From the Department of Chest Diseases (Drs Bakan, Özkan, Çamsari, Gür, Acikmese, and Çetinkaya), Yedikule Teaching Hospital for Chest Diseases and Thoracic Surgery; and the Department of Chest Diseases (Dr Bayram), Bezmialem Vakif University, School of Medicine.
Correspondence to: Nur Dilek Bakan, MD, 2. Kisim mah. Buket sok., Spradon Quartz sitesi AC1 blok D:6, Bahcesehir 34488 Istanbul, Turkey; e-mail: firstname.lastname@example.org
Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).
© 2012 American College of Chest Physicians
We thank Dr Akgun and colleagues for their interest regarding our article1 published in CHEST and appreciate the data regarding the effects of age and invasive procedures on mortality. We acknowledge that the relationship between reduced lung functions at the time of diagnosis and mortality cannot be used to ascertain the causes leading to progressive massive fibrosis and death. It is already discussed in the article1 that we were not able to conduct work-site visits that might clarify the possible causes for development of severe illness, such as size of the work site, protective measures, ambient dust level, and so on. Unfortunately, the factors leading to more severe disease and death are still unclear.
In contrast to previously published data,2 we found no association between age and mortality (P = .69). The mean age difference between the patients who died and the entire study population is a result of the calculation time. The given mean age in the article was the age at first admission and not at the end of the follow-up period, as it was for the patients who died. Considering the number of fatal cases, it would have been more accurate to give the median age (31.5) instead of the mean age.
Five of the six patients who died had undergone invasive procedures (two open-lung biopsies, three transbronchial biopsies). Although it was not presented in the article, it seems that there is a relationship between invasive procedures and mortality (P = .0084), parallel with results from studies by Akgun et al.2,3 Therefore, it is crucial to raise awareness among physicians regarding the denim sandblasting occupation in order to avoid interventional procedures in patients with silicosis.
All nine patients who were compensated were covered by insurance. The uninsured workers received no compensation until the end of the follow-up period of the study (December 2009). Presently, the temporary law enables uninsured workers only to file for disability. It is expected that uninsured workers are more likely to work in poorer conditions than insured workers, and all workers who develop silicosis must be encouraged to seek compensation.
Whatever the reason for the tragic outcomes of silicosis in denim sandblasters, it still continues to kill young people. Unfortunately, four more patients died after the submission of the manuscript.
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