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Fluoride Pollution from Coal Burning in China |
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1) Fluoride pollution from coal burning in China 2) Increased Lung Cancer from inhaling coal smoke in China 3) Increased Lung Cancer among Fluoride Exposed Cryolite Workers 4) Other Respiratory Problems among Fluoride Exposed Aluminum Workers 5) Respiratory Problems in Communities Surrounding Aluminum Industry 6) Respiratory Problems from Other Sources of Fluoride Air Pollution 7) Animal Study Examining Ingested Fluoride's Effect on Lungs 1) Fluoride pollution from coal burning in China Sci Total Environ 2001 Apr 23;271(1-3):107-16
(back to top) Fluoride 2000 Vol. 33 No. 3 135-139 (back to top) Skeletal Fluorosis from Indoor Burning of Coal in Southwestern China Watanabe T, Kondo T, Asanuma S, Ando M, Tamura K, Sakuragi S, Rongdi J, Chaoke L. Usuda, Shiojiri, Tsukuba, Minimata, Tama, Japan and Beijing, China SUMMARY: The effects of airborne fluoride from unvented indoor burning of fluoride-rich coal on the bones and teeth of residents of two rural villages in SW China were investigated and compared. In the highly polluted village of Xaochang in Sichuan Province, stage III skeletal fluorosis was found in 43 (84%) of 51 examinees. In the moderately polluted village of Minzhu in Guizhu Province, this stage was seen in 25 (51%) of 49 examinees. In the nonpolluted control village of Shucai in Jiangxi Province in SE China, none of 47 examinees showed any evidence of skeletal fluorosis. In Minzhu, but not in Xao-chang, significantly more males than females were afflicted with stage III skeletal fluorosis. In contrast with Xaochang, some examinees in Minzhu had serious skeletal effects but normal teeth or minor dental fluorosis. A high frequency of extremital transverse bone growth lines was observed in Xaochang but not in Minzhu. These findings suggest that greater exposure to fluoride occurred during infancy and early childhood in Xaochang than in Minzhu. http://www.FLUORIDE-journal.com/00-33-3/333-135.pdf Environ Health Perspect 1998 May;106(5):239-44 (back to top) Health effects of indoor fluoride pollution from coal burning in China. Ando M, Tadano M, Asanuma S, Tamura K, Matsushima S, Watanabe T, Kondo T, Sakurai S, Ji R, Liang C, Cao S. Regional Environment Division, National Institute for Environmental Studies, Ibaraki, Japan. The combustion of high fluoride-content coal as an energy resource for heating, cooking, and food drying is a major exhaust emission source of suspended particulate matter and fluoride. High concentrations of these pollutants have been observed in indoor air of coal-burning families in some rural areas in China. Because airborne fluoride has serious toxicological properties, fluoride pollution in indoor air and the prevalence of fluorosis have been analyzed in a fluorosis area and a healthy nonfluorosis area in China and in a rural area in Japan. For human health, fluoride in indoor air has not only been directly inhaled by residents but also has been absorbed in stored food such as corn, chilies, and potatoes. In the fluorosis area in China, concentrations of urinary fluoride in the residents have been much higher than in the nonfluorosis area in China and in the rural area in Japan. In the fluorosis area, almost all elementary and junior high school students 10-15 years of age had dental fluorosis. Osteosclerosis in the skeletal fluorosis patients was very serious. Urinary deoxypyridinoline in rural residents in China was much higher than in rural residents in Japan. Data suggest that bone resorption was extremely stimulated in the residents in China and that fluoride may stimulate both bone resorption and bone formation. Because indoor fluoride from combustion of coal is easily absorbed in stored food and because food consumption is a main source of fluoride exposure, it is necessary to reduce airborne fluoride and food contamination to prevent serious fluorosis in China. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PMID: 9518433 [PubMed - indexed for MEDLINE] Nippon Igaku Hoshasen Gakkai Zasshi 1997 Jun;57(7):425-6 (back to top) [Endemic fluorosis in southern China: radiological findings] [Article in Japanese] Watanabe T, Kondo T, Asanuma S, Sakurai S, Tamura K, Ando M. Saku Central Hospital. Fluorosis continues to be prevalent in the southern regions of China. The endemic fluorosis caused by inhalation of fluoride-containing coal dust etiologically contrasts with the common occurrence of endemic fluorosis due to the intake of fluoride-containing water. We investigated the radiologic findings in 49 affected individuals in a district of this region. More than 80% of patients exhibited radiologic evidence of skeletal fluorosis, and most patients belonged to stage 3 of Singh and Jolly's classification. The most common skeletal abnormality was ossification of the interosseous ligaments in the extremities, which warranted radiographic examination of the limbs as a tool for screening. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PMID: 9232992 [PubMed - indexed for MEDLINE] Soc Sci Med 1995 Oct;41(8):1191-5 (back to top) Outline of control practice of endemic fluorosis in China. Wang LF, Huang JZ. Xinjiang Institute for Endemic Disease Control and Research, Urumqi, People's Republic of China. Endemic fluorosis is prevalent in China covering 29 provinces, municipalities and autonomous regions. The endemically affected areas can be divided, according to the sources of fluoride, into three types: high fluoride water, pollution from coal burning, and drinking brick tea in excess. Since the 1960's, several pilot surveys of the disease have been made and control programmes carried out in some of the areas. An Expert Consultation Committee on Endemic Fluorosis Control of the Ministry of Public Health was formally established in 1979. A national survey programme and series of working criteria for the disease were drawn up at the First National Congress of Endemic Fluorosis Control in 1981. Under the Central Government of China, administrative organizations and institutions concerned at all levels have been set up, forming a nation-wide network of control. Cooperation and coordination among such departments as health, water conservancy, geology and finance have been achieved in the planning and implementation of control programmes. Since 1980, many projects for improving drinking water quality through de-fluoridation have been completed. At the same time, new methods and technologies for improving stove and grain baking have become widely used in some of the areas where environmental fluoride pollution exists from burning coal. After all the control programmes had been introduced, the incidence of the illness was reduced with some patients making a complete recovery. PMID: 8578341 [PubMed - indexed for MEDLINE] Hua Xi Yi Ke Da Xue Xue Bao 1994 Jun;25(2):188-91(back to top) [Effect of excessive fluoride intake on mental work capacity of children and a preliminary study of its mechanism] [Article in Chinese] Li Y, Li X, Wei S. We made an investigation in 157 children, aged 12-13, born and grew up in a coal burning pattern endemic fluorosis area and an experiment on excessive fluoride intake in rat. The results showed: (1) Excessive fluoride intake since early childhood would reduce mental work capacity (MWC) and hair zinc content: (2) The effect on zinc metabolism was a mechanism of influence on MWC by excessive fluoride intake; (3) Excessive fluoride intake decreased 5-hydroxy indole acetic acid and increased norepinephrine in rat brain; whether this is also a mechanism of the influence on MWC awaits confirmation. