Summary
Definition
History and exam
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)
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
Treatment algorithm
Contributors
Authors
Professor of Medicine
Division of Occupational and Environmental Medicine
Michigan State University
East Lansing
MI
Disclosures
KDR is an author of several references cited in this topic.
Peer reviewers
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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