Summary

• A group of chronic lung diseases caused by exposure to a mineral dust or a metal. The major pneumoconioses include asbestosis, silicosis, coal workers' pneumoconiosis (black lung disease), and chronic beryllium disease.
• Full details about asbestosis are available in a separate monograph.
• A complete occupational and environmental history is an important part of the diagnostic approach.
• Typically, presentation is asymptomatic with an abnormal CXR (incidental finding or result from a screening test). Alternatively, there is a gradual onset of dyspnoea on exertion, with progression to more severe shortness of breath. Cough and wheezing may be present. Acute conditions, due to particularly heavy exposure to silica or beryllium, rarely occur in developed countries.
• Diagnosis is usually by typical CXR appearance. The availability of beryllium lymphocyte proliferation test for identification of sensitisation to beryllium is important to confirm the diagnosis of chronic beryllium disease.
• There is an increased risk of connective-tissue disease, vasculitides, lung cancer, chronic obstructive pulmonary disease (COPD), active tuberculosis (TB), and chronic renal failure among patients with silicosis, and an increased risk of connective-tissue disease and COPD among patients with coal workers' pneumoconiosis. The risk of lung cancer is increased among patients with chronic beryllium disease.
• Depending on the degree of impairment, patients may benefit from oxygen therapy and pulmonary rehabilitation. Oral corticosteroid therapy is used in the treatment of chronic beryllium disease. Patients should be advised regarding legal rights to compensation and should be removed from further occupational exposure.
• The risk of lung cancer is increased among patients with beryllium and silica exposure.