Last reviewed: November 2017
Last updated: November  2017

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors

Other diagnostic factors

  • dyspnoea on exertion
  • cough
  • normal chest examination
  • crackles on chest auscultation
  • chest tightness and/or wheezing
  • prolonged expiration and wheezing on chest auscultation
  • areas of dullness on chest percussion
  • cyanosis
  • barrel chest
  • haemoptysis, fever, or night sweats
  • clubbing of fingers and toes
  • weight loss
  • signs of rheumatoid arthritis or scleroderma
  • signs of renal failure (e.g., weight gain, oedema, hypertension)

Risk factors

  • occupational exposure to silica
  • occupational exposure to coal
  • occupational exposure to beryllium
  • high cumulative dose of inhaled silica or coal
  • cigarette smoking
  • glutamic acid at position 69 of the HLA-DP1 beta chain (chronic beryllium disease)
  • high cumulative dose of inhaled beryllium

Diagnostic investigations

1st investigations to order

  • chest x-ray (posteroanterior and lateral)
  • spirometry
  • beryllium lymphocyte proliferation test (BeLPT)
Full details

Investigations to consider

  • bronchoscopic biopsy and/or lavage
  • high-resolution CT (HRCT) scan chest
  • oxygen saturation
  • arterial blood gases (ABG)
  • open lung biopsy
  • tuberculin skin test
  • interferon gamma-release assay (IGRA)
  • sputum smear and culture
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Professor of Medicine

Division of Occupational and Environmental Medicine

Michigan State University

East Lansing

MI

Disclosures

KDR has been an expert witness for patients with silicosis. KDR is also the author of several papers referenced in this monograph.

Peer reviewers VIEW ALL

Associate Professor of Medicine

Stanford University

Staff Physician

US Department of Veterans Affairs

Palo Alto Health Care System

Palo Alto

CA

Disclosures

WGK declares that he has no competing interests.

Division of Pulmonary and Critical Care Medicine

Veterans Affairs Palo Alto Health Care System (VAPAHCS)

Palo Alto

CA

Disclosures

HP declares that he has no competing interests.

Professor

Box Hill Hospital and Monash University

Victoria

Australia

Disclosures

FT declares that he has no competing interests.

Professor of Medicine

Section of Pulmonary and Critical Care Medicine

West Virginia University School of Medicine

Morgantown

WV

Disclosures

ELP declares that he has no competing interests.

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