Beryllium Awareness Transcript

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Preface: Dr. Donna Cragle is Vice President and Director of Occupational Exposure and Worker Health Programs at Oak Ridge Associated Universities, Oak Ridge, Tenn. Lee S. Newman, M.D., is an Internal Medicine and Pulmonary Disease Specialist at the National Jewish Medical Research Center, Denver, Colo.

Transcript

Dr. Donna Cragle:

The Beryllium Lymphocyte Proliferation Test is a very specific test that looks at an individual’s lymphocytes, or white cells, and grows them in the presence of Beryllium. If they do react with Beryllium that could mean that the individual is sensitized, and we do know that people that are sensitized to Beryllium are at higher risk of developing Chronic Beryllium Disease.

Lee S. Newman, M.D.

If someone is found to have an abnormal or positive BeLPT, then the recommendation is going to be made for them to see a doctor, to be evaluated, to see if they have CBD or not.

Dr. Donna Cragle:

But not everybody who has an abnormal Beryllium Lymphocyte Proliferation Test will develop Beryllium disease.
Beryllium Disease is primarily a disease that is in the lungs of the individuals, and it is caused by the lung tissue reacting to particles of Beryllium that have been breathed into the lung.

Lee S. Newman, M.D.

Beryllium gets into the body, usually the lungs, and the immune system reacts to it. Cells from the immune system travel to where the Beryllium is and inflammation starts. Microscopic balls of cells from the immune system will gather around the Beryllium particles. Over time, as that inflammation continues, the lungs become scarred and it becomes difficult to breathe because Oxygen can’t get into the blood stream through the lungs.

Dr. Donna Cragle:

This special test that we use to test for Beryllium sensitization, called the Beryllium Lymphocyte Proliferation Test, is a very difficult test to do, and there are only about 5 laboratories in the United States that can do this particular test. Your cells will have to be sent to the laboratory within 24 hours of being drawn. Once they’re in the laboratory, the lab will separate out those specific cells that they want, and then they’re going to put your cells into different concentrations of Beryllium, and will culture some of them for 5 days and some for 7 days. And so you end up with 3 answers on each day, so you have 6 answers all together to look at, and if 2 of your answers are high then you have an abnormal test. If only one of your answers is high then you would have a borderline test and your physician would want you to get another test until you do have a test that a definite answer can come from. The other kinds of results that you might get are “normal”, which means that your lymphocytes grew at the same rate in Beryllium cultures as they did without Beryllium, so that means you’re not reacting to Beryllium whatsoever.  It’s not unusual for an individual to get a test result that simply can’t be read. Some labs call it “unsatisfactory” some call it “uninterpretable” and that’s really nothing to be concerned about. It simply meant that the test didn’t work in the laboratory, and so they will as for another test to be done until you do have at test that a definite answer can come from.  The Department of Energy requires two abnormal tests before they will label someone as sensitized to Beryllium, and one reason for this is that, as any laboratory test has a probability, this test has a probability, occasionally, of giving a false abnormal result. If you have one abnormal test and then over a course of many years your never have another, then that might mean that that one test was a false abnormal and therefore you would be falsely labeled as being sensitized to Beryllium. It’s actually very difficult to determine whether you have a false negative test. Now, in all of the years that I’ve been looking at tests, and I’ve look at more than 25,000 people’s individual Beryllium Lymphocyte Proliferation test results, I can only name maybe two people that have had actually Beryllium Disease that had repeatedly normal blood tests. So this test is a really good tool to determine who is having problems with Beryllium and should go on and visit a pulmonologist for further testing and who can continue to work with Beryllium into the future.

If you get a normal test result and you’re working with Beryllium now, then you will be recommended to have another test in about a year. If you used to work with Beryllium, and you get a normal test result then it will be recommended that you have another test in about 3 years. If you get any other test result like “unsatisfactory,” or “borderline,” or “abnormal,” regardless of whether you’re working with or not working with Beryllium it would be recommended that you get another test right away, so that it can be determined whether that test is a correct result or not. If, however, in between your recommended testing you should develop symptoms that are those kinds of symptoms that come with Beryllium Disease, you should request another test before it’s time for your next test.

Lee S. Newman, M.D.

If a person is diagnosed with Beryllium Sensitization, their doctors will continue to monitor them for any signs or symptoms related to the disease.

Dr. Donna Cragle:

If you have one abnormal test, regardless of what your subsequent results might be, you will qualify to be in the EEOICPA Program, and through that program you will receive medical benefits, which would mean that you could go to a lung specialist or pulmonologist for an appointment every year to see if you might be developing Beryllium Disease.

Lee S. Newman, M.D.

Research has shown that the sensitivity to Beryllium can be influenced by a number of different factors. Some people are at increased risk because of genetic factors; however, what we know is that the cause of Beryllium Disease is exposure to Beryllium. The exposure levels may be important, how long someone has been exposed to Beryllium, as well as factors like particle size may influence the risk.

