Journal of Exposure Science and Environmental Epidemiology (2015) 25, 26–36

& 2015 Nature America, Inc. All rights reserved 1559-0631/15

www.nature.com/jes

ORIGINAL ARTICLE
Personal exposure to asbestos and respiratory health of heavy
vehicle brake mechanics
Marı́a Fernanda Cely-Garcı́a1, Carlos A. Torres-Duque2,3, Mauricio Durán3, Patricia Parada2, Olga Lucı́a Sarmiento4,
Patrick N. Breysse5 and Juan P. Ramos-Bonilla1

Asbestos brake linings and blocks are currently used in heavy vehicle brake repair shops (BRSs) in Bogotá, Colombia. Some brake
products are sold detached from their supports and without holes, requiring manipulation before installation. The aim of this study
was to assess asbestos exposures and conduct a preliminary evaluation of respiratory health in workers of heavy vehicles in BRSs.
To estimate asbestos exposures, personal and area samples were collected in two heavy vehicle BRSs. Each shop was sampled
during six consecutive days for the entire work shift. Personal samples were collected on 10 workers including riveters, brake
mechanics, and administrative staff. Among workers sampled, riveters had the highest phase contrast microscopy equivalent
(PCME) asbestos concentrations, with 8-h time-weighted average (TWA) personal exposures ranging between 0.003 and
0.157 f/cm3. Respiratory health evaluations were performed on the 10 workers sampled. Three workers (30%) had circumscribed
pleural thickening (pleural plaques), with calcifications in two of them. This finding is strongly suggestive of asbestos exposure.
The results of this study provide preliminary evidence that workers in heavy vehicle BRSs could be at excessive risk of developing
asbestos-related diseases.

Journal of Exposure Science and Environmental Epidemiology (2015) 25, 26–36; doi:10.1038/jes.2014.8; published online 5 February 2014
Keywords: brake mechanics; riveters; chrysotile; Colombia; pleural plaques; pleural thickening

INTRODUCTION common practice in passenger vehicle BRSs.13 This study

Asbestos-containing products are still used in low- and middle-
income countries, where occupational regulations tend to be
scarce.1,2 Chrysotile is the type of asbestos with the most
extended use worldwide.3,4 All types of asbestos, including
chrysotile, are classified as carcinogenic to humans.5
Brake mechanics have been identified as an occupational group
potentially exposed to asbestos fibers and there is an ongoing
debate about whether brake mechanics are at excessive risk of
developing asbestos-related diseases. Lemen6 concluded that the
manipulation processes of asbestos-containing brake products can
release asbestos fibers, and that short chrysotile fibers found in
brake products increase the risk of disease.6 Other studies have
concluded that heavy vehicles brake mechanics are exposed to
asbestos concentrations in compliance with the US Occupational
Safety and Health Administration personal exposure limit (US OSHA
PEL) of 0.1 f/cm3, and that they are not at excessive risk of
developing asbestos-related diseases.7–11 All these studies were
conducted in high-income countries, especially in the United States.
The working conditions and potential asbestos exposures of
brake mechanics working in heavy vehicle brake repair shops
(BRSs) located in low- and middle-income countries may be
different from those reported in studies conducted in high-income
countries. In a study conducted with brake mechanics in Iran, it
was found that mechanics were exposed to extremely high fiber
concentrations12 determined using phase contrast microscopy
(PCM). In a previous study conducted in Colombia, we found that
the manipulation of asbestos-containing brake linings is a very
1
Department of Civil and Environmental Engineering, Universidad de Los Andes, Bogotá, Colombia; 2Research Department, Fundación Neumológica Colombiana, Bogotá,
Colombia; 3Medical Department, Fundación Neumológica Colombiana, Bogotá, Colombia; 4School of Medicine, Universidad de Los Andes, Bogotá, Colombia and 5Bloomberg
School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA. Correspondence to: Dr. Juan P. Ramos-Bonilla, Department of Civil and Environmental Engineering,
Universidad de Los Andes. Cra 1 Este No 19 A-40, Office ML 328, Bogotá, Colombia.
Tel.: +57 1 339 4949 extension 3693. Fax: +57 1 332 4313.
E-mail: jramos@uniandes.edu.co
Received 22 October 2013; accepted 7 January 2014; published online 5 February 2014
identified that riveters are the workers in charge of attaching
the brake linings to the supports, and perform a lengthy
manipulation process during this task.13 The study concluded
that although riveters were exposed to asbestos concentrations in
compliance with the US OSHA PEL based on phase contrast
microscopy equivalent (PCME) concentrations, these workers were
exposed to extremely high asbestos concentrations based on
assessment using transmission electron microscopy (TEM).13
The relationship between asbestos exposure and respiratory
disease has been studied for many years.14 Because of
confounding factors, understanding the pathogenesis of lung
carcinomas, mesothelioma, and asbestosis is complex.15 Although
some studies have suggested that chrysotile is less harmful
compared with amphiboles,14 there is robust evidence showing an
excess mortality risk because of lung cancer, all cancers, and non-
malignant respiratory diseases in chrysotile-exposed workers,
even for those exposed to low concentrations.16
Asbestos-containing brake pads, brake linings, and brake blocks
are still commercialized in Colombia. Brake linings are used for
both passenger and heavy vehicles (i.e., with important differ-
ences in size and thickness), whereas brake blocks are exclusively
used for heavy vehicles. Many brake blocks and linings are
commercialized detached from their supports and without holes.
For this reason, they are subject to manipulation processes in
order to attach them to the supports.
Colombia is a unique setting to assess occupational exposures
to asbestos because asbestos regulations are recent. In November

