renault groups Smoking habits were also identical in both groups there was a total of 43 cigarette smokers in the two groups In the exposed group the mean cigarette consumption was 26.5 years there were 17 light smokers less than 20 years and 26 heavy smokers 20 years or more In the control group the 140 Annals New York Academy of Sciences mean cigarette consumption was 28 years there were 15 light cigarette smokers and 28 heavy smokers Clinical data are given in TABLE 2. Respiratory symptoms chronic bronchitis dyspnea were observed with the same frequency in the two groups except chest pain which was significantly more frequent in the exposed group than in the controls Voice hoarsening and intestinal transit abnormality were more frequent in the exposed group gastralgia dyspepsia and abdominal pain were more frequent in the control group These differences were not significant however Results of functional tests in the exposed group were 39 patients with normal tests six men with air flow obstruction with an FEV1 ratio less than 80 of predicted values and four workers with restrictive abnormalities FVC less than 80 of predicted values These findings were not significantly different between the two groups However the mean values of FVC percent predicteanddMEFR FVC . ~ percent predicted were significantly lower exposed group FVC 96 MEFR FVC than in the control group FVC 103 MEFR FVC 106 p . 0.03 and 0.05 - _: opacities parenchymal in -. ray findings are given TABLE 3. With regard there - was no significant difference between the two groups By contrast three ~ pleural _ abnormalities were significantly more frequently observed in the exposed group than - FIGURE 1. Rectitude of diaphragm posteroanterior ray in an asbestos worker FIGURE 2. Rect in the controls in FIGURES 1 & 2 pl calcification Cytologic exami have bronchoalveolar one exposed worker ,, TABLE 2 Ferruginous bod exposed group and i number of ferrugino recalled previous lig bile factory By cont from 1 to 282 FB w FB one had 35 FB : the frequency of sor number of FB for parenchymal opaciti arette smokers -- chitis cj pain con ..+. Voice n the exposed in the control is with normal ss than 80 of > less than 80 tween the two FR FVC C 96 MEFR VC 106 p = pacities there three pleural sed group than Hirsch et al Asbestos Risk 141 posed worker ' FIGURE 2. Rectitude of diaphragm lateral ray in an asbestos exposed worker controls frequency in the ' in decreasing localized rectitude of the diaphragm - thickening pleural FIGURES & 2 calcification more than 5 mm thick FIGURE 3 and pleural Cytologic examination of sputa revealed that exposed subjects more frequently TABLE bodies were found sputa workers % FB the 18 have bronchoalveolar cells none had atypical cells suggestive of malignancy although oneexposed , worker examined a few months later was found to have a a lung carcinoma 2 1 - - Ferruginous were ininthe of 32.7 in exposed group andin only three workers 5.6 %in the control group however the number of ferruginous bodiesin the latter subjects was very low 1-2 FB and all recalled previous light asbestos exposures before they started workingin the automo- bile factory By contrast the number of FB in the exposed group was much higher from 1 to 282 FB with a mean of 24 FB for the positive cases 16 subjects had 1 - 17 FB one had 35 FB and one had 282 FB TABLE 2 A correlation was found between the frequency of some abnormalities possibly related to asbestos exposure and the number of FB for both groups TABLE 4 However there was no relation to parenchymal opacities on 142 Annals New York Academy of Sciences Analysis of th airborne fibers in fibers in the air of The finding o that there is a ri power plant The have been heavy i was not restrict _ asbestos : _ asbestos in air in _ FIGURE 3. Pleural thickening in an asbestos exposed worker . Building Electricity " power station . exposed New station _ osderiag Old station TABLE 4 Percentage OF ABNORMAlities RelaTED TO NUMBER OF FERRUGINous Bodies IN SPUTUM n = 108 Abnormality Pleural calcification Pleural thickening Hoarsening of voice 5mm Gastrointestinal symptoms Small opacities rounded and irregular 1/1 in lower two thirds of lung Number of Ferruginous Bodies per Sputum Sample 0 1-10 10 n = 87 n = 14 = 7 3.5 14.8 8 30.7 35.7 35.7 28.6 52.4 42.9 54.1 62.5 78.6 57.1 P 0.001 0.01 0.06 0.06 NS Automobile Automobile factor controls ND = not detectat indicated low le buildings One 1 material this par was used only in longer periods in asbestos dust alt high concentratio deposited and ha There is me diseases in the e as pleural calcifi demonstrated th rectitude of the c gastrointestinal t worker . JMBER 08 uginous Sample- .