Chronic beryllium disease is lung inflammation caused by inhaling dust or fumes that contain beryllium, a metal that is used in small amounts in many industries.
People with chronic beryllium disease may gradually develop coughing, difficulty breathing, fatigue, and night sweats.
Acute beryllium disease is now rare because most industries have reduced exposure levels.
Diagnosis of chronic beryllium disease is typically based on the person’s history of exposure, results of chest imaging (x-rays, computed tomography (CT)), tests of the immune system’s reaction to beryllium, and lung biopsy when indicated.
Oxygen and corticosteroids may be needed for treatment.
People with chronic beryllium disease should be removed from further exposure.
(See also Overview of Environmental and Occupational Lung Disease.)
Causes of Beryllium Disease
Beryllium exposure can occur in many industries, including beryllium mining and extraction, alloy production, metal alloy machining, electronics, telecommunications, nuclear weapon and defense industries, aerospace, and metal reclamation and recycling. Small amounts of beryllium may also be added to copper, aluminum, nickel, and other metals to make beryllium alloys.
Relatively low-level exposures can cause chronic beryllium disease. Individuals can develop beryllium sensitization (their T cells in the immune system become sensitized to beryllium and then increase rapidly in number on re-exposure). The risk of progression from beryllium exposure to beryllium sensitization has many factors, including the dose of exposures, duration of exposures, and genetic factors. Workers with bystander exposures, such as administrative assistants and security guards, can also develop beryllium sensitization and disease, though at lower rates.
Symptoms of Beryllium Disease
People with chronic beryllium disease have shortness of breath, cough, night sweats, fatigue, and weight loss. Symptoms may develop within months of first exposure or more than 30 years after exposure has ceased.
Signs and symptoms of chronic beryllium disease are often similar to those of sarcoidosis.
Diagnosis of Beryllium Disease
A history of exposure to beryllium
Chest imaging (x-ray or computed tomography)
Test for sensitization to beryllium
A chest x-ray may be normal or show abnormalities, often resembling those seen in people with sarcoidosis. High-resolution chest computed tomography is more sensitive than x-ray, although people with beryllium disease can have normal imaging test results.
Pulmonary function test results vary and can show restriction, reduced diffusing capacity for carbon monoxide (DLCO), and/or obstruction in people with beryllium disease.
A test called the BeLPT, in which lymphocytes (a type of white blood cell), obtained from a blood sample or from fluid obtained through bronchoalveolar lavage, are cultured with beryllium sulfate, is used to detect sensitization to beryllium. However, the BeLPT test is not widely available.
The diagnosis of beryllium disease can be challenging. However, doctors can make a diagnosis of probable beryllium disease based on various combinations of diagnostic criteria, including a history of exposure, chest imaging, abnormal pulmonary function test results, abnormal BeLPT results,, and lung biopsy. Certain findings, such as an abnormal BeLPT, provide greater diagnostic certainty than others, such as nonspecific x-ray changes.
Treatment of Beryllium Disease
Discontinuation of exposure
Sometimes corticosteroids and immunosuppressants
People with chronic beryllium disease should be removed from further exposure to beryllium.
The natural history of beryllium disease varies, and some people do not require treatment because the disease is stable or progresses relatively slowly. Otherwise, treatment is similar to that of pulmonary sarcoidosis.
Spontaneous remission of chronic beryllium disease is uncommon. People with end-stage disease may be eligible for lung transplantation.
Supportive measures, such as supplemental oxygen therapy, pulmonary rehabilitation, and medications for treating right-sided heart failure, are used as needed.
Prognosis for Beryllium Disease
Chronic beryllium disease has a variable clinical course. Disease can remain stable or progress slowly with loss of respiratory function over time. In a subset of cases, chronic beryllium disease can progress to end-stage lung disease. Disease frequently progresses even after exposure to beryllium is eliminated.
Prevention of Beryllium Disease
Facilities that use beryllium-containing products should implement a control program to minimize exposure to beryllium. The United States Occupational Safety and Health Administration (OSHA) has set the permissible exposure limit of beryllium to 0.2 micrograms per cubic meter of air, averaged over 8 hours (see OSHA Beryllium Standards). This standard is expected to reduce the number of cases but not entirely eliminate chronic beryllium disease, as cases can still develop at exposure levels below the OSHA standard. Efforts should also be made to minimize skin exposure, given the potential for sensitization following skin contact.