2011, the first Colombian regulation regarding occupational
exposures to asbestos was issued (i.e., Resolution 007/2011).
Resolution 007/2011 adopts the asbestos threshold limit value
(TLV) recommended by the American Conference of Govern-
mental Industrial Hygienists (ACGIH) as the Colombian permissible
limit value (PLV).17 The asbestos TLV is set at 0.1 f/cm3 for a
TWA of 8 h. In the United States, OSHA establishes an 8 h PEL of
0.1 f/cm3, and a short-term exposure limit for 30 min (US OSHA
STEL) of 1 f/cm3.
This paper extends our previous work in passenger vehicle BRSs
by assessing asbestos exposures in two heavy vehicle BRSs.
Asbestos exposures in heavy duty vehicle BRSs are expected to be
different than passenger vehicle BRSs because of differences in
the manipulations performed and the size of the brake products.
In addition, we have added a preliminary respiratory health
component to the assessment of workers of these BRSs.
MATERIALS AND METHODS
In 2012, two asbestos sampling campaigns of six consecutive days were
conducted in two heavy vehicle BRSs located in Bogotá, Colombia.
Respiratory health was evaluated in 10 workers of these BRSs. As an
exploratory study, the BRSs and workers evaluated were selected by
convenience. Because the evaluation of respiratory health was preliminary
and exploratory, no control group was formally established. This is
discussed in more detail in the Discussion section. For the interpretation of
the results of the workers analyzed in the current study, information in the
literature18–20 describing the prevalence of pleural plaques in populations
non-exposed to asbestos was used.
A structured questionnaire, based on the US OSHA Medical Question-
naire,21 was translated and culturally adapted by members of our research
team to collect information from the workers. This information included
brake products used, manipulation procedures, and general characteristics
of the shops. In addition, a specific set of questions regarding riveters’
occupational history were part of the questionnaire.
Ethics Committees of the two institutions directly involved on the
sampling campaigns and respiratory health evaluations (i.e., Universidad de
Los Andes and Fundación Neumológica Colombiana, respectively)
approved the methods and study design. All workers signed an informed
consent. To participate in the study, workers were required to have health
insurance.
Asbestos Exposure Campaigns
BRS1 was sampled between 16 and 21 January 2012, and BRS2 was
sampled between 30 January and 4 February 2012. Personal samples were
collected on riveters, brake mechanics, and administrative staff. Area
samples and quality control samples were collected as well.
Workers were instructed to maintain their regular daily activities and
working procedures without modifications. The full shift was divided into
shorter partial-period sampling windows as a strategy to prevent filter
overloading. Brake mechanics and administrative staff had at least two
partial-period personal samples collected daily. For riveters, several
personal samples were collected during the entire work shift, including
short-term personal samples (i.e., 30 min) collected during the manipula-
tion of brake products.
Samples were collected and analyzed following NIOSH methods 7400
(ref. 22) and 7402.23 Personal and area samples were collected using
AIRChek XR5000 pumps (SKC, Eighty Four, PA, USA) connected to 25-mm
MCE filters, with 0.45 mm pore size, mounted on 25-mm sampling cassettes
equipped with 50-mm conducting extension cowls (SKC Preloaded
Cassette, SKC). Samples were collected at a flow rate of B2 LPM
measured at the beginning and at the end of each sampling window
using a Defender 510 High or 520 High BIOS International Calibrator (BIOS
International, Butler, NJ, USA) following standard procedures. To determine
regulatory compliance, personal PCME concentrations were compared
against both the Colombian and the US OSHA standards. PCME
concentrations were estimated correcting PCM concentrations with the
fraction of asbestos fibers to total fibers (f/F) reported by TEM Method
7402.23,24 Using asbestos fiber counts, TEM asbestos concentrations were
also estimated.
In Colombia, brake mechanics have on average longer work shifts (i.e.,
B540 min) than the traditional 480 min per day stipulated in the standard.
& 2015 Nature America, Inc.
Asbestos exposure of brake workers
Cely-Garcı́a et al
27
The Colombian regulation determines that in these cases the PLV should
be adjusted using Eqs. (1) and (2):
PLVc ¼ CF PLV ð1Þ
Where PLVc is the corrected PLV, and CF is a correction factor calculated
using Eq. (2).
CF ¼ ð8=hdÞ ½ð24  hdÞ=16 ð2Þ
Where hd is the number of hours worked per day.
The adjusted PLV for a 9 h work shift is 0.083 f/cm3. PCME 9 h TWA
asbestos concentrations were calculated for comparison purposes against
the adjusted Colombian standard. When the work shift exceeded 8 h, and
for comparison purposes against the US OSHA PEL, the worker’s 8 h TWA
exposure was estimated using the worst partial-period sampling windows,
following the recommendations of the US OSHA Technical Manual.25
When work shifts were o8 or 9 h (i.e., depending on the standard
analyzed), full-shift TWAs were calculated assuming that the concentration
during the unsampled time was 0 f/cm3. This assumption was made
because in these cases, the worker was not longer in the BRS (e.g.,
Saturday’s work shifts finished at B1500 h). Samples analyzed by PCM that
had concentrations below the limit of detection (LOD) were not analyzed
by TEM, preventing us from estimating PCME concentrations. In these
cases, the same assumption of 0 f/cm3 was made for these sampling
windows. A sensitivity analysis to determine the impact of this assumption
is described in the Results section.
For samples that were overloaded with particulate matter, two radically
different assumptions were made to estimate TWA concentrations. One
assumption assigned 0 f/cm3 for sampling windows that were overloaded.
As this assumption could underestimate the TWA concentration, a second
assumption was made assigning to the overloaded sampling windows the
TWA PCME concentration of the remaining sampling windows of the same
work shift.
Manipulation zones and office facilities area samples were collected at a
respiratory height of 1.5 m. In BRS1, area samples were also collected at the
warehouse. Area samples were only analyzed by PCM. During sampling
campaigns, temperature and relative humidity were recorded using a
HOBO U10 Temperature Relative Humidity Data Logger U10-003 (ONSET,
Bourne, MA, USA).
Blank samples were collected each sampling day, and background
samples were collected during one or two nights of the sampling days.
Asbestos counts and identification was done by an American Industrial
Hygiene Association (AIHA)-certified laboratory (Forensic Analytical
Laboratories, Hayward, CA, USA). Samples were analyzed using a Philips
CM12 TEM (Philips, Eindhoven, The Netherlands). Counting of fibers with
length 45 mm was conducted at a magnification of  2500. A magnifica-
tion of  10,000 was used to determine fiber dimension and countability
of fibers close in length to 5 mm. The accelerating voltage used was
100 keV. An Energy Dispersive X-ray (EDXA) (Evex NanoAnalysis System IV,
Princeton, NJ, USA) was also used.26 In the Supplementary Material a
discussion regarding quality control strategies applied in this study on
laboratory analysis of air samples is explained.
All activities were recorded in activity diaries during the entire sampling
campaigns. Asbestos concentrations and exposure results were commu-
nicated to BRS owners and workers.
Respiratory Health Evaluation
Respiratory health evaluation was performed at Fundación Neumológica
Colombiana (FNC) facilities by pulmonologist expert on occupational
diseases. Health evaluation results were personally communicated to each
worker. The evaluation included:
 Clinical evaluation (interview and physical examination) conducted by a
pulmonologist. A detailed interview was performed looking for
respiratory symptoms, exposures, and potential causes of pulmonary
and pleural disease.
 Pulmonary function tests (PFTs): Flow-volume curve with bronchodilator
and carbon monoxide diffusing capacity (DLCO) were performed in a
Vmax Encore 22D (Care Fusion, San Diego, CA, USA) according to the
American Thoracic Society (ATS) and the European Respiratory Society
(ERS) standards.27 DLCO results were adjusted to Bogota’s elevation
(2640 m).28 Airflow obstruction was defined as a FEV1/FVC ratio less than
the lower limit of normal using Crapo’s reference values.29
 Chest X-ray and CT scans: Chest X-rays were taken using a Duodiagnost
X-ray equipment (Phillips, Andover, MA, USA) and ILO (International
Labor Office) criteria. Scans were taken using a CT Scanner with
Journal of Exposure Science and Environmental Epidemiology (2015), 26 – 36
 Asbestos exposure of brake workers
Cely-Garcı́a et al
28
hardware version Somaton Sensation 64, and software version Syngo CT
2006A VB20B (Siemens, Erlangen, Germany). Chest X-rays were Table 1. Demographic characteristics and risk factors for workers
interpreted independently by a pulmonologist certified by NIOSH as a sampled.
ILO B reader, and by a radiologist. CT scans were interpreted
independently by two experienced radiologists using previously Sociodemographic characteristics N (%)
Sex
described criteria.30 Any lack of concordance in the interpretation was Male 8 (80)
resolved by consensus. Female 2 (20)
 Tuberculin skin tests (TSTs), using monopuncture intradermal technique
(Mantoux): TSTs were performed in workers with evidence of pleural Age
(circumscribed (plaques) or diffuse thickening or calcification) or 26-32 3 (30)
parenchymal abnormalities. Results were interpreted based on the TST 33-44 4 (40)
quantitative value established by ATS.31,32 45-56 3 (30)

