Baritosis : Causes, Symptoms, Diagnosis, Treatment, Prevention

Baritosis is a medical condition affecting the lungs, which usually develops in people who are exposed chronically to Barium Dust. This disease is caused by chronic inhalation of Barium Sulfate dust. These Barium Sulfate particles can be present in the lungs for quite some time before presentation of symptoms of Baritosis. Baritosis is also known as the benign pneumoconiosis. Baritosis causes abnormal symptoms, physical signs, incapacity for work, interference with lung function, or liability to develop pulmonary or bronchial infections or other thoracic disease.¹ Baritosis is nonfibrotic forms of pneumoconiosis like Siderosis and stannosis.²

• Baritosis is also known as Benign Pneumoconiosis.
• The disease is often asymptomatic for several years, despite particles lying within the alveoli.
• Later the lungs deposited with barium particle is prone to develop bronchial and alveolar infection.
• Barium particles are radio opaque and X-ray shows radio-opaque shadow following exposure.
• Baritosis as stated is observed in people who work in industries where barium powder is used and worker is exposed to barium dust.
• Due to chronic inhalation of barium dust, these particles settle in the lungs causing respiratory difficulties along with other symptoms.
• People involved with manufacture of paints are more likely to develop baritosis.

• Exposure to barium dust– As stated, people working in industries where barium dust is utilized in huge amounts, especially those who are involved in manufacturing paints, are at increased risk for developing Baritosis, as they inhale Barium Dust chronically. In the initial stages, there may be no symptoms to speak of but as the disease progresses, respiratory symptoms start to creep in, as the barium Dust settles in the lungs.
• Dental Technician– Baritosis is been observed in dental technician after several years of exposure to barium dust.³

• Dry Cough- Barium dust following inhalation, deposits in alveoli and bronchioles. The dust does cause mild inflammatory changes within alveolar and bronchiolar mucosa resulting in dry cough.
• Asymptomatic- The short-term exposure often causes minimum symptoms for few days and later patient is asymptomatic, though Chest X-Ray may show radiopaque shadows of barium dust.
• Incidental Radiological Study- Barium is highly radio opaque and hence when radiographs are taken, there will be observation of dense distinct opacities on the radiographs. The distribution of these opacities is usually uniform and once the exposure reduces these opacities decrease in numbers. Hilar lymph nodes are often radiopaque and mildly enlarged.4

• Dry Cough- Long-term exposure causes wide spread deposits of barium dust in lungs and alveoli. The deposits cause inflammations of the mucosal membrane resulting in initial dry cough.
• Cough With Expectoration- The long-term exposure of barium dust causes persistent alveolar and bronchiolar inflammation resulting in cough with expectoration.
• Short of Breath and Wheezing- The persistent inflammation of bronchioles and alveoli causes mucosal edema and thickening followed by wheezing and shortness of breath. The symptoms of wheezing and shortness of breath are caused by bronchospasm and alveolar edema.
• Frequent Sniffing and Nasal Irritation- In few cases barium deposits in nasal mucosa causes irritation of nasal mucosal membrane. The barium deposits in nasal mucosa causes nasal irritation. Patient often complaints of sneezing and nasal itching.
• Radiological Evidence- The abnormalities seen on x-ray images gradually clear as the exposure to barium is reduced.

• Discrete uniform multiple tiny peripheral opacities are observed in plain X-Ray of the lungs.
• Occasional radiopaque shadow may be 3 to 4 mm in diameter.
• The barium particles are seen on x-ray images as opaque shadows, although this is a rather benign medical condition and does not cause any significant symptom or discomfort.
• Radio opaque hilar lymph nodes are rarely enlarged.

• Normal Results- The pulmonary function test is normal in early stages.
• Abnormal Results- The pulmonary function test is abnormal in patient suffering with advanced wide spread Baritosis.¹ The list of pulmonary function test are as follows-

• Mediastinal and small peripheral radio opaque shadow are better analyzed using thin-section computed tomography (CT) or MRI studies.²

• Rarely in few cases diagnosis is confirmed by histopathological studies to rule out fibrotic lesions or giant cell interstitial pneumonia caused by hard metal pneumoconiosis.

The lung or pulmonary function test involves computing of volume and capacity of lungs. Lung volume is the amount of air that moves in and out of lung at different stages of breathing. Lung capacity includes lung volume stored in lung at different stages of breathing.

• Tidal Volume (VT)- Quantifies amount of air inhaled or exhaled during normal breathing.
• Minute Volume (MV)- Test determines total amount of air exhaled per minute.
• Forced Expiratory Volume (FEV)- The test determines the volume of air expired during the first, second, and third seconds of the FVC test.
• Vital Capacity (VC)- VC is the total volume of air that can be exhaled after maximum inspiration.
• Functional Residual Capacity (FRC)- FRC is the amount of air remaining in lungs after normal expiration.
• Total Lung Capacity- The total volume of lungs when maximally inflated is assessed as total lung capacity.
• Forced Vital Capacity (FVC). The amount of air exhaled forcefully and quickly after maximum inspiration is assessed as FVC.

• The most effective treatment once the diagnosis is confirmed is to eliminate the exposure to barium dust.

• The persistent cough should be treated with expectorant. Expectorant helps to soften mucosa and helps to cough out the sputum and barium particles.

• Irritation of throat and dry cough is treated with cough suppressants.

• Alveolar and bronchial inflammation is treated with Non-steroidal anti-inflammatory drugs (NSAIDs).

In case if an individual is working in the above mentioned industries then the following safety measures can be taken:

• In case if a worker comes in contact with barium dust, then the worker should wash the affected area thoroughly by applying soap and then washing it with water
• If there is a risk for exposure to barium Dust, then before starting work and after finishing work, the clothes should be changed and the employer should provide work clothes for its employees
• Worker should wear mask all the time during working hours and around the working place.

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