B

berylliosis Chronic damage to the LUNGS, also
called chronic beryllium disease, resulting from
industrial exposure to beryllium, a heavy metal
that has many commercial uses and applications in
contemporary manufacturing processes. Inhaled
beryllium fumes and dust cause irritation to the
delicate alveoli that activates the body’s IMMUNE
RESPONSE. In the United States berylliosis occurs pri-
marily in people who work in the electronics,
nuclear, and aerospace industries where beryllium
usage is high. People who work in metal machining
or alloy reclamation jobs are also at risk. The US
Environmental Protection Agency (EPA) classifies
beryllium dust and fumes as toxic substances, and
the US Occupational Safety and Health
Administration (OSHA) has established regulatory
guidelines to minimize on-the-job beryllium expo-
sure. Beryllium particles can remain in the lung tis-
sues for six months to several years after exposure.
Berylliosis results from delayed-type hypersensi-
tivity (DTH) in which helper T-cell lymphocytes
flood the sites of exposure and encase the beryllium
dust particles or the areas of INFLAMMATION, causing
granulomas to form. Over time the granulomas
evolve into fibromas, well-defined structures of
SCARtissue that replace normal lung tissue. As the
penetration of granulomas and fibromas extends
deeper into the lungs, the loss of alveolar function
cripples the ability of the lungs to pass oxygen to
the BLOOD.

Rarely, an individual may develop an

immediate response, called acute chem-

ical PNEUMONITIS, to beryllium exposure.

Acute chemical pneumonitis requires

prompt medical treatment to reduce

airway irritation and INFLAMMATION.

Symptoms and Diagnostic Path

Symptoms of berylliosis are similar to symptoms

of other chronic inflammatory diseases affecting

the lungs, though employment in an occupation

involving beryllium use is a key indication of the

cause and nature of disease. Symptoms typically

include

• chronic, nonproductive (dry) COUGH


• chest tightness or PAIN


• unintended weight loss


• shortness of breath (DYSPNEA), particularly with
  exertion


• fatigue

The diagnostic path includes chest X-RAY, BRON-

CHOALVEOLAR LAVAGE, and a specialized test called

the beryllium lymphocyte proliferation test

(BeLPT). The pulmonologist may also choose to

perform high-resolution COMPUTED TOMOGRAPHY

(CT) SCAN, which reveals small lesions within the

lungs, and bronchial biopsy via BRONCHOSCOPYto

further evaluate lesions that imaging procedures

show. Pulmonary function tests and sometimes

cardiopulmonary exercise testing can help assess

the status of lung capacity and the ability of the

lungs to oxygenate the blood. Conclusive diagno-

sis may require varied and numerous tests as well

as thorough medical and personal histories, as

berylliosis is similar to other interstitial lung dis-

eases including sarcoidosis.

Treatment Options and Outlook

The first line of treatment is removal from the

source of beryllium, which for most people means

leaving the jobs that require exposure to beryl-

lium. CORTICOSTEROID MEDICATIONS may help sup-

press the immune response and subdue the

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