Educational level completed

RESULTS University 1 (10)
Technical 1 (10)
Sampled Population General Characteristics Grade and high school 8 (80)
Workers sampled in BRS1 included one riveter (R1), one auxiliary
Non-occupational risk factors
riveter (R2), one brake mechanic (W1), one secretary (W2), one Smokera 6 (60)
warehouseman (W3), and the owner of the shop (W4). Workers Current smoker 4 (40)
sampled in BRS2 included two riveters who also work as brake Former smoker 2 (20)
mechanics (R3 and R4), one secretary/warehousewoman (W5), and Type of cooking fuel
Gas 10 (100)
the owner of the shop (W6). Otherb 0 (0)
Table 1 summarizes the information collected with the adapted
structured questionnaire, including the demographic character- Occupational risk factors
istics and occupational and non-occupational risk factors of Current task
Riveterc 4 (40)
workers sampled. Of the 10 workers, 2 were females. The mean Otherd 6 (60)
age of sampled workers was 40 (±9.8) years, and 8 out of 10 Number of years working in the task
workers reached high school educational level. Of the 10 workers, 1–10 6 (60)
4 were current smokers (R1, R2, R4, and W3) and 2 were former 11–20 3 (30)
420 1 (10)
smokers (W1 and W4). Workers did not have additional history of Previous asbestos exposuree
asbestos exposure with previous employers, and two workers (W3 As riveter 2 (20)
and W4) were riveters in the past in the BRS where they currently None 8 (80)
work. Only 1 of the 10 workers used respiratory protection. Use of respiratory protection equipment (all workers)
Filtering face piece respirator 1 (10)
None 9 (90)
Description of Heavy Vehicle Brake Product Manipulation a
Includes current and former smoking exposure.
Activities b
Includes gasoil and wood.
Based on the working practices recorded in activity diaries, the c
Includes riveter (R1), auxiliary riveter (R2), and riveters who also work as
steps involved in the manipulation process of brake products were brake mechanics (R3 and R4).
d
identified (Figure 1). Brake mechanics that do not directly Includes brake mechanic (W1), secretaries (W2 and W5), warehouseman
manipulate asbestos-containing brake products only performed (W3), and owners (W4 and W6).
e
steps 1–3 in Figure 1. Riveters perform the other manipulation Previous asbestos exposures in other type of industry or in other activity
different than current task.
steps identified in Figure 1.
The use of either brake linings or brake blocks depended on the
size of the wheel. Larger wheels tend to use brake blocks. The initial
step in the preparation of brake products included the removal of
repaired at their facilities, and used asbestos- and non-asbestos-
the old brake lining (or block) from the original support (i.e., shoe).
containing brake linings and blocks. Characteristics of the BRSs
When brake products were commercialized without holes, the
sampled are shown in Table 2.
manipulation process included drilling and countersinking the
brake product, and then riveting it to the support. When the brake
blocks were previously holed from factory, it was only necessary to
Airborne Sample Results
rivet them to the support. Based on what was observed in these
heavy vehicle BRSs, beveling and grinding brake products were less A total of 235 air samples were collected during the 12
common activities compared with passenger vehicle BRSs.13 If the sampling days, including 115 personal samples, 44 short-term
edges of the brake linings or blocks extended beyond the support’s personal samples, 61 area samples, 3 background samples, and 12
borders, they were reduced by using either an electric circular saw blanks.
or an emery disc followed by grinding the brake products’ edges. PCME 8 h and 9 h TWA personal samples for riveters are
In BRS1, the riveter occasionally manipulated asbestos and non- presented in Table 3 (a detailed description of the results of all the
asbestos brake pads, and small asbestos and non-asbestos brake personal samples collected is included in Supplementary Tables
linings for emergency brakes. The manipulation processes on S1 and S2). Riveter 1 (R1) was exposed to asbestos concentrations
brake pads were similar to those conducted on brake linings or exceeding the US OSHA PEL and the Colombian standard in 5 of
blocks. When necessary, brake pads were cut with an emery disc the 6 days sampled. All other riveters were exposed to asbestos
and the edges were ground until the pads fitted the brake shoe. concentrations in compliance with the Colombian and US OSHA
The manipulation processes on small linings were similar to those standards. Riveter 4 (R4) in BRS2 had personal 8 h TWA
described in a previous study of passenger vehicle BRS.13 concentrations in compliance but above the US OSHA PEL action
level (0.05 f/cm3) in 3 of the 6 sampled days. Chrysotile fibers were
the only type of asbestos fibers identified.
Description of the BRSs Sampled All riveters had sampling windows with PCM concentrations
Both BRSs that participated in this study worked with heavy below the LOD. Most of the samples that had concentrations
vehicles. They prepared brake products exclusively for the vehicles below the LOD were collected during non-manipulation activities,

