Pulmonary fibrosis in workers exposed to non-asbestiform tremolite asbestos minerals.

BACKGROUND Studies of the health effects of non-asbestiform asbestos minerals remain inconclusive. Nephrite is a type of non-asbestiform tremolite mineral. We assessed the risk for pulmonary fibrosis in workers who process nephrite. METHODS A cross-sectional study that included 344 stone workers and their families was undertaken in Taiwan in 2010. The diagnostic criteria for pulmonary fibrosis included (1) radiographic fibrosis profusion of 1/1 or greater and (2) audible lung crackles confirmed by physician. The nephrite samples were analyzed using polarized light and transmission electron microscopy combined with selected-area electron diffraction and energy-dispersive x-ray spectroscopy. RESULTS After excluding 16 subjects with histories of tuberculosis or previous employment in metal casting and welding, as well as 23 family members who had not worked in the stone industry, we analyzed 305 subjects. Processing nephrite increased the risk for pulmonary fibrosis (odds ratio = 2.8 [95% confidence interval = 1.0-9.9] and unchanged after adjustment for age and smoking). Bulk sample analyses showed that the nephrite is a tremolite mineral composed of both asbestiform and non-asbestiform components. The cat's-eye nephrite had the highest asbestiform fibrous content, and the average length and aspect ratio of elongated mineral particles were the highest of all the nephrite types. Compared with workers processing other types of nephrite, workers processing cat's-eye nephrite had the highest risk for pulmonary fibrosis. CONCLUSION Processing non-asbestiform tremolite mineral may increase the risk for pulmonary fibrosis. Medical monitoring is warranted for workers with such exposure.