- 10 ) = 28.6 52.4 42.9 54.1 57.1 : P 0.001 0:01 0.06 0.06 NS Hirsch et al Asbestos Risk 143 Analysis of the air in the power plant TABLE 5 demonstrated the presence of airborne fibers in the range 0.1-6000 ^ 10 mthere were virtually no asbestos fibers in the air of the automobile factory DISCUSSION The finding of asbestos bodies in the sputa of 33 of exposed workers confirms that there is a risk from asbestos for the time staff of an generating power plant The intensity of asbestos exposure was moderate in most cases but must have been heavy in others as indicated by the mean value of 24 FB The asbestos risk was not restricted to workers involved in lagging operations because FB and asbestos abnormalities were also found in other workers Measurements of asbestos in air inside and outside the power station made at the time of this survey TABLE 5 LEVELS OF ASBESTOS IN THE AIR OF BUILDINGS WHERE EXPOSED AND CONTROL GROUPS WERE AT WORK Asbestos in Air Building Sampling Conditions Sampling Site 10-9 m Chrysotile Amphibole generating power station exposed New station during usual work : : storeroom asbestos materials repair shop asbestos sprayed indoor 0 45 50 6000 8 0.1-0.5 0.4 ND ND ND ND ND - level ; outdoor Old station ; 24 hr after| indoor 2 to 10 - . 2-40 1-90 _ insulating from lagging operations =. 0.4 . ND a - operations outdoor eo, i . ; Automobile factory during usual .indoor - 4 ND . ad _ controls a work : sok, old . Loe ND = not detectable m = meter ; he d indicated low levels of fiber contamination The power station is housed in two buildings One building is old in which many areas are insulated with asbestos material this part of the station was in time use from 1928 to 1964 and thereafter was used only intermittently All of the workers the study worked for shorter or . longer periodsin the power station The new building appears to be less polluted by asbestos although no sample has yet been taken during insulating operationsand usually storeroom high concentrations have been foundin a deposited and handled where asbestos materialis s of diseases symptoms There is medical diseasesin the exposed evidence asbestos or of such group In addition to classic asbestos conditions such thoracic as pleural calcification pleural thickening and decreased vital capacity this study demonstrated the statistical significance of other abnormalities such as localized rectitude of the diaphragm recent hoarsening of thevoicethoracic pain and various gastrointestinal tract symptoms These abnormalities may also be related to asbestos 144 Annals New York Academy of Sciences exposure as suggested by their relationship to the number of FB in sputum samples TABLE 4 a factor known to be correlated with the intensity of asbestos exposure These abnormalities may correspond to early symptoms that might be useful in detecting asbestos exposure in different occupations occupations although it is well known that the use of respiratory questionnaires is very difficult and the interpretation of data must be cautious By contrast abnormal irregular parenchymal opacities even more than 1/1 were not significantly different between exposed and control groups moreover their frequency was not greater in cases with more than 10 FB per sputum sample More severe diseases were also observed during this study four cases of asbestosis were declared to the French Social Security system for compensation and one case of bronchogenic carcinoma was diagnosed 6 months after the end of the study There were no FB in the sputum of this patient and on operation no pleural plaque was found in the left thorax parenchymal samples from the lower lobe of the left lung showed no fibrosis and only a very small amount of asbestos fibers 63 cmof fixed lung tissue 5.10 TEM fibers mostly of the amphibole type 83 with a mean diameter of 0.10 mand a mean length of 4.7 m20 of the fibers were more than 8 min length Furthermore during 1977 two laryngeal carcinomas were diagnosed among the 500 other workers of the power station this finding should be of compared with the significantly high frequency of voice changes observed among the . workers investigated The finding must however be interpreted with caution in view of the selected nature of the population studied this rate of laryngeal carcinoma should be compared with the incidence this tumor in the general population or in control group without asbestos exposure Periodical medical surveillance by regular examinations including chest radiography will continue at the power station not only for workers previously investigated but also for other workers even after retirement These findings emphasize the following points An analogous asbestos risk must exist in other power stations in other plants where high temperatures demand the use of insulation materials This aspect of occupational asbestos exposure in workers not directly involved in lagging operations requires further investigation The present survey was an etiologic retrospective study without measurement history in the different workplaces during the entire working period A more precise study of the response relationship at this kind of asbestos exposure would require more