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 Asbestos exposure of brake workers
Cely-Garcı́a et al
29

Figure 1. Steps involved in the manipulation process of heavy vehicle brake linings or blocks.

except for 4 short-term personal samples (i.e., samples R1–day 6– below the LOD, a sensitivity analysis was conducted using half the
a, R3–day 2–c, R3–day 4–b, and R4–day 4–e shown in Table 5). To PCM LOD instead of assuming zero. The sensitivity analysis
determine the potential impact of assuming 0 f/cm3 for samples showed that using half the PCM LOD did not result in new TWA

& 2015 Nature America, Inc. Journal of Exposure Science and Environmental Epidemiology (2015), 26 – 36
 Asbestos exposure of brake workers
Cely-Garcı́a et al
30
Table 2. Description of heavy vehicle brake repair shops (BRSs) sampled.

Shop characteristics BRS1 BRS2

Type of vehicles serviced Buses Buses and trucks

% Vehicles that require brake maintenance B85% (35–40) B80% (15–20)
(number of vehicles served daily)
Workers involved in brake repair 1 Riveter 2 Riveters who also work as brake mechanics
1 Auxiliary riveter
4 Brake mechanics
Area of the shop (covered area) B1000 m2 (780 m2) B1400 m2 (95 m2)
Area of office and warehouse Area of B80 m2 Area of B84 m2
Location of office and warehouse Located at B10 m from manipulation area Located at B50 m from manipulation area
Description of manipulation area Covered area of B7 m2 Covered area of B11 m2
Isolated with two walls and a fence Surrounded by walls and a big window with no
glass
Manipulation equipment 2 Drills 1 Drill
2 Countersinks with grinder stone 1 Countersink with grinder stone
2 Rivet machines 1 Rivet machine
1 Emery machine (with emery stone and emery 1 Electric circular saw used outside the
disc) manipulation room
Ventilation system Local ventilation system in each machine, None
constantly used by riveter
Cleaning of the manipulation area activities At the end of almost every work shift Seldom
Respiratory protection equipment Riveter used a filtering face piece respirator during None during sampling campaign
almost all manipulation and cleaning activities

PCME concentrations above the occupational standard. For TWA
concentrations that exceeded the standard of 0.1 f/cm3, the results
show a negligible impact of this assumption on the TWA
concentrations. For TWA concentrations below 0.1 f/cm3, using
half the PCM LOD to estimate 8 h TWA concentrations could lead
to larger TWA estimations; however, in these cases, the
concentrations were so small that the actual concentration
change was negligible as well. The sensitivity analysis described
above is included in Supplementary Table S3.
Three of the samples collected on R1 and one sample collected
on R3 were overloaded (i.e., see footnote ‘‘c’’ in Table 3). Two
methods were used in these cases to estimate TWA concentra-
tions. One method assumed that the concentration in overloaded
sampling windows was 0 f/cm3 (i.e., this assumption was applied
in all the TWA estimations showed in all the tables). The other
method assumed that the concentration in overloaded sampling
windows was the average concentration of the remaining
sampling windows of that work shift. A sensitivity analysis of
these assumptions is presented in Table 4.
As expected, assuming 0 f/cm3 underestimates TWA concentra-
tions. However, sample R3–day 1, which was the only sample in
compliance among the four samples analyzed in Table 4, did not
change from compliance to non-compliance of the regulatory
standards after using a different assumption.
Table 5 describes the manipulation activities performed by
riveters, and the short-term asbestos concentrations associated
with these activities. The largest TEM and PCME short-term
asbestos concentrations were associated with complete manip-
ulation activities (i.e., manipulation that included beveling and
grinding, on top of unriveting, drilling, countersinking, and
riveting). Manipulation activities that performed all but beveling
and grinding (i.e., unriveting, drilling, countersinking, and riveting)
were associated with the second highest short-term concentra-
tions, followed by exposures during cleaning activities. For short-
term samples that exceeded 30 min, the TWA was estimated using
the entire sampling time. All short-term exposures were in
compliance with the US OSHA STEL (1 f/cm3). However, several
PCME 30 min asbestos concentrations were 450% of the US
OSHA STEL, and some 30 min samples had TEM concentrations of
41 f/cm3 (i.e., recognizing that TEM concentrations cannot be
used to determine regulatory compliance).
A summary of the results of PCME personal samples for both 8 h
TWA and 30 min samples for each type of worker is presented in
Table 6. As riveters were the workers with the highest exposures,
personal concentrations of other workers were grouped together
in one category (i.e., other workers). Other workers were exposed
to 8 h TWA PCME asbestos concentrations in compliance with
both the Colombian and the US OSHA standards.
For area samples, most of the PCM concentrations were below
the LOD, including samples collected close to the manipulation
equipment. PCM concentrations for area samples (i.e., including
manipulation area, office facilities, and warehouse) ranged from
o0.003 to 0.020 f/cm3. The highest PCM area concentration was
collected at the manipulation area of BRS2.
All blank filters were analyzed by both PCM and TEM and had
no fibers detected. Background samples had PCM concentrations
below the LOD and were not analyzed by TEM. Four samples were
considered suspect because of flow drift above 5%. Flow drift for
these samples ranged between 5.03% and 8.8%. Two of these
samples were area samples and the other two were personal
samples of riveter 1 (R1–day 4, Table 3) and worker 5 (W5). This is
important because the sample of R1 was used in the TWA
estimation of one of the non-compliance days of this worker. The
suspect sample of this day was collected over 106 min, and the
PCME concentration of this sample was 0.058 f/cm3.
During sampling days, air temperature was B20 1C in both the
manipulation area and office facilities in BRS1, and relative humidity
was B53% and B57% in each microenvironment, respectively. In
BRS2, air temperature was B22 1C at the manipulation area and
B21 1C at the office facility, and relative humidity was B50% and
B52% in each microenvironment, respectively.
Respiratory Health Evaluation of Workers Sampled
Table 7 summarizes the results of the respiratory evaluation of the
10 workers. All chest X-rays were normal. CT scans were abnormal
in 4 of 10 subjects; some of them had more than one abnormality.
Of the three subjects with pleural calcifications (R2, W3, and W4),
two had circumscribed pleural thickening (plaques). In these three
subjects, the TST was negative. We found two mild abnormalities
in PFT, but the four subjects with abnormal CT scan had normal
PFT.
Table 8 shows detail information of smoking status and imaging
results for each worker sampled. Two subjects had mild alteration
of pulmonary function; W2 had obstructive defect, and R4 had
decreased diffusing capacity (i.e., detailed information regarding
pulmonary function results is presented in Supplementary Table
S4). All the subjects with CT abnormalities had normal PFT. Based

Journal of Exposure Science and Environmental Epidemiology (2015), 26 – 36 & 2015 Nature America, Inc.
 Asbestos exposure of brake workers
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31
Table 3. Phase contrast microscopy equivalent (PCME) TWA personal samples for riveters.