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PMID: 7528715 [PubMed - indexed for MEDLINE] Arch Environ Health 1993 Jul-Aug;48(4):246-9 (back to top) Air pollution-type fluorosis in the region of Pingxiang, Jiangxi, Peoples' Republic of China. Chen Y, Lin M, He Z, Xie X, Liu Y, Xiao Y, Zhou J, Fan Y, Xiao X, Xu F. Jiangxi Institute of Labor Hygiene and Occupational Medicine, Nanchang, Jiangxi, Peoples' Republic of China. This paper reports on the epidemiology, environmental factors, geological features, and total amount of fluoride intake by residents of the Pingxiang region in the Peoples' Republic of China where there is a high incidence of endemic fluorosis. The results demonstrate that the type of endemic fluorosis is related to air pollution, the major source of which comes from coal that is burned by the residents in their homes. Air pollution also originates from the small kilns that are used to make bricks and tile. The fluorine content in the coal and mud used to mix the coal is considerably high; the content in the mud used as adobe for tiles exceeds 10,000 mg/kg. During the process of burning coal or baking bricks or tiles, a large amount of nonsoluble fluorine is converted into water-soluble fluoride, which can have major human health effects. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PMID: 8357274 [PubMed - indexed for MEDLINE] Biomed Environ Sci 1990 Dec;3(4):384-90 (back to top) The physical and chemical characteristics of particles in indoor air where high fluoride coal burning takes place. Gu SL, Ji RD, Cao SR. Institute of Environmental Health and Engineering, Chinese Academy of Preventive Medicine, Beijing. In China, more than 10 million people suffer from fluorosis caused by the burning of high fluoride coal. Analysis of the particulate matters of indoor air from these fluorosis areas reveals a logarithmic distribution of particle sizes. The levels of F- and SO4(2-) adsorbed or absorbed on the particles ranged from 16.27 to 46.18 micrograms/m3 and from 244.7 to 374.6 micrograms/m3, respectively. Gaseous and soluble fluorides constituted a considerable proportion of the inorganic fluorides. Nevertheless, the level of F- in air was considered to be inadequate to cause the observed severity of fluorosis. It is speculated that additional intake of F- from contaminated foods might also be a major factor contributing to the fluorosis. Additionally, some volatile elements (e.g., sulfur and its derivatives) might have some relation to fluorosis of this type. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PMID: 2096842 [PubMed - indexed for MEDLINE] Zhonghua Liu Xing Bing Xue Za Zhi 1990 Oct;11(5):302-6 (back to top) [Epidemiological survey of endemic fluorosis in Xiou Shan and Bao Jing areas] [Article in Chinese] Yan L. Chinese Research Academy of Environmental Sciences. It may be affirmed that Mushan in Bao Jing county is a light fluorosis area and Yan Tian in Xiou Shan county is a middle fluorosis area with the help of following investigations: fluoride levels in inhalatable dust, food, drinking water, soil, coal, biological effects of fluoride on habitants and the burden of fluoride in the body of habitants. It is demonstrated that the cause of fluorosis in above areas is essentially the oral intake of excess fluoride through the foods, mainly maize, polluted by burning coal fly ash containing fluoride. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PMID: 2261621 [PubMed - indexed for MEDLINE] Zhonghua Yu Fang Yi Xue Za Zhi 1990 Jan;24(1):1-5 (back to top) [The investigation of the total amount of fluoride intake with correlative dental fluorosis polluted by burn coal in the epidemic fluorosis districts] [Article in Chinese] Wu DL, Li YL. Fuling Prefeture Health Bureau, Sichuan. By means of the investigation in the five different townships with contrasting of the others, the main sources of fluorosis were found from pollution of the coal smoke, the content and total amount of fluoride intake from the maize and capsicum were calculated to be 74.35-94.72% by drying of the heat of burn coal and increased with the total amount of fluoride intake. The clear doses of the prevalence rates of dental fluorosis, the mean output of urinary fluoride and the total amount of fluoride intake--response relationship, showing a semilogarithmic positive correlation between 8 and 15 years of age. At the age the prevalence rates of bad incomplete teeth and milk-teeth showed a linear correlation with the total amount of fluoride intake and the mean output of urinary fluoride respectively.And seven regression equations were calculated. The question concerning the epidemic fluorosis districts caused by burn coal was discussed. We suggest that sick districts can be affirmed on the basis of the total amount of fluoride intake, the prevalence rates of dental fluorosis, bad incomplete teeth, milk-teeth and the mean output of urinary fluoride between 8 and 15 years of age. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PMID: 2340759 [PubMed - indexed for MEDLINE] Zhonghua Yu Fang Yi Xue Za Zhi 1991 May;25(3):171-3 (back to top) [An investigation of endemic fluorine poisoning caused by food contaminated by smoke containing fluorine] [Article in Chinese] Chen MJ. Kaixian County Hygienic and Antiepidemic Centre, Sichuan. This paper reports an investigation of two endemic fluorine poisoning areas, where living conditions are special and life habits backward. It was found that fluorosis was also caused by burning coal in a primitive way, even though the average fluorine content of the burning was as low as 61.80 mg/kg. