Talcosis

Definition

Talcosis belongs to a group of pulmonary dust disorders collectively called pneumoconioses. In these diseases, nodules form in the lungs as the result of inhaling dust. More commonly, talcosis arises from the injection of talc during illicit drugs abuse.

Description

Talc is the mineral magnesium sulfate hydroxide. In its solid form, it is called soapstone. In loose form, it is known as talcum powder and is used to absorb moisture. Talc is used in, among other things, the manufacture of plastics, paints, ceramics, cosmetics, and as filler for some pharmaceutical drugs manufactured in oral tablet (pill) form. China is the world's leading producer of talc, but the mineral is abundant and mined in many other countries, including South Korea, India, Finland, France, and the United States.

Talcosis was recognized as a lung disease over 100 years ago. When inhaled, talc causes a disease quite similar to the more common lung disease silicosis. However, beginning in the 1960s, a new cause of talcosis began to appear. Talc is used as filler in some drug tablets. Intravenous drug abusers sometimes crush tablets, mix them with water, and inject the mixture into a vein. Talc particles do not dissolve in water. Instead, they travel through the circulatory system lodging in blood vessels and the lungs, causing talcosis.

Risk factors

Babies who inhale baby powder containing talc are at risk for developing acute talcosis, a condition in which the cilia lining the airways stop working and the air passages fill up with mucus. Other people at risk for talcosis are miners, stonecutters, ceramics workers, sandblasters, tunnel workers, rock drillers, and individuals who work in industries where talc is used during the manufacturing process. Intravenous drug abusers who inject multiple drugs derived from crushed and powdered pills are at highest risk. People who snort cocaine that has been cut with talc are also at risk for developing talcosis. Risk increases with the frequency of exposure.

Demographics

It is difficult to determine how many people may have talcosis. Inhaled talcosis is uncommon, especially in countries where workplace health and safety rules regulate the amount of particulate matter to which workers can be exposed. Individuals working in industries using or making talc tend not to develop symptoms until they are in their 40s and 50s. Talcosis in intravenous drug users usually is diagnosed only on autopsy, as these individuals tend to die young and from other causes.

Causes and symptoms

The exact mechanism by which talcosis develops is not completely understood. When talc dust get trapped in alveoli in the lungs where air exchange takes place, white blood cells called macrophages enter the alveoli, ingest the talc, and die. The resulting inflammation attracts other macrophages to the region. Granulomas form when the immune system makes fibrous tissue to seal off the reactive area. The disease process may stop at this point or speed up and destroy large areas of the lung. The fibrosis may continue even after the individual no longer is exposed to talc.

Symptoms of talcosis can include shortness of breath after exercising and a harsh, dry cough. Individuals may have more trouble breathing and cough up blood as the disease progresses. They are also at higher risk for developing other respiratory diseases. Intravenous drug abusers also may have elevated blood pressure in the pulmonary artery.

Diagnosis

A diagnosis of talcosis may be made based on the following:

Treatment

There is no cure for talcosis. Treatment involves therapy to relieve symptoms, treat complications, and prevent respiratory infections. Respiratory symptoms may be treated with bronchodilators to expand the airwatys, increased fluid intake, steam inhalation, and physical therapy. Patients with severe breathing difficulties may be given oxygen therapy or placed on a mechanical ventilator. Drugs may help to control high blood pressure.

A second aspect of treatment involves lifestyle changes. Individuals with talcosis should stop smoking, work to prevent infections by avoiding crowds and persons with colds or similar infections, and receive vaccinations against influenza and pneumonia. They should be encouraged to keep up regular activity and learn to pace themselves with their daily routine. Intravenous drug abusers should receive treatment for their addiction.

Prognosis

The degree which talcosis impairs daily life and the rate at which it progresses to respiratory failure vary considerably. Talcosis is only one of many health problems intravenous drug abusers face, so its effect is often difficult to discern.

Prevention

Talcosis is a preventable disease. In the United States, the National Institute for Occupational Safety and Health (NIOSH) and the Occupational Safety and Health Administration (OSHA) set standards limiting the amount of particulate matter to which workers may be exposed. These workplace rules have substantially decreased the number of cases of inhaled talcosis in American workers.

KEY TERMS
Alveoli—
The small air sacs located at the ends of the breathing tubes of the lung, where oxygen normally passes from inhaled air through the membranes into the capillaries and the bloodstream.
Bronchoscopy—
A procedure in which a fiber optic instrument called a bronchoscope is inserted in the airways allowing the physician to inspect the linings of the airways.
Cilia—
Tiny, hair-like projections from a cell. In the respiratory tract, cilia beat constantly in order to move mucus and debris up and out of the respiratory tree, in order to protect the lung from infection or irritation by foreign bodies.
Fibrosis—
A condition characterized by the presence of scar tissue or collagen proliferation in tissues to the extent that it replaces normal tissues.
Granuloma—
A small nodule that forms when immune system cells called macrophages gather to wall off foreign material in the body. Granulomas are a specialized type of inflammation that can occur many places in the body.
Pneumoconiosis (plural, pneumoconioses)—
Any chronic lung disease caused by inhaling particles of silica or similar substances that lead to loss of lung function.

Other preventive measures include:

See also Chronic obstructive pulmonary disease ; National Institute for Occupational Safety and Health ; Occupational Safety and Health Administration .

Resources

PERIODICALS

Bhadra, Krish, and Benjamin T, Suratt. “Drug-induced Lung Diseases: A State-of-the-art Review.” Journal of Respiratory Diseases 30, no 1 (2009). http://jrd.consultantlive.com/display/article/1145425/1372109 (accessed September 10, 2012).

Restrepo, Carlos, et al. “Pulmonary Complications from Cocaine and Cocaine-based Substances: Imaging Manifestations.” RadioGraphics, 27 (July 2007): 941–56. http://radiographics.rsna.org/content/27/4/941.long (accessed September 10, 2012).

WEBSITES

Centers for Disease Control and Prevention. “Research on Long-term Exposure: Talk Miners and Millers (Talc).” http://www.cdc.gov/niosh/pgms/worknotify/Talc.html (accessed September 10, 2012).

MedlinePlus. “Talcum Powder Poisoning.” http://www.nlm.nih.gov/medlineplus/ency/article/002719.htm (accessed September 10, 2012).

ORGANIZATIONS

Centers for Disease Control and Prevention, 1600 Clifton Rd., Atlanta, GA, 30333, (800) 232-4636, cdcinfor@cdc.gov, http://www.cdc.gov .

Mine Safety and Health Administration, 4015 Wilson Blvd., Arlington, VA, 22203, (877) 778-6055, MSHAhelpdesk@dol.gov, http://www.msha.gov .

National Toxicology Program, PO BOX 12233, MD K2-03, Research Triangle Park, NC, 27709, (919) 541-3345, http://ntp.niehs.nih.gov .

U.S. Food and Drug Administration, 10903 New Hampshire Ave., Silver Spring, MD, USA, 20993-0002, (888) INFO-FDA (463-6332), http://www.fda.gov .

Tish Davidson, AM

QUESTIONS TO ASK YOUR DOCTOR
  This information is not a tool for self-diagnosis or a substitute for professional care.