Worker–day Sampling Actual sampling PCME TWA only US OSHA STANDARD COLOMBIAN STANDARD
windows used in time (total using actual (0.1 f/cm3 for 8 h TWA) (0.083 f/cm3 for 9 h TWA)
calculations sampling time) sampling time
(total sampling (min) (f/cm3)
windows)
Time assumed PCME Time assumed PCME
with 0 f/cm3 to concentration with 0 f/cm3 to concentration
complete 8 h for 8-hr TWA complete 9 h for 9-hr TWA
TWA (min) (f/cm3) TWA (min) (f/cm3)

R1–day 1 5 (5) 540 (540) 0.107 0 0.118a 0 0.107

R1–day 2 7 (8) 283 (497) 0.180b 197 0.106c 257 0.094c
R1–day 3d 8 (10) 365 (537) 0.206b 115 0.157c 175 0.139c
R1–day 4e 8 (8) 561 (561) 0.139 0 0.157a 0 0.143f
R1–day 5 5 (6) 325 (440) 0.173b 155 0.117c 215 0.104c
R1–day 6 4 (4) 447 (447) 0.030 33 0.028 93 0.025
R2–day 2 2 (2) 61 (61) 0.093 419 0.012 479 0.010
R2–day 4d 0 (3) 0 (453) — — — — —
R2–day 5 2 (2) 550 (550) 0.005 0 0.005a 0 0.005f
R2–day 6d 1 (2) 169 (430) 0.011 311 0.004 371 0.003
R3–day 1d 2 (4) 152 (340) 0.046b 328 0.015c 388 0.013c
R3–day 2d 3 (7) 258 (533) 0.076 222 0.041 282 0.036
R3–day 3d 0 (2) 0 (480) — — — — —
R3–day 4d 1 (6) 30 (408) 0.209 450 0.013 510 0.012
R3–day 5d 1 (5) 29 (491) 0.056 451 0.003 511 0.003
R3–day 6d 1 (4) 32 (388) 0.182 448 0.012 508 0.011
R4–day 1d 5 (7) 242 (444) 0.139 238 0.070 298 0.062
R4–day 2 8 (8) 512 (512) 0.080 0 0.084a 28 0.076
R4–day 3d 2 (3) 72 (435) 0.140 408 0.021 468 0.019
R4–day 4d 8 (10) 344 (460) 0.088 136 0.063 196 0.056
R4–day 5d 3 (6) 169 (489) 0.059 311 0.021 371 0.018
R4–day 6d 0 (1) 0 (85) — — — — —
R1, riveter 1 in BRS1; R2, riveter 2 in BRS1; R3, riveter 3 in BRS2; R4, riveter 4 in BRS2. ‘‘—’’ It was not possible to calculate 8 h PCME concentration because all
samples were oLOD.
a
PCME 8 h TWA calculated using the worst 8 h of the work shift.25
b
TWA estimated without including an overloaded sampling window.
c
PCME TWA had an overloaded sampling window that was assumed with a concentration of 0 f/cm3.
d
TWA estimated assuming 0 f/cm3 for sampling window(s) with PCM concentration oLOD.
e
TWA includes a suspect sample that had a flow drift of 7.6%, with a sampling time of 106 min and a PCME concentration of 0.058 f/cm3.
f
As sampling time exceeded 9 h (i.e., 540 min), the worst 540 min were used to estimate PCME, according to the OSHA Technical Manual.25

Table 4. Comparison of TWA phase contrast microscopy equivalent (PCME) asbestos concentrations using two estimation approaches for
overloaded samples.

Worker–day Calculation assuming 0 f/cm3 Calculation assuming TWA concentration of the remaining
for overloaded samples sampling windows for overloaded samples

Actual PCME TWA PCME PCME Sampling time PCME TWA for PCME PCME
sampling for actual concentration concentration including time new sampling concentration concentration
time (min) sampling for 8 h TWA for 9 h TWA of overloaded time (f/cm3) for 8 h TWA for 9 h TWA
time (f/cm3) (f/cm3) (f/cm3) sample (min) (f/cm3) (f/cm3)

R1–day 2 283 0.180 0.106 0.094 497 0.180 0.180 0.166

R1–day 3 365 0.206 0.157 0.139 423 0.206 0.182 0.161
R1–day 5 325 0.173 0.117 0.104 440 0.173 0.159 0.141
R3–day 1 152 0.046 0.015 0.013 283 0.048 0.028 0.025

on the questionnaire, W5 reported recurrent acute bronchitis, DISCUSSION

and W4 reported untreated high blood pressure, self-reported
conditions that cannot be directly associated with asbestos
exposure.
Based on information collected with the structured question-
naire, the occupational history of the three subjects with pleural
calcifications and negative TST was as follows: R2 has been
working as an auxiliary riveter over the past 4 years, and had
previously worked as full-time riveter for B3 years. W3 reported
working as riveter for B2 years, and in the past 7 years had
worked as a warehouseman. W4 has been working in BRS over the
past 15 years, and at the beginning of this job he worked as a
riveter for B4 months.
This study showed that 3 out of 10 workers of two heavy vehicle
BRSs located in Bogotá (Colombia) had pleural calcifications and
circumscribed thickening, strongly suggestive of asbestos expo-
sure. The three workers who had pleural calcifications and
circumscribed thickening are current or former riveters.
This study included an exploratory analysis of the respiratory
health of a population potentially exposed to chrysotile asbestos
that work in BRSs. There are limited number of studies that
address respiratory health in occupational groups with these
characteristics. Taking into consideration issues associated with
exposure to radiation derived from chest X-ray and CT scans, and
the exploratory character of this study, a formal control group of

& 2015 Nature America, Inc. Journal of Exposure Science and Environmental Epidemiology (2015), 26 – 36
 Asbestos exposure of brake workers
Cely-Garcı́a et al
32
Table 5. Short-term transmission electron microscopy (TEM) and phase contrast microscopy equivalent (PCME) asbestos concentrations and related
activities.