data on the concentration of airborne asbestos fibers in different areas of the power station during usual work hours and during the different operations of insulation and of removal of old lagging The concentration of asbestos fibers in biologic specimens sampled from the workers should also be investigated more extensively New asbestos thermal insulating materials must be promoted for use in generating power stations and in other plants where asbestos materials have commonly been used in the past In England a decision was made as early as 1969 to abandon the use of containing materials throughout the central electricitygenerating system For the replacement of old insulating containing material special protection is needed to avoid the contamination of the air in the whole building which would otherwise pose the risk of asbestosis for the entire staff of the plant ACKNOWLEDGMENTS Microscopic analyses of air samples and sputum samples were performed by LEPI Laboratoire d'Etude des Particules Inhal^'es Direction de l'Action Sanitaire et Sociale Paris France by I chest rays A matched survey of generating pow an automobile plant has b confirmed by the presence air sampled during the sur of the workers The foll exposure |. the study gro pleural thickening pleura studied gastrointestinal s cantly related to the numb DOE 1. NAVRATIL M. & persons exposed to ast 2. ANDERSON H. A. R. . Household as 3. FONTAINE J. H. & D. plants Amer Ind Hy 4 J. BONNELL A. R. M. O. MASSEY 197 Electricity Generatin Occupational Health 5 Bignon J. P. Sebasti quantitative study of 9 155 160 6. SEBASTIEn P. J. BignC microscope ^'lectroni l'amiante Arch Mal 7. SAMETJ. M. F. E. SPE in asbestos exposed v 8. STELL M. & T. Laryngol Otol 89 5 9. LILIS R. S. Daum ^ monograph in sputum samples asbestos exposure. mi - useful in W vn that the cta data must nore than 1/1 were ps moreover their um sample ir cases of asbestosis tion and one case of of the study There pleural plaque was obe of the left lung bers 63 cmof type 83 with a the fibers were more al carcinomas were is finding should be observed among the with caution in view aryngeal carcinoma al population or in veillance by regular wer station not only n after retirement other plants where pect of occupational operations requires ective study without e working period A ~ of- tos exposure Os in different di t operations of asbestos fibers in e investigated more promoted for use in bestos materials have as early as 1969 to e central electricitycontaining materi- the air in the whole - he entire staff of the > performed by LEPI Action Sanitaire et : Hirsch et al Asbestos Risk 145 Sociale Paris France by Dr. G. Bonnaud and Mr. P. Sebastien Dr. R. Lilis read the chest rays SUMMARY A matched survey of 55 time workers probably exposed to asbestos in an generating power station exposed group and of 53 unexposed workers in an automobile plant has been conducted The asbestos risk in the power station was confirmed by the presence of airborne fibers in the range 0.1-6000 ^ 10flmin the air sampled during the survey period and by the presence of FB in the sputa of 32.7 of the workers The following parameters were significantly related to asbestos exposure in the study group FB in the sputa localized rectitude of the diaphragm pleural thickening pleural calcification and chest pain Moreover for all persons studied gastrointestinal symptoms and recent hoarsening of the voice were significantly related to the number of FB in the sputa REFERENCES ] Navratil M. & J. Dobias 1973. Development of pleural hyalinosis in longterm studies of persons exposed to asbestos dust Environ Res 6 455-472 2 ANDERSON H. A. R. LILIS S. M. DauM A. S. FISCHBEIN & I. J. Selikoff 1976 Household asbestos neoplastic risk Ann N.Y. Acad Sci 271 311-323 3. FONTAINE J. H. & D. M. Trayer 1975. Asbestos control in electric generating wey plants Amer Ind Hyg Ass J. 36 126 130 4. BONNELL J. A. J. R. Bowker R. C. BROWNE J. F. Erskine R. H. P. FernandEZ & P. M. O. MASSEY 1975. A review of the control of asbestos processes in the Central Pe r mw Electricity Generating Board Paper presented at the XVIII XVIII International Congress on Occupational Health Brighton England 5. BIGNON J. P. Sebastien M. C. Jaurand & B. HEM 1974. Microfiltration method for quantitative study of fibrous particles in biological specimens Environ Health Perspect TP 9 155-160 6. SEBASTIEN P. J. Bignon M. A. Billon X. Janson & G. Bonnaud 1978. Utilisation du hai microscope ^'lectronique^ transmission MET pour la mesure des contaminations par l'amiante Arch Mal Prof. Hyg Toxicol Ind 39 229 248 7. SAMET M. E. SPEIZEr & E. A. Gaensler 1978. Questionnaire reliability and validity ae in asbestos exposed workers Bull Eur Physio Respir 14 177 188 8. STELL P. M. & T. MCGILL 1975. Exposure to asbestos and laryngeal carcinoma J. Laryngol Otol 89 513 517 - 9. LILIS R. S. Daum H. Anderson M. Sirota G. ANDREWS & 1. J. SELIKOFF This monograph