Beryllium disease is the term used to describe various conditions resulting from exposure to beryllium and its compounds or alloys. These conditions can be grouped into acute beryllium disease and chronic beryllium disease.

Depending on how workers are exposed, the diseases can affect different tissues and organs. Breathing in fumes or dusts of beryllium compounds may injure the lungs. Direct contact with beryllium fumes or dusts may injure the exposed areas of the body, such as the eyes or the skin. Beryllium may also affect such organs as the liver, kidneys, heart, nervous system, and the lymphatic system, which carries water, white blood cells and proteins to the blood.

Acute diseases develop after a short and heavy exposure and usually last for less than one year. Acute beryllium disease may take several forms.

Contact dermatitis is an inflammation of the skin, causing itching, redness, rashes, swelling, and blisters. These symptoms appear on the exposed areas of the body, especially the face, neck, arms, and hands. Contact dermatitis usually improves a few weeks after exposure ends. Skin effects (lesions, ulcerations, wart-like bumps) also develop if beryllium penetrates into cuts or scratches. Beryllium particles must be removed from a wound if it is to heal properly.

The membrane that covers the front of the eye can become inflamed in association with dermatitis. Splashes of beryllium solutions may also burn the eyes causing fluid accumulation and reddening around the eyes.

Nasopharyngitis is an inflammation of the nose and throat. Symptoms include pain and swelling. Signs include bleeding of the nose. This condition clears up three to six weeks after exposure ends. (Check How Do Particulates Enter the Respiratory System? for a picture and description of different parts of the respiratory system.)

Tracheobronchitis is an inflammation of the windpipe and the airways beyond it. Symptoms are coughing and discomfort, and tightness of the chest. Recovery takes about one month.

Pneumonitis is an inflammation of the lungs confined to the walls of the air sacs. Pneumonitis is the most serious of the acute effects from beryllium exposure. It varies in severity and can result in death. But fatal cases are rare and recovery is usually complete in about six months. Symptoms are coughing, breathing difficulties, tightness of the chest, appetite and weight loss, and general weakness and tiredness.

According to the United States Beryllium Case Registry, established in 1952, about 17 percent of patients with acute disease developed chronic disease. It is unknown why chronic disease developed in persons who have had previous acute disease.

Chronic beryllium disease develops after months or years of exposure to beryllium. The period between first exposure and appearance of the disease is 10 to 15 years. The disease may develop while the individual is still exposed to beryllium or it may occur up to 25 years after the last exposure.

Chronic beryllium disease primarily affects the lungs. But it may also affect other organs because the blood transports beryllium throughout the body. The mechanism of beryllium disease is not absolutely known. Most likely, once in the body, beryllium combines with certain proteins, causing the release of toxic substances. These are responsible for the lesions seen in the lungs. Certain cells form masses of tissue called granulomas in response to beryllium. Granulomas mark chronic beryllium disease and are typically found in the lungs. But granulomas may also occur in the skin, liver, spleen, kidney, bone, nervous system, skeletal muscles, lymph glands and the wall of the heart.

Symptoms of chronic beryllium disease are breathing difficulties, coughing, chest pain, and general weakness. Signs include enlargement of the liver, spleen and right heart, and kidney stones. The course of chronic beryllium disease varies. Some affected people may have few or no symptoms at all for many years followed by eventual deterioration.

The International Agency for Research on Cancer (IARC) has concluded that exposure to beryllium can cause lung cancer.

Beryllium is a metal widely used in industry because of its important properties including light weight, high melting point, high strength, and good electrical conductivity. The beryllium-containing materials that Canadian industry commonly use are the metal itself, beryllium oxide, and beryllium alloys. Industrial uses include the manufacture of thermal coating, nuclear reactors, rocket heat shields, brakes, x-ray tubes, and dental plates. The occupations listed below involve exposure to beryllium.

Industrial processes that use beryllium or products that contain the metal include:

• extraction of beryllium (smelting and refining)
• beryllium metallurgy (production of beryllium metal and compounds)
• precision machining
• nuclear applications
• microcircuits
• stamping/cutting
• die casting
• plastic moulding
• welding electrodes
• handling/assembly
• dental plates manufacturing
• thermal castings
• x-ray tube window manufacturing
• guidance and navigation systems manufacturing
• rocket parts and heat shields.

Diagnosis and evaluation of acute beryllium disease requires the identification of the conditions of exposure through an analysis of the victim's employment history.

The diagnosis of chronic beryllium disease is based upon criteria established by the Beryllium Case Registry. These include the evidence of significant beryllium exposure, abnormalities in the chest x-ray and lung function tests, and the presence of beryllium in lung or other tissue.

Treatment for acute beryllium disease includes removal from exposure, bed rest, administration of oxygen and corticosteroids, which prevent inflammation. The only available therapy for chronic beryllium disease is corticosteroids. Lifetime therapy is usually required. Victims who stopped treatment have experienced aggravated symptoms.

Workplaces need to identify sources of beryllium. WHMIS requires the identification of beryllium, if present in more than 0.1 percent in a product other than in a manufactured article or in hazardous waste.

Very stringent measures are required to prevent possible exposure to beryllium. They are:

• process modification
• process enclosure
• automation of the work procedures
• local exhaust ventilation systems
• good housekeeping
• protective clothing
• convenient washing facilities
• good sanitation practices
• training and education

Using pellets instead of powders can help reduce exposure. Enclosing processes separates workers from harmful substances. Adequate local exhaust systems prevent toxic substances from escaping into the workroom. Workers should use wet processes, such as cutting fluids and wet grinding, honing and polishing. Workplaces need light and sound warning devices attached to detectors in areas where there is a potential of massive contamination. Air from the area ventilation and local exhaust system should be exhausted to the atmosphere through high-efficiency filtration equipment.

Good housekeeping includes proper storage of substances, frequent disposal of waste, prompt spill clean-up, periodic maintenance of the equipment and no dry sweeping.

Respiratory protective devices and protective clothing can help reduce exposure. If workers must use respirators for breathing protection, the employer should have a written respirator program that describes the proper procedures for respirator selection, care, and use.

Guidance for developing a program can be found in the current CSA Standard Z94-.4-93 (R 1997) "Selection, Care, and Use of Respirators." Workplaces must follow all legal requirements for respirator use and approval. These may vary between jurisdictions in Canada. OSHA and NIOSH recommend using air-purifying respirators equipped with High Efficiency Particulate Air (HEPA) filter cartridges (or a self-contained breathing apparatus, depending on the airborne dust concentration). Newer models of HEPA filter cartridges or masks will be marked N100, R100, or P100.

Workers should also use protective clothing such as coveralls, headgear, and shoes. They should use high-efficiency particulate air (HEPA) vacuums to clean equipment and the floor. Never use compressed air. Workers should remove contaminated clothing in change rooms only. Workplaces need to conveniently locate washrooms, toilets, showers, and locker facilities. Separate locker facilities will ensure that work clothes do not contaminate street clothes. The workplace should also provide training and educational programs to inform workers about the nature of substances they are exposed to, and how to work safety.