Worker–day– Sampling Chrysotile TEM asbestos PCME asbestos PCME TWA 30 min Activities
sample time (min) fibers counted concentration concentration asbestos concentration
(TEM f/F ratio) (f/cm3) (f/cm3) (f/cm3)

R1–day 1–a 31 17 (1) 0.297 0.389 0.389 Manipulation activitiesa of 4 asbestos-

containing blocks.
R1–day 1–bb 33 127 (1) 2.084 0.645 0.645 Complete manipulationc of 2 smalld brake
liningse and beveling of 2 asbestos-containing
blocks.
R1–day 1–c 30 13 (1) 0.233 0.435 0.435 Manipulation activitiesa of 4 asbestos-
containing blocks. Worker shook his clothes
after performing manipulation activities.
R1–day 2–a 32 14 (0.93) 0.229 0.077 0.077 Manipulation activitiesa of 4 asbestos-
containing linings.
b
R1–day 2–b 32 53 (1) 1.423 0.043 0.043 Manipulation activitiesa of 4 non-asbestos-
containing blocks.
R1–day 2–c 30 55 (1) 0.991 0.438 0.438 Manipulation activitiesa of 4 smalld asbestos-
containing linings. Worker blew the dust from
the countersinking machine.
R1–day 2–d 30 13 (1) 0.238 0.365 0.365 Manipulation activitiesa of 4 smalld non-
asbestos-containing linings.
R1–day 2–e 30 16 (1) 0.293 0.260 0.260 Riveting 8 previously holed non-asbestos-
containing blocks. Worker swept part of the
manipulation area.
R1–day 2–f 10 12 (1) 0.640 0.688 0.229 Cleaning activities of the manipulation area (dry
conditions).
R1–day 3–a 39 4 (1) 0.055 0.136 0.136 Manipulation activitiesa of brake padse. Cutting
brake padse with emery disc. Unriveting 4
liningse.
R1–day 3–b 27 26 (1) 0.517 0.265 0.239 Complete manipulationc of 4 asbestos-
containing and 4 non-asbestos-containing
blocks.
R1–day 3–c 34 34 (1) 0.519 0.313 0.313 Manipulation activitiesa of 4 non-asbestos-
containing linings. Worker blew the dust from
the countersinking machine. Complete
manipulationc of 2 smalld liningse.
R1–day 3–d 29 16 (0.94) 0.297 0.280 0.271 Cleaning of the manipulation area (dry
conditions).
R1–day 4–a 31 44 (1) 0.763 0.389 0.389 Complete manipulationc of 2 asbestos- and
non-asbestos-containing linings.
R1–day 4–b 22 69 (1) 1.699 0.823 0.604 Complete manipulationc of 2 smalld non-
asbestos-containing linings.
R1–day 4–c 31 47 (0.98) 0.835 0.582 0.582 Complete manipulationc of 4 smalld asbestos-
containing linings. Complete manipulationc of 2
non-asbestos-containing pads.
R1–day 4–d 29 37 (1) 0.707 0.210 0.203 Cleaning of the manipulation area (dry
conditions).
R1–day 5–a 30 46 (1) 0.820 0.433 0.433 Complete manipulationc of 2 smalld non-
asbestos-containing linings.
R1–day 5–b 30 45 (1) 0.781 0.411 0.411 Complete manipulationc of 2 smalld non-
asbestos-containing linings.
g
R1–day 6–a 33 6 (1) 0.098 0.019 0.019 Beveling and grinding 4 non-asbestos-
containing linings. Complete manipulationc of 4
smalld non-asbestos-containing linings.
R2–day 2–a 29 11 (0.92) 0.220 0.089 0.086 Riveting blocks. Manipulation activitiesa of 2
asbestos-containing linings.
R2–day 2–b 32 14 (1) 0.254 0.096 0.096 Manipulation activitiesa of 4 smalld asbestos-
containing linings.
R3–day 1–a 29 2 (1) 0.037 0.059 0.057 Manipulation activitiesa of 2 non-asbestos-
containing linings.
R3–day 2–a 31 14 (1) 0.253 0.126 0.126 Manipulation activitiesa of asbestos-containing
linings.
R3–day 2–b 32 30 (1) 0.516 0.255 0.255 Manipulation activitiesa of 2 asbestos-
containing linings.
f
R3–day 2–c 34 — — — — Installation of brake linings in vehicle’s brake
system.
R3–day 4–a 30 30 (1) 0.511 0.209 0.209 Manipulation activitiesa of 2 asbestos-
containing linings. Worker blew the dust from
the countersinking machine.
R3–day 4–bf 29 — — — — Complete manipulationc of 2 non-asbestos-
containing linings. Worker used the electric
circular saw outside the manipulation area.
R3–day 5–a 29 2 (1) 0.038 0.056 0.054 Manipulation activitiesa of linings.e
R3–day 6–a 32 31 (1) 0.494 0.182 0.182 Manipulation activitiesa of 4 asbestos-
containing blocks. Worker blew the dust from
the countersinking and riveting machine.
R4–day 1–a 33 38 (1) 0.612 0.238 0.238 Manipulation activitiesa of 4 asbestos-
containing linings.
R4–day 1–b 33 24 (1) 0.388 0.219 0.219 Manipulation activitiesa of 2 asbestos-
containing linings.