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PMID: 1914685 [PubMed - indexed for MEDLINE] 2) Increased Lung Cancer from inhaling coal smoke in China A number of studies in China have found that exposure to indoor coal pollution is linked with higher rates of lung cancer. While the studies don't specify what chemical agent in the coal smoke is inducing the cancer, it's reasonable to suggest that the high level of fluoride is a (major) contributing factor. Some studies of workers in the aluminum industry (see below), who are exposed to high levels of fluoride, have also reported increased rates of lung cancer (as well as other types of cancer) - however, again, these cancers have not been linked to any specific chemical. Ann Epidemiol 2000 Oct 1;10(7):469 (back to top) Lung cancer and indoor air pollution in rural china. Kleinerman R, Wang Z, Lubin J, Zhang S, Metayer C, Brenner A. Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA PURPOSE: Indoor air pollution has been linked with lung cancer in China. In contrast to previous studies conducted in urban areas with high levels of industrial pollution, we undertook a lung cancer case-control study in a rural area of China, where residents live in underground dwellings. We evaluated the effects of radon, wood and coal combustion, cooking oil fumes, and environmental tobacco smoke on lung cancer risk.METHODS: We enrolled 886 lung cancer cases (656 males, 230 females) diagnosed between 1994-98, aged 30-75 years and 1765 frequency matched population-based controls from two prefectures in Gansu Province in Northwestern China. We conducted interviews with subjects or next of kin on smoking, housing characteristics, fuel use and cooking practices. Year-long radon detectors were placed in current and former homes of subjects.RESULTS: Subjects primarily used coal (22%), wood (56%) or a combination of both (22%) for heating. Odds Ratios (OR) for lung cancer rose with increasing percent of time that coal was used to heat homes over the past 30 years (ORs = 1.00, 1.17, 1.35, 1.23 compared to wood only, adjusted to smoking, P for trend = 0.025). Among non-smoking females and males, the OR for ever exposed to environmental tobacco smoke was 1.19, 95% CI = 0.7-2.0 with a significant trend for increasing years of exposure. Fumes from cooking with rapeseed oil increased the risk of lung cancer (OR = 1.56, 95% CI = 1.0-2.5) among non-smoking women. Among these women, occasional and frequent eye and throat irritation during cooking appeared to be associated with increased risk of lung cancer (ORs = 1.00, 1.42, 2.28, p trend < 0.01), whereas, increasing level of smokiness during cooking did not appear to affect risk.CONCLUSIONS: There is a suggestion that coal used for heating, environmental tobacco smoke, and cooking oil fumes contribute to the risk of lung cancer in this rural area of China. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PMID: 11018397 [PubMed - as supplied by publisher] Zhonghua Yi Xue Za Zhi
2001 Jul 25;81(14):876-80 (back to top) Wang D, He X, Liu Y. Department of Clinical Pharmacology, National Centre for AIDS Prevention and Control, Beijing 100050, China. OBJECTIVE: To systematically analyze the risk factors of lung cancer in Xuanwei, Yunnan Province, an area with a high prevalence of lung cancer, and in view of the above to propose a comprehensive preventive strategy. METHODS: A cohort study of 42,434 Xuanwei farmers who were born 1917-195, and still alive on 1st January 1976 was carried out from 1992 to 1996 with a follow-up time of 21 years. The data collection was done in two steps. A retrospective cohort study was conducted in the form of questionnaire survey in 1992 to understand the health situation of the interviewees from 1st January 1976 to 31st December 1991. In the second stage, a prospective cohort study was conducted to review the death records of the interviewees from 1st January 1992 to 31st December 1996. The data thus collected were analyzed by the Mantel-Haezel analysis method, COX model and risk state analysis method. RESULTS: Indoor air pollution caused by biturminous coal burning is the major risk factor of lung cancer in Xuanwei. Stove improvement decreased the lung cancer mortality rate in both male and female subjects, but its beneficial [effect] can be recognized at least 10 years after. Smoking is another important risk factor of lung cancer in males in Xuanwei. In course of a long time since stove improvement smoking will become the major risk factor of lung cancer. The risky factors can be arranged in sequence of riskiness from high to low as bituminous coal burning, family history of lung cancer, personal history of chronic bronchitis, and smoking in males; and bituminous coal burning, family history of lung cancer, and personal history of chronic bronchitis in females. The risk state classification model established upon the basis of risk state analysis can be used in identifying effectively high risk population quantitatively for local administrators of health as well as for local residents. CONCLUSION: According to the comprehensive strategy for lung cancer control in Xuanwei, priority should be given to primary prevention with three steps: firstly to further reduce indoor air pollution by means of stove improvement and ventilation improvement, secondly strengthen smoking cessation, and thirdly to carry out chemoprevention and susceptibility study of lung cancer among high risk populations. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PMID: 11702686 [PubMed - in process] Zhonghua Liu Xing Bing Xue Za Zhi 2001 Apr;22(2):119-21 (back to top) [Meta-analysis of risk factors on lung cancer in non-smoking Chinese female] [Article in Chinese] Zhang Y, Chen K, Zhang H, et Al. Department of Epidemiology, The Affiliated Medical College of Zhejiang University, Hangzhou 310006, China. OBJECTIVE: To evaluate the risk factors of lung cancer in non-smoking Chinese women. METHODS: The results of 7 case-control studies from 1990 to 1999 were analyzed by Meta-analysis method in this study. The cumulative cases and controls were 1 115 and 1 520, respectively. Der Simonian and Nan Laid model were applied to process data. RESULTS: The pools OR values of family history of lung cancer, personal history of non-neoplastic lung disease, cooking oil fume pollution, coal pollution and exposure to environmental tobacco smoking (ETS) were 2.87, 2.79, 2.52, 1.42 and 1.64 respectively. CONCLUSION: Family history of lung cancer and personal history of non-neoplastic lung disease might serve as the most important risk factors of female lung cancer in China. There appeared also significantly positive relationship between female lung cancer and the degree of cooking oil fume pollution or pollution of coal burning. The effect on lung cancer of exposure to ETS was uncertain in this study which calls for further investigation. Bias and confounding factors were also discussed in this study. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PMID: 11860860 [PubMed - in process] World Health Stat Q 1990;43(3):127-38 (back to top) Indoor air pollution in developing countries. Chen BH, Hong CJ, Pandey MR, Smith KR. International Programme on Chemical Safety, World Health Organization, Geneva. Of the four principal categories of indoor pollution (combustion products, chemicals, radon and biologicals), research in developing countries has focused on combustion-generated pollutants, and principally those from solid-fuel-fired cooking and heating stoves. Such stoves are used in more than half the world's households and have been shown in many locations to produce high indoor concentrations of particulates, carbon monoxide and other combustion-related pollutants. Although the proportion of all such household stoves that are used in poorly ventilated situations is uncertain, the total population exposed to excessive concentrations is potentially high, probably several hundred million. A number of studies were carried out in the 1980s to discover the health effects of such stove exposures. The majority of such studies were done in South Asia in homes burning biomass fuels or in China with coal-burning homes, although a sprinkling of studies examining biomass-burning have been done in Oceania, Latin America and Africa. Of the health effects that might be expected from such exposures, little, if any, work seems to have been done on low birthweight and eye problems, although there are anecdotal accounts making the connection. Decreased lung function has been noted in Nepali women reporting more time spent near the stove as it has for Chinese women using coal stoves as compared to those using gas stoves. Respiratory distress symptoms have been associated with use of smoky fuels in West India, Ladakh and in several Chinese studies among different age groups, some with large population samples. Acute respiratory infection in children, one of the chief causes of infant and childhood mortality, has been associated with Nepali household-smoke exposures. Studies of chronic disease endpoints are difficult because of the need to construct exposure histories over long periods. Nevertheless, chronic obstructive lung disease has been associated with the daily time spent near the stove for Nepali women and found to be elevated among coal-stove users compared to gas-stove users in Shanghai. In contrast to early reports, there seems to be little or no risk of nasopharyngeal cancer from cookstove smoke. Several studies in China, however, have found smoke to be a strong risk factor for lung cancer among non-smoking women. In addition, severe fluorosis has been observed in several parts of China where coal fluoride levels are high.(ABSTRACT TRUNCATED AT 250 WORDS) http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= 3) Increased Lung Cancer Incidence among Fluoride Exposed Cryolite Workers J Natl Cancer Inst 1992 Dec 16;84(24):1903-9
(back to top) BACKGROUND: Although a recent bioassay showed increased frequency of bone cancer in rats with high oral intake of fluoride, the data are reported as equivocal evidence of carcinogenicity. In humans, occupational fluoride exposure may cause skeletal fluorosis, and our earlier follow-up of fluoride-exposed workers showed increased incidence of respiratory cancers. PURPOSE: To further evaluate occupational fluoride exposure as a carcinogenic risk factor, we extended by approximately one decade the follow-up of a cohort of 425 men and 97 women employed for at least 6 months in the period 1924-1961 at the Copenhagen cryolite processing plant. Cryolite ore contains about 50% fluoride. METHODS: Cancer mortality was determined for the period 1941-1989, and incidence for 1943-1987. For comparison, we used national mortality rates and cancer incidence rates for the Copenhagen area. RESULTS: Among the men, 300 deaths occurred; 223 were expected. Respiratory (lung and laryngeal) cancers and violent death were responsible for most of this excess; rates for mortality from cardiovascular disease were close to the rates expected. Of the 423 male workers, 119 developed cancers; 103.6 were expected. There was excess incidence of cancers of the lungs (35 men; standard incidence ratio [SIR] = 1.35), larynx (5 men; SIR = 2.29), and urinary bladder (17 men; SIR = 1.84). Maximum incidence occurred after 10-19 years of employment, but otherwise, no stable relationship between cancer incidence and duration of employment was observed. The incidence of respiratory and urinary cancers was particularly high in men less than 35 years old at first employment. Cancers in female workers were too few to allow detailed evaluation. CONCLUSIONS: The increased incidence of respiratory cancers suggests that cigarette smoking was frequent in this cohort, despite the unremarkable cardiovascular mortality, but the disproportionate increase in the incidence of bladder cancer is difficult to explain by smoking habits alone. Because this industrial cohort was exposed to high concentrations of fluoride dust, heavy respiratory exposure to fluoride may have contributed to the increased cancer risk. If these workers inhaled a carcinogenic substance partly excreted in the urine, an increased incidence of respiratory and bladder cancers would not be inconceivable. IMPLICATION: The potential role of fluoride as a cause of bladder cancer needs to be explored. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= Am J Epidemiol 1985 Jan;121(1):57-64
(back to top) 4) Other Respiratory Problems among Fluoride Exposed Aluminum Workers Scand J Work Environ Health 2000 Dec;26(6):470-5 (back to top) Nonmalignant mortality among workers in six Norwegian aluminum plants. Romundstad P, Andersen A, Haldorsen T The Cancer Registry of Norway, Oslo. pr@kreftregisteret.no OBJECTIVES: This study investigated the associations between exposure to fluorides and polycyclic aromatic hydrocarbons (PAH) and mortality from nonmalignant diseases among workers in the Norwegian primary aluminum industry. METHODS: Mortality among 10,857 men, employed for more than 3 years in 1 of 6 aluminum plants, was investigated from 1962 to 1996, giving 239,246 person-years during follow-up. Ajob-exposure matrix covering all 6 plants was used to estimate the individual exposure to total fluorides and particulate PAH. The observed cause-specific deaths were compared with expected figures calculated from national rates. Dose-response relations were investigated by internal comparisons using Poisson regression and by stratified analyses for standardized mortality ratio. Potential confounding by smoking was investigated in subanalyses restricted to 3 of the plants for which information on smoking habits was accessible. RESULTS: Mortality from circulatory disease was slightly lower than expected [SMR 0.95, 95% confidence interval (95%CI) 0.9-1.0], while there was an increased mortality from asthma, emphysema, and chronic bronchitis combined, SMR 1.2 (95% CI 1.0-1.5). Mortality from these diseases was associated with cumulative exposure to fluorides. The rate ratio in the internal analysis rose steadily to 2.5 (95% CI 1.5-4.3) for the upper exposure category. No association was observed between cumulative fluoride exposure or PAH exposure and circulatory mortality. CONCLUSIONS: The study showed an association between exposure to potroom emissions measured by fluorides and mortality from asthma, emphysema, and chronic bronchitis combined. http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query_old?uid=11201393 PMID: 11201393, UI: 21041973 Scand J Work Environ Health 1999 Aug;25(4):326-34 (back to top) Increased CD3 positive cells in bronchoalveolar lavage fluid after hydrogen fluoride inhalation. Lund K, Refsnes M, Sandstrom T, Sostrand P, Schwarze P, Boe J, Kongerud J. Department of Thoracic Medicine, The National Hospital, University of Oslo, Norway. OBJECTIVES: This study examined whether experimental hydrogen fluoride exposure for 1 hour induces an inflammatory response in the lower respiratory tract that is detectable in bronchoalveolar lavage fluid. METHODS: Nineteen healthy, nonsmoking men were exposed for 1 hour to constant low (<0.6 mg/m3), intermediate (0.7-2.4 mg/m3), or high (2.5-5.2 mg/m3) concentrations of hydrogen fluoride. Bronchoalveolar lavage was performed at least 3 weeks before and 24 hours after the exposure. For 15 subjects differential countings were performed. RESULTS: There was a significant increase in the percentage of CD3 positive cells in the bronchial portion for those exposed to "intermediate" and "high" concentrations. For the "high" exposure group the increase in the bronchoalveolar portion was also significant. A significant correlation was found between the increase in the percentage of lymphocytes and CD3 positive cells in the bronchoalveolar portion (Spearman's coefficient r=0.68, P=0.008). Myeloperoxidase and interleukin-6 increased significantly in the bronchial portion for those exposed to "high" concentrations. There was a significant increase in myeloperoxidase (P=0.005) for all the exposures, while there was a decrease in E-selectin (P=0.007). CONCLUSIONS: Hydrogen fluoride may induce an inflammatory reaction in the airways at concentrations that can occur in the ambient air in the primary aluminum industry. Publication Types: * Clinical Trial PMID: 10505658 [PubMed - indexed for MEDLINE] Sci Total Environ 1995 Feb 24;163(1-3):137-45 (back to top) Asthma and respiratory problems--a review. O'Donnell TV. University of Otago, Wellington School of Medicine, New Zealand. Occupational asthma is the principal respiratory health problem within the primary aluminium industry. Current evidence indicates that it is irritant induced and due to occupational exposure to the inhalation of gaseous or particulate fluoride compounds. Following transfer from the occupational exposure of those who develop asthma, there is commonly symptomatic improvement. A programme of compulsory respiratory protection, progressive engineering improvements and of regular screening of potroom workers aimed at early detection, and the transfer of asthmatic workers from that environment has resulted not only in improvement of asthmatic symptoms among them, but also in the majority of an improvement in bronchial responsiveness as assessed by methacholine inhalation. The majority of studies indicate a slightly increased prevalence of symptoms of chronic bronchitis and of chronic obstructive pulmonary disease among workers in carbon bake areas, although tobacco smoking has a greater and additive effect. Only a trivial number of clinical cases of pulmonary fibrosis ascribed to aluminium compounds has been reported. Particle size limits smelter grade primary alumina reaching the alveoli of the lung. PMID: 7716491 [PubMed - indexed for MEDLINE] Eur Respir J 1995 Sep;8(9):1520-4 (back to top) Occupational asthma in aluminium potroom workers related to pre-employment eosinophil count. Sorgdrager B, Pal TM, de Looff AJ, Dubois AE, de Monchy JG. Dept of Allergology, University Hospital Groningen, The Netherlands. Occupational asthma still occurs in aluminium potroom workers despite pre-employment medical selection. The purpose of our study was to identify workers with an increased risk of developing "potroom asthma". A nested, case-control study was carried out in two Dutch aluminium producing plants. Pre-employment data of 364 potroom workers (182 cases and 182 controls) were analyzed. Cases were workers unable to work because of work-related respiratory disease, meeting the criteria for potroom asthma. The selected controls were matched for age, year of starting employment and working conditions. Pre-employment eosinophil count was significantly related to the occurrence of potroom asthma, even though the mean number of the eosinophils in cases was within the normal range (< 275 cells.mm-3; 0.28 cells x 10(9).L-1). Hence, 39 of the 45 individuals with blood eosinophil counts in the upper range of normal (> 220 cells.mm-3; 0.22 cells x 10(9).L-1) developed potroom asthma with time. We conclude that workers without respiratory symptoms, with normal lung function and normal bronchial responsiveness before employment developed potroom asthma. Fluoride exposure, combined with an elevated eosinophil count, might induce an immunological or cytotoxic process. PMID: 8575578 [PubMed - indexed for MEDLINE] Thorax 1994 Oct;49(10):984-9 (back to top) Relation between exposure to fluoride and bronchial responsiveness in aluminium potroom workers with work-related asthma-like symptoms. Soyseth V, Kongerud J, Ekstrand J, Boe J. Hydro Aluminium, Health Department, Ardal Aluminium Plant, Norway. BACKGROUND--The relation between plasma fluoride levels and bronchial responsiveness was investigated in a longitudinal study in aluminium potroom workers who reported work-related asthmatic symptoms. METHODS--From a cross-sectional respiratory survey, 26 men who reported work-related asthmatic symptoms on a validated questionnaire were selected for repeated measurements of bronchial responsiveness to methacholine. Regular analyses of plasma fluoride levels were performed. Exposure to fluoride and total particulates was assessed from routine surveillance of the workplace. Bronchial responsiveness was expressed as the dose-response slope of the line through the origin and last data point. RESULTS--A positive association was found between bronchial responsiveness and plasma fluoride levels, such that an increase in the plasma fluoride level of 10 ng/ml was associated with an increase in the dose-response slope by a factor of 1.11 (95% confidence interval 1.05 to 1.17). Plasma fluoride levels were associated with the total atmospheric fluoride concentration in mg/m3 (beta = 28.1), but not