There are different ways in which the body reacts to Beryllium. There is Beryllium Sensitization and then there are two forms of lung disease: an acute form called, Acute Beryllium Disease and a chronic more gradual form called Chronic Beryllium Disease or CBD. Beryllium Sensitization can occur in as little as two months after someone’s first exposure to Beryllium. There is research showing that the majority of people who develop Beryllium Sensitization will develop it within the first few years after they’ve been exposed to Beryllium, although it can take many years for sensitization to occur. The rate at which people go from being sensitized to developing CBD is about 6 percent per year. That being said, not everybody with Beryllium Sensitization develops CBD. Depending upon other factors, such as someone’s age when they’re diagnosed, they may or may not ever have any problems from CBD itself. If someone is sensitized to Beryllium, they should be paying attention to their bodies and to the development of new signs or symptoms that might be an indication Chronic Beryllium Disease.

Acute Beryllium Disease usually occurs after people have had high levels of exposure, and symptoms will start within a few days after the exposure has occurred. Acute disease is rare today, probably because the exposure levels that people have to Beryllium are much lower.

Chronic Beryllium Disease can occur within the first few months after first exposure to Beryllium. Although, the average latency, which is the amount of time from first exposure to when someone develops the disease, can be anywhere from about 5 years up to about 15 years.  We do have some people who develop the disease even 40 years from when they were first exposed. Over time, people may or may not develop symptoms related to Chronic Beryllium Disease. When people are asymptomatic, it means they have Chronic Beryllium Disease, but at that point and time they do not have any symptoms of the disease. In fact, their X-rays maybe normal, their cat scans might appear normal, and their breathing tests and even the oxygen levels in their blood might still be normal or nearly normal. People with asymptomatic CBD are commonly found at those early stages because they participated in medical monitoring programs. If they’ve had the BeLPT done, that test was done to try to pick up the disease at these very early stages. It’s important for people who have asymptomatic CBD to be followed up on a regular basis because over time they are at an increased risk of the disease progressing into the later stages where they’ll start to experience symptoms. Now some people can go many years with no symptoms at all and for others, they may after a few years or sometimes many years later start to develop the typical symptoms of CBD.

CBD can affect many organs, but predominately it affects the lungs. Because of that, the main symptoms that people develop are breathing symptoms: shortness of breath, usually with activity, cough, which is usually a dry cough that doesn’t produce phlegm, fatigue, and night sweats. Some of the less common symptoms are chest pains, symmetrical joint pains, weight loss, and loss of appetite. It’s important to realize that these kinds of symptoms can be caused by things other than CBD. Also, that not everybody that has CBD will necessarily get all of these symptoms.

It’s important to have medical evaluation for Chronic Beryllium disease because CBD is a disease that can be treated even though it can’t be cured. When a person with two abnormal BeLPT’s is referred to the lung doctor for further evaluation, the doctor is going to offer them a variety of tests.  Now not every patient has to have every one of the tests and that is a decision that is made by the individual.  The most common test will include a set of pulmonary function tests, these are breathing tests, tests of the oxygen levels in their blood, X-rays or cat scans to take a look for spots in the lungs, and they may offer them a bronchoscopy. Bronchoscopy is an outpatient procedure in which the lung doctor will take biopsies of the lungs and also do a washing of a section of a lung, which is called lavage. Now that is an outpatient procedure, it does include anesthesia and sedation and it’s up to the individual whether they go through that test or not after they’ve discussed that with their doctor.

There is medical treatment available for Chronic Beryllium Disease. The treatment slows down the disease. It also can improve someone oxygen levels and it can improve someone’s symptoms. The majority of people with Chronic Beryllium Disease do not require immediate treatment. There is time to determine how severe the disease it, to determine whether it’s worsening or how rapidly it’s worsening before deciding about treatment. There are some people with mild forms of Chronic Beryllium Disease who don’t require treatment at all.

The main treatment is with prednisone. Prednisone is a steroid and it’s a medicine that helps reduce the inflammation in the lungs. Now it’s a medicine that can benefit people with CBD, but it is also a medicine that has side effects. It’s very important for patients to be aware of what the side effects are and to discuss the pros and cons of using that medicine with their doctor before they start treatment. In more severe cases of Chronic Beryllium Disease, Oxygen may be prescribed. In addition, it’s recommended that people with Chronic Beryllium Disease get a pneumonia shot and an annual flu shot and that they get early treatment for respiratory infections. Beryllium exposure may increase someone’s chances of developing lung cancer. So it’s important that if someone is smoking that they stop smoking so they don’t compound that risk.

It’s important to remain physically active if you have Chronic Beryllium Disease. It’s important to exercise, although you should check with your doctor before you start an exercise program. It might be necessary to check the Oxygen levels in your blood during exercise to make sure your oxygen levels are O.K. when you are exerting yourself.

Most of our patients with Chronic Beryllium disease are able to maintain a normal lifestyle. It’s really important to keep doing the things that you enjoy doing-your favorite hobbies and other activities.