Journal of Exposure Science and Environmental Epidemiology (2015), 26 – 36 & 2015 Nature America, Inc.
 Asbestos exposure of brake workers
Cely-Garcı́a et al
33
Table 5. (Continued )

Worker–day– Sampling Chrysotile TEM asbestos PCME asbestos PCME TWA 30 min Activities
sample time (min) fibers counted concentration concentration asbestos concentration
(TEM f/F ratio) (f/cm3) (f/cm3) (f/cm3)

R4–day 2–a 31 70 (0.99) 1.215 0.459 0.459 Worker used electric circular saw on asbestos-
containing blocks.
R4–day 2–b 24 19 (1) 0.425 0.251 0.201 Manipulation activitiesa of 2 asbestos-
containing linings.
R4–day 2–c 31 24 (1) 0.428 0.222 0.222 Manipulation activitiesa of 4 asbestos-
containing linings.
R4–day 3–a 30 19 (1) 0.352 0.141 0.141 Manipulation activitiesa of 4 non-asbestos-
containing linings.
R4–day 4–a 34 19 (1) 0.297 0.112 0.112 Manipulation activitiesa of 4 asbestos-
containing blocks.
R4–day 4–b 35 26 (1) 0.410 0.236 0.236 Cleaning activities of brake system. Unriveting
old liningse.
R4–day 4–c 30 32 (1) 0.565 0.287 0.287 Manipulation activitiesa of 4 asbestos-
containing blocks.
R4–day 4–d 30 20 (1) 0.343 0.072 0.072 Manipulation activitiesa of 4 asbestos-
containing blocks.
f
R4–day 4–e 29 — — — — Brake mechanic’s activities. Unriveting old
linings.e
R4–day 4–f 30 0 (0) o0.018 0.000 0.000 Manipulation activitiesa of 2 asbestos-
containing linings. Worker drilled the edges to
get the proper size of these linings.
R4–day 5–a 30 9 (1) 0.168 0.181 0.181 Manipulation activitiesa of 2 asbestos-
containing linings.
R4–day 5–b 30 25 (1) 0.447 0.151 0.151 Manipulation activitiesa of 2 asbestos-
containing linings.
R1, riveter 1; R2, riveter 2; R3, riveter 3; R4, riveter 4.
a
Manipulation activities include: unriveting old lining or block, drilling, countersinking, and riveting new lining or block.
b
Filter loaded with particulate that may affect analytical result.
c
Complete manipulation activities include: unriveting old lining or block, drilling, countersinking, riveting, beveling, and grinding new lining or block.
d
Small linings are used for emergency brakes.
e
Asbestos presence in brake products cannot be determined.
f
Samples were not analyzed by TEM because PCM concentrations were oLOD.
g
PCM fiber concentration was oLOD, but sample was analyzed by TEM.

workers non-exposed to asbestos was not established. However,
our results can be contextualized in relation with the prevalence
of pleural plaques in the general population reported in the
literature that ranges from 0.02% to 7.5%,18–20 and in men can go
up to 12.8%.20 These values are below the percentage found in
the current study. Furthermore, because tuberculosis can cause
pleural thickening and plaques, TSTs were performed in all the
workers who had imaging evidence of pleural plaques. The three
workers with pleural calcifications had a negative TST result.
Although this finding does not completely rule out tuberculosis, it
is strongly suggestive that the pleural plaques could be related
with asbestos exposure. Moreover, no other causes of pleural
diseases were identified in the clinical evaluation. Recognizing
that the sample size of workers evaluated is small (n ¼ 10), this
finding is important because of the high apparent prevalence
(30%) of pleural calcifications, and because these workers were
exclusively exposed to chrysotile. Furthermore, imaging
evaluation included both chest X-ray and CT scans, and some
studies have shown that CT scans are better for the detection of
pleural plaques.18,33,34 Several samples collected in the BRSs
where these mechanics currently work exceeded both the US
OSHA and Colombian occupational standards. To the best of our
knowledge, this is the first study to analyze simultaneously
asbestos exposures and respiratory health of brake mechanics and
riveters of heavy vehicle BRSs in low- and middle-income
countries.
This study documented that riveters working in the
heavy vehicle BRSs sampled have to perform manipulation
activities of asbestos-containing brake products, and in some
cases this manipulation resulted in asbestos exposures not
in compliance with the US OSHA and Colombian standards.
In other cases, the exposures exceeded the US OSHA action level.
Thus, riveters could be at excessive risk of developing asbestos-
related diseases. This is aggravated because of the high
prevalence of smoking observed in this group of workers.
Smoking has a synergistic effect with asbestos exposure in the
risk of developing lung cancer.35
Manipulation activities are required because brake products are
commercialized detached from their supports and in most cases
without holes. Grinding and beveling, which were some of the
manipulation activities identified in the current study, have been
identified in previous studies as opportunities of exposure
because of the release of asbestos fibers.6,36
A study similar in design to the current study conducted on
passenger vehicle BRSs13 found that all the workers were exposed
to concentrations in compliance with the US OSHA PEL and US
OSHA STEL. Recognizing that the sample size in both studies in
terms of the number of BRSs and workers sampled is small, the
results suggest that riveters who work in heavy vehicle BRSs
appear to be at higher risk for overexposure compared with
workers in passenger vehicle BRSs.
Our findings differ from the results of several studies conducted
in high-income countries that have concluded that brake
mechanics are not at excessive risk of developing asbestos-related
diseases.7–11 However, brake mechanics in high-income countries
do not routinely manipulate asbestos-containing brake products
to the extent observed in this study.
High exposure concentrations in BRSs were reported in a study
conducted in Iran. Brake mechanics analyzed worked in both
passenger vehicle and heavy vehicle shops, and were exposed to
a mean PCM concentration of 0.46 f/cm3.12 PCM concentrations
reported in the Iran study were higher compared with the results
of the current study. Unfortunately, the Iran study did not estimate
PCME concentrations.

& 2015 Nature America, Inc. Journal of Exposure Science and Environmental Epidemiology (2015), 26 – 36
 Asbestos exposure of brake workers
Cely-Garcı́a et al
34
Table 6. Phase contrast microscopy equivalent (PCME) personal statistics summary for both brake repair shops (BRS) sampled.

Type of sample Type of worker PCME asbestos concentrations (f/cm3)

n Mean SD Median Min Max

8-h TWA personal samplesa R1 6 0.114 0.047 0.118 0.028 0.157

R2 3 0.007 0.004 0.005 0.004 0.012
R3 5 0.017 0.014 0.013 0.003 0.041
R4 5 0.052 0.029 0.063 0.021 0.084
Short-term personal samplesb R1 20 0.324 0.179 0.339 0.019 0.645
R2 2 0.091 0.007 0.091 0.086 0.096
R3 6 0.147 0.082 0.154 0.054 0.255
R4 13 0.194 0.111 0.201 0.000 0.459
8 h TWA personal samples Other workersc 19 0.005 0.005 0.004 0.000 0.017
R1, riveter 1; R2, riveter 2; R3, riveter 3; R4, riveter 4.
a
Calculated using 8 h TWA PCME asbestos concentrations shown in Table 3 (column 6).
b
Calculated using 30-min PCME asbestos concentrations shown in Table 5 (column 6).
c
Other workers include a brake mechanic (W1), secretaries (W2 and W5), warehouseman (W3), and owners (W4 and W6).