with total particulates in the environment. CONCLUSIONS--Bronchial responsiveness in aluminium potroom workers reporting work-related asthmatic symptoms appears to be related to plasma levels of fluoride. The underlying mechanism is, however, unknown. PMID: 7974315 [PubMed - indexed for MEDLINE] Eur Respir J 1994 Jan;7(1):165-72 (back to top) Aluminium potroom asthma: the Norwegian experience. Kongerud J, Boe J, Soyseth V, Naalsund A, Magnus P. Dept of Thoracic Medicine, Rikshospitalet, University of Oslo, Norway. Work-related asthma in aluminium potroom workers, is reviewed and discussed, mainly on the basis of own investigations. The occurrence of work-related asthma has been shown to be associated with the duration of potroom employment, although the prevalence of asthmatic symptoms is not significantly different from that of the general population. Typical manifestations of occupational asthma are described in potroom workers, and a close relationship between the levels of fluoride exposure and work-related asthmatic symptoms has been observed. The existence of occupational asthma in aluminium potroom workers has been confirmed by characteristic patterns of repeated peak flow measurements, supported by changes in methacholine responsiveness in workers with suspected work-related asthma. However, no immunological test is available to establish the diagnosis. Methacholine challenge appears to be inappropriate for screening aluminium potroom workers in order to detect work-related asthma. Current smoking, but not self-reported allergy, is a risk factor for potroom asthma. A family history of asthma and previous occupational exposure may have some effect on the risk of developing symptoms. The prognosis of potroom asthma seems to depend on early replacement to unexposed work. The pathogenetic mechanisms are unknown, although some studies indirectly imply a hypersensitivity reaction. Future studies involving specific bronchial challenge appear to be necessary to find the causal agent(s) of aluminium potroom asthma. PMID: 8143817 [PubMed - indexed for MEDLINE] Med Lav 1992 Sep-Oct;83(5):414-7 (back to top) Respiratory disorders in aluminium potroom workers. Kongerud J. Department of Thoracic Medicine, Rikshospitalet, University of Oslo, Norway. Epidemiological studies of aluminum potroom workers have been in progress in Norway since 1986. The occurrence of work-related asthmatic symptoms and their determinants were studied. Work-related asthmatic symptoms and airflow limitation were closely associated with duration of potroom employment. A significant relationship between current fluoride exposure and work-related asthmatic symptoms was observed in a smaller, cross-sectional population where a detailed exposure classification was carried out. A similar association and also a dose-response gradient was found in a longitudinal study of new employees. The existence of occupational asthma in aluminium potroom workers was confirmed by characteristic patterns of repeated peak flow measurements supported by changes in methacholine responsiveness in workers with suspected work-related asthma. Current smoking as a risk factor for work-related asthmatic symptoms was observed both in cross-sectional and in longitudinal investigations. Similarly to current fluoride exposure, a dose-response gradient was demonstrated in the association between work-related asthmatic symptoms and current amount of tobacco smoked. Allergy was not shown to be a determinant of work-related asthmatic symptoms in any part of the investigation. A family history of asthma and previous occupational exposure may have had some influence on the risk of developing symptoms but the findings were inconsistent and probably of minor importance. Methacholine challenge seemed inappropriate for the screening of aluminium potroom workers in order to detect work-related asthmatic symptoms, but was closely correlated to the severity of symptoms.(ABSTRACT TRUNCATED AT 250 WORDS) PMID: 1297049 [PubMed - indexed for MEDLINE] Br J Ind Med 1992 Feb;49(2):125-3 (back to top) Prevalence of respiratory disorders among aluminium potroom workers in relation to exposure to fluoride. Soyseth V, Kongerud J. Medical Department, Hydro Aluminium, Ardal Aluminium Plant, Norway. In a survey of 370 aluminium potroom workers in western Norway, bronchial responsiveness, lung function, and respiratory symptoms were studied in relation to occupational exposure to air contaminants in the potroom. Increased prevalences of respiratory symptoms, work related asthmatic symptoms, and abnormal lung function were found in subjects exposed to total fluorides above 0.5 mg/m3 when compared with workers exposed to total fluorides at concentrations of less than 0.5 mg/m3. No significant association between bronchial responsiveness and exposure to fluoride was found and the prevalence of respiratory symptoms was independent of the degree of dust exposure. These findings indicate that work related asthmatic symptoms in potroom workers may be related to exposure to fluorides. PMID: 1536819 [PubMed - indexed for MEDLINE] Am J Ind Med 1986;9(3):239-42 (back to top) The role of atopy in potroom workers' asthma. Saric M, Godnic-Cvar J, Gomzi M, Stilinovic L. A study was performed to clarify a possible role of atopy in the occurrence of acute bronchoconstrictive impairment observed in some workers in a plant using the Alu-Swiss process for the electrolytic extraction of aluminum. Of 227 workers examined the percentage of those with a history of atopy and positive skin tests for common allergens was within the expected range. Six had positive patch test with 2% NaF. Among seven workers with paroxysmal wheezing and dyspnea, of whom three were only light smokers, three had positive skin test with common allergens but only one of them had an increased IgE value. The same worker also had positive patch test for 2% NaF. The average age of workers with paroxysmal wheezing and dyspnea was 32.6 years, and only two had symptoms defined as chronic bronchitis. Although their forced expiratory volumes, with two exceptions, measured at the beginning of work shift were within normal limits, in most of those workers bronchial hyperreactivity was also objectively assessed using nonspecific bronchoprovocative tests with histamine (or metacholine). The results support our previous findings that acute respiratory impairment in some workers is most probably based on bronchial hyperreactivity and not on an allergic mechanism. PMID: 3963006 [PubMed - indexed for MEDLINE] 5) Respiratory Problems in Communities Surrounding Aluminum Industry Allergy 1996 Oct;51(10):719-23 (back to top) Allergen sensitization and exposure to irritants in infancy. Soyseth V, Kongerud J, Boe J. Hydro Aluminium Ardal, Ovre Ardal, Norway. We investigated the