Prognosis of patients with silicosis due to denim sandblasting.

We read with great interest the article by Bakan et al 1 in a recent issue of CHEST (November 2011). The authors describe the patient characteristics in yet another important but tragic description of the ongoing silicosis epidemic among denim sandblasters in the textile sector in Turkey. As they report, this silicosis outbreak emerged with the new millennium, the magnitude of the problem has continued to increase, 2 5 and it remains uncertain how much of the iceberg has been revealed. Although they give detailed information about the patients and report a statistically signifi cant association of reduced lung function tests with mortality, the information provided about fatal cases is insuffi cient to ascertain the cause of death and the progression to massive fi brosis. Younger workers dominate this work sector, 3 and we noted rapid progression of the disease, and mortality was associated with younger age and also with higher exposures to crystalline silica. However, in their study, the mean age of the patients in the fatal cases is older compared with the entire study population (35 years vs 311⁄2 years). We also wonder if there was a relationship between invasive procedures and mortality for the patients in their study. Before silicosis was recognized in the textile sector, we established a diagnosis using invasive procedures, including bronchoscopic transbronchial biopsy and surgical lung biopsy, as detailed in our previous studies. 2 , 3 However, both patients who had surgical biopsies died following the biopsy. Their study dataset might shed infor mation about such risks. In addition to disease progression and mortality, the high compensation rates of the patients in the study by Bakan et al 1 also attracted our attention. It would be useful to know whether the patients received compensation because they were insured or if they were successful in receiving compensation as the results of the temporary national law that provided compensation rights for uninsured workers through May 2011. It is plausible too that poor working conditions are more likely for workers employed without insurance because such workplaces are unlikely to be well regulated and inspected. Thus, being insured might confer better working conditions and better health outcomes .