Although short-term personal samples of the current study
were in compliance with the US OSHA STEL, some TEM short-term
personal concentrations were 41 f/cm3. The higher TEM concen-
trations provide additional support to the conclusion that brake
mechanics could be at excessive risk of developing asbestos-
related diseases.
Interestingly, some short-term personal samples collected
during the manipulation of non-asbestos-containing brake pro-
ducts detected the presence of asbestos fibers (i.e., R1–day 2–b
and R1–day 4–b; Table 5). This result could have two potential
explanations: first, labels were incorrect and the brake products
did in fact have asbestos fibers; second, as the manipulation
equipment was covered with dust and fibers from previous
manipulation activities, the manipulation process may have
resuspended fibers exposing the worker. A similar event was
observed in passenger vehicle BRSs.13
The elevated personal asbestos concentrations identified for R1
occurred despite the fact that a local ventilation system was
constantly operated during the manipulation activities. Thus, a
false expectation of safety may have been created for this worker.
It was strongly recommended that the ventilation design and
performance be revaluated and that major improvements should
be implemented.
Although asbestos concentrations were high, only four samples
were overloaded. This highlights the importance of designing a
proper sampling strategy in heavily polluted occupational
environments. Although the number of overloaded samples was
small, their impact on exposure underestimation can be
important. Because of this, strategies to include overloaded
samples in TWA estimations have to be considered, as it was
discussed in the Results section of this study.
Administrative staff spend most of their work shifts at the office
facilities and the warehouse that are microenvironments where no
manipulation activities are performed. Although they were exposed
to asbestos fibers, all administrative workers and brake mechanics
who do not manipulate brake products had personal asbestos
exposures in compliance with the standards. The maximum 8 h TWA
PCME concentration for non-riveter workers was 0.017 f/cm3.
Asbestos-related diseases were not diagnosed in any of the
workers evaluated in this study. Reports of pulmonary diseases on
brake repair workers exclusively exposed to chrysotile asbestos are
scarce.4,33,37,38 Furthermore, some authors report that brake
mechanics are not at excessive risk of developing asbestos-
related diseases.36,39 Previous studies have shown that asbestos-
exposed brake mechanics can have functional abnormalities
including restrictive impairment with decreased forced vital
capacity and total lung capacity.37 This was not the case for the
workers sampled in the current study. Erdinc¸ et al.37 reported that
pulmonary function loss was higher on asbestos-exposed workers
who also smoke.37 As smoking is common in the workers sampled,
including riveters, these workers should be followed-up closely.
Imaging evaluations showed that 3 workers (30%) had pleural
thickening with calcifications that are considered markers of
asbestos exposure,34,35,40 and can occur in 20–60% of occupation-
ally exposed workers.35 A fourth worker also had these CT features,
but was positive in the TST that can confound this finding. Similar
pleural abnormalities have been recently described in a study of
103 French brake mechanics that reported 5 cases (4.9%) with
pleural thickening.33 However, none of the workers evaluated in the
current study had interstitial compromise (i.e., asbestosis), as
reported in the French study. Brake mechanics in the French
study were exposed to chrysotile, similar to the workers sampled in
the current study. Both studies used CT scans that are the most
accurate method to detect pleural thickening.33,34 Recognizing that
there is an important difference in sample size between the two
studies (i.e., the current study only evaluated 10 workers), the
prevalence of pleural thickening in Bogotá is higher than the results
obtained in the French study.33 Manipulation activities performed
by the riveters of Bogotá, and the use of non-appropriate
respiratory protection, could help explain this difference.
As chrysotile was the only type of asbestos found, and workers
sampled did not have other occupational history of asbestos
exposure, this study provides additional information regarding
personal exposures of workers exclusively exposed to chrysotile.4,16,41
This study, combined with the results presented in a previous
study of our research group,13 could help inform current efforts to
reconstruct historical asbestos exposures of brake mechanics.
Nevertheless, additional efforts are needed to characterize asbestos
exposures, not only for brake mechanics, but also for other
occupations that use and manipulate asbestos-containing products.
This study has a number of weaknesses. The principal limitation
is the small sample size in terms of numbers of shops and workers
sampled. The small sample size may limit the generalizability of
the data. We have visited a number of other BRSs in Bogotá
(Colombia) and the shops sampled are typical of the city in terms
of size, manipulation activities, and amount of work. Although the
number of shops and workers sampled is small, their exposure
characterization is extensive, with a total of 235 samples collected
during the assessment campaigns. In addition, these results are
important because very few assessments of BRSs in developing
countries have been published. As a result, this paper is a
significant contribution to the literature, highlighting the impor-
tant public health problem of asbestos and brake repairs in low-
and middle-income countries.
In conclusion, this study identified the deplorable working
conditions of a group of heavy vehicle brake mechanics,

Journal of Exposure Science and Environmental Epidemiology (2015), 26 – 36 & 2015 Nature America, Inc.
 Asbestos exposure of brake workers
Cely-Garcı́a et al
35
ACKNOWLEDGEMENTS
Table 7. Respiratory health evaluation of workers sampled.
We thank the owners, administrative staff, brake mechanics, and riveters from the
BRSs sampled. We also thank the Research Vice-presidency, the School of
Previous cardiorespiratory diseases reported by workers N (%)
Engineering, and the Department of Civil and Environmental Engineering from
Previous respiratory diseasesa 1 (10) Universidad de Los Andes for their financial support. The collaboration received from
Previous CHDb 1 (10) the staff of Fundación Neumológica Colombiana and the Radiology Department in
Respiratory health resultsc Fundación Cardioinfantil in Bogotá is also greatly appreciated. Finally, we thank
Pulmonary function tests Forensic Analytical Laboratories for the analysis of the samples. All the equipment
Normal 8 (80) used to assess exposure was acquired with the financial support of the Department
Obstructive defect 1 (10) of Civil and Environmental Engineering from Universidad de Los Andes. Laboratory
Decreased diffusing capacity 1 (10) analysis and respiratory health evaluations were performed with the financial support
Chest X-ray of the Research Vice-presidency, the School of Engineering, and the Department of
Normal 10 (10) Civil and Environmental Engineering from Universidad de Los Andes.
CT scan
Normal 6 (60)
Abnormal (two workers had more than one 4 (40)
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