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High levels of indium exposure relate to progressive emphysematous changes: a 9-year longitudinal surveillance of indium workers
  1. Atsuko Amata1,2,
  2. Tatsuya Chonan1,
  3. Kazuyuki Omae3,
  4. Hiroshi Nodera1,
  5. Jiro Terada2,
  6. Koichiro Tatsumi2
  1. 1Department of Medicine, Nikko Memorial Hospital, Hitachi, Japan
  2. 2Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
  3. 3Department of Preventive Medicine and Public Health, School of Medicine, Keio University, Tokyo, Japan
  1. Correspondence to Dr Jiro Terada, Department of Respirology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana Chuoku Chiba city, Chiba 2608670, Japan; jirotera{at}


Background During the last decade it has been clarified that the inhalation of indium compounds can evoke alveolar proteinosis, cholesterol granuloma, pulmonary fibrosis and emphysema. In this study, we aimed to elucidate the characteristics and time course of pulmonary disorders among indium workers using comprehensive pulmonary examinations at an indium-processing factory.

Methods Data for 84 male workers who underwent the examinations for nine consecutive years from 2002 to 2010 were analysed regarding their symptoms, serum indium concentration (sIn), serum markers of interstitial pneumonia, pulmonary function test parameters and high-resolution CT (HRCT) findings of the lungs.

Results In association with improvements in the work environment and work practice, the sIn levels decreased with significant reductions in the KL-6 and surfactant protein D (SP-D) levels. Regarding the HRCT findings, the interstitial lesions regressed partially, whereas emphysematous lesions increased progressively in the workers with high sIn values. FEV1/FVC decreased with the years and the rate of decrease was significantly greater in those with high sIn. The biological half-life of sIn was estimated to be 8.09 years.

Conclusions The present findings suggest that the sIn, SP-D, KL-6 levels and radiological interstitial changes can be reduced in indium workers by alleviating exposure to indium, whereas emphysematous lesions can progress among those with a history of heavy exposure.

  • Occupational Lung Disease
  • Interstitial Fibrosis
  • Emphysema
  • Alveolar proteinosis

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