relationship between residence in the neighbourhood of an aluminium smelter and the prevalence of atopy in schoolchildren (7-13 years of age). Atopy was assessed in 556 of the 620 participants by a skin prick test with eight common aeroallergens. The median exposures to sulphur dioxide and fluoride during the pollen season in the age interval 19-36 months were 24 and 3.1 micrograms/m3 in the spring and 20 and 3.3 micrograms/m3 in the summer, respectively. The odds ratio (OR) of having atopy was 2.0 (95% CI: 1.2-3.3) in those children who had lived in the index area for 7 years or more compared with those who had lived there less than 7 years (cumulative effect). The OR of atopy was 2.5 (1.4-4.4) in those who had lived in the index area during the age interval of 19-36 months compared with rural residence during this age-interval (age-specific effect). When the age-specific effect and the cumulative effect were compared in the same logistic model, the former decreased to 1.1 (0.4-3.0), whereas the latter was 2.2 (0.7-6.6). The results indicate that exposure to these low levels of irritants during early childhood increases allergen sensitization in children. PMID: 8905000 [PubMed - indexed for MEDLINE] Arch Dis Child 1995 Nov;73(5):418-22 (back to top) Bronchial responsiveness, eosinophilia, and short term exposure to air pollution. Soyseth V, Kongerud J, Broen P, Lilleng P, Boe J. Health Department, Rikshospitalet, University of Oslo, Norway. The number of capillary blood eosinophils and the prevalence of bronchial hyperresponsiveness (BHR) were compared between schoolchildren living in a polluted area (Ardal) and unpolluted area (Laerdal). In Ardal there is an aluminium smelter emitting sulphur dioxide and fluoride to the environment. Daily measurements of these pollutants in ambient air were available. The mean number of eosinophils in Ardal was 220 x 10(6)/l compared with 106 x 10(6)/l in Laerdal. The prevalence of BHR was 15.9% in Ardal and 11.8% in Laerdal. The odds ratio of having BHR in relation to these pollutants during the last 24 hours were: 1.12 (95% confidence interval (CI) 1.01 to 1.24) by increasing sulphur dioxide with 10 micrograms/m3, and 1.31 (95% CI 1.07 to 1.60) when fluoride exposure increased with 1 micrograms/m3. Similarly, these exposures were associated with a decrease in eosinophils of -21 x 10(6)/l (95% CI -36 to -6) and -52 x 10(6)/l (95% CI -98 to -8), respectively, in atopics. It is hypothesised that recent exposure to irritants induces changes in the airways leading to BHR in addition to recruitment of eosinophils to the airways in atopic subjects. PMID: 8554358 [PubMed - indexed for MEDLINE] Lancet 1995 Jan 28;345(8944):217-20 (back to top) Relation of exposure to airway irritants in infancy to prevalence of bronchial hyper-responsiveness in schoolchildren. Soyseth V, Kongerud J, Haarr D, Strand O, Bolle R, Boe J. Hydro Aluminium Ardal, Norway. To find out whether exposure to sulphur dioxide during infancy is related to the prevalence of bronchial hyper-responsiveness (BHR), we studied schoolchildren (aged 7-13 years) from two areas of Norway--a valley containing a sulphur-dioxide-emitting aluminium smelter and a similar but non-industrialised valley. Bronchial responsiveness was assessed in 529 of the 620 participants. The median exposures to sulphur dioxide and fluoride were 37.1 micrograms/m3 and 4.4 micrograms/m3 at ages 0-12 months and 37.9 micrograms/m3 and 4.4 micrograms/m3 at 13-36 months. The risk of BHR increased with exposure to sulphur dioxide and fluoride at these ages; the odds ratio for a 10 micrograms/m3 increase in sulphur dioxide exposure at 0-12 months was 1.62 (95% CI 1.11-2.35) and that for a 1 microgram/m3 increase in fluoride exposure was 1.35 (1.07-1.70) at 0-12 months and 1.38 (1.05-1.82) at 13-36 months. Exposure to these low concentrations of airway irritants during early childhood is associated with an increased prevalence of BHR in schoolchildren. PMID: 7823714 [PubMed - indexed for MEDLINE] Am Rev Respir Dis 1986 Feb;133(2):307-12 (back to top) Respiratory survey of North American Indian children living in proximity to an aluminum smelter. Ernst P, Thomas D, Becklake MR. We explored the relationship of respiratory symptoms and lung function to exposure to ambient air pollution consisting of particulate and gaseous fluorides. The subjects were 253 North American Indian children 11 to 17 yr of age living on the Akwasasne reserve, which is adjacent to an aluminum smelter. Among boys, closing volume (CV/VC%) was increased in those raised closest to the smelter as opposed to those having lived most of their lives farthest from this source of air pollution. In both sexes, there was a significant linear relationship between increasing CV/VC% and the amount of fluoride contained in a spot urine sample. We conclude that exposure to fluoride air pollution in the community may be associated with abnormalities in small airways. The implication of these abnormalities for future respiratory health is unknown. PMID: 3946926 [PubMed - indexed for MEDLINE] 6) Respiratory Problems from other sources of Fluoride Air Pollution: Lav Um 1977 Mar;29(2):50-7 (back to top) [Chronic broncopneumopathy and pneumoconiosis in workers employed in phosphoric acid production (author's transl)] [Article in Italian] Fabbri L, Mapp C, Rossi A, Cortese S, Saia B. Thirty-five subjects employed in a phosphoric acid producing plant were studied by the authors. The investigation included: history, according to the C.E.C.A. questionnaire for chronic bronchitis and emphysema; physical examination, chest X-ray spirometry and lung diffusing capacity for carbon monoxide by the steady state method (DLCOSS). High prevalence of chronic bronchitis (45.7%), obstructive spirometric impairment (37.1%), and decreased values of DlcoSS (31.4%) were detected. Two subjects were found to be affected with p 1/0 and 7 with p 0/1 pneumoconiosis. Such findings were significantly related to the lenght of working activity as well as to dust and gaseous fluoride (hydrofluoric acid, hexafluorosilicic acid and silicon tetrafluoride) exposure. PMID: 865215 [PubMed - indexed for MEDLINE] Int Arch Occup Environ Health 1997;70(5):314-20 (back to top) Respiratory impairment among children living in the vicinity of a fertilizer plant. Gomzi M, Saric M. Institute for Medical Research and Occupational Health, Zagreb, Croatia. The study included 162 second-grade children (85 boys and 77 girls) aged 8-9 years, attending two schools in an area with a fertilizer production plant, and 59 second-graders of the same age (32 boys and 27 girls) from a small neighbouring town located 20 km west of the plant, without any particular source of pollution. During the period from December 1990 to May 1991 the incidence of acute respiratory diseases was surveyed in children and their family members, and forced expiratory volumes were measured in selected second-graders in December 1990 and April 1991. In the area with the fertilizer plant as well as in the compared area ammonia, hydrogen fluoride, nitrogen dioxide, total suspended particulate matter and smoke were measured daily in ambient air and inside the school buildings. The mean concentrations of pollutants during the study period were below the recommended limits, with only a few exceptions, but daily fluctuations, particularly of ammonia and hydrogen fluoride in the area around the plant happened to exceed these values. The observed differences in the levels of air pollution correlated to some extent with the health parameters followed up during the study period. The incidence of acute respiratory diseases corresponded to the registered differences in the exposure to measured pollutants. Forced expiratory volume values in the compared groups of children did not consistently reflect the differences in exposure levels. PMID: 9352334 [PubMed - indexed for MEDLINE] Gig Sanit 1998 Nov-Dec;(6):11-3 (back to top) [Anthropogenic environmental factors and their role in the occurrence of acute respiratory diseases] [Article in Russian] Skachkov MV, Verashchagin NN, Skachkova MA, Kalinina TN, Osiian SA. The incidence of acute respiratory diseases (ARD) in two districts of the Orenburg Region which have different levels of environmental pollution was comparatively analyzed. The higher incidence of ARD in the more polluted district (Kuvandyksky) than in the control one (Belyaevsky). The incidence rate (41.8%) of ARD correlated with the level of the ambient air pollution by dust, CO, NO2, NF and fluoride aerosols in the Kuvandyksky district. PMID: 11013734 [PubMed - indexed for MEDLINE] Ann Epidemiol 1992 May;2(3):213-30 (back to top) A community-based epidemiologic study of health sequelae of exposure to hydrofluoric acid. Dayal HH, Brodwick M, Morris R, Baranowski T, Trieff N, Harrison JA, Lisse JR, Ansari GA. University of Texas Medical Branch, Galveston 77550. An accident at an oil refinery in Texas City, Texas, released around 40,000 lb of hydrogen fluoride, exposing the community to the highly toxic and corrosive substance. A population-based epidemiologic study was conducted to evaluate the impact of the accident on the health of the community. Exposure assessment was done using a multipronged approach through a door-to-door survey of 10,811 individuals. A symptom survey resulting in 1994 completed interviews was conducted with a stratified random sample selected from the exposure study database. The sampling was balanced with respect to age, gender, and predisposition across the three ordinal exposure categories. The results show a strong dose relationship (P < 10(-4)) between the exposure and symptoms reported following the accident and 2 years later, most notably breathing and eye symptoms. However, substantial improvement in health was reported over the 2-year period regardless of the level of exposure. Problems of recall bias and behavioral sensitization are considered and it is recognized that the study may have overestimated the effect. It is also recognized that the study may not have completely unraveled the relative importance of exposure and host response in health outcome, since the two were probably conflated in the exposure measure. Nevertheless, the independence of predisposition and reported level of exposure, the magnitude of effect and its consistency, the unmistakable dose response, the large sample size, and the mutual corroboration of various findings make it difficult to dismiss the interpretation that the hydrofluoric acid exposure indeed caused health problems in the community that continued for at least 2 years after the accident. PMID: 1342272 [PubMed - indexed for MEDLINE] Respiration 1998;65(6):486-8 (back to top) Acute lung injury after inhalation of water-proofing spray while smoking a cigarette. Jinn Y, Akizuki N, Ohkouchi M, Inase N, Ichioka M, Marumo F. Second Department of Internal Medicine, Tokyo Medical and Dental University, Tokyo, Japan. A 34-year-old Japanese woman developed acute lung injury soon after inhaling a water-proofing spray which she applied onto her ski suit while smoking a cigarette at the same time. She initially demonstrated arterial hypoxemia (PaO2 = 59 mm Hg) and ground-glass opacities in both lung fields on the CT scan, which both returned to normal without any medication. Several water-proofing sprays, which are easily obtainable in Japan, contain 1,1,1-trichloroethane, liquefied petroleum gas and fluoride resin. Although these components have not been reported to be toxic to the lung yet, high concentrations of these components and/or the pyrolytic products of fluoride resin may have caused acute lung injury in this case. PMID: 9817966 [PubMed - indexed for MEDLINE 7) Animal Sudy Examining Ingested Fluoride's Effect on Lungs: Indian J Chest Dis Allied Sci 1999 Jan-Mar;41(1):27-34 (back to top) Experimental pulmonary fluorosis. Purohit SD, Gupta RC, Mathur AK, Gupta N, Jeswani ID, Choudhary VK, Purohit SK. Department of Tuberculosis, J.L.N. Medical College, Ajmer. An experimental study was undertaken to observe effects of fluoride ingestion on lung tissue. The study was conducted on 15 albino rabbits of either sex and experimental fluorosis was induced by daily oral administration of sodium fluoride (NaF) solution. Rabbits were divided into three groups according to the quantity of fluoride ingestion: Group A: rabbits fed with 10 mg/kg/day NaF, Group B: 20 mg/kg/day NaF; and Group C: controls. After six months, the rabbits were sacrificed and their lung tissue was submitted for histopathological examination and fluoride content estimation. On gross examination, pale areas on the surface and dark brown congested areas on cut-section of lungs were seen in rabbits of groups A and B. Histopathological changes of alveolar haemorrhage, congestion, edema fluid, necrosis of alveolar epithelium, distortion of alveolar architecture and desquamation of epithelium of respiratory tract with damage to tracheal cartilage were observed in these groups. These changes were more marked in group B rabbits. Fluoride content of lung tissue homogenate was significantly higher in groups A and B (mean 1.206 ppm and 1.978 ppm respectively) as compared to control (0.1585 ppm). It was concluded that prolonged fluoride ingestion damages pulmonary tissues of rabbits. To the best of our knowledge, effect of chronic fluoride ingestion on lungs has not been reported in the literature, therefore, we had undertaken this study to analyse the effect of chronic fluoride ingestion on lungs. PMID: 10639761 [PubMed - indexed for MEDLINE]
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