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 topic.
A complete occupational and environmental history is an important part of the diagnostic approach.
Patients may be asymptomatic with an abnormal chest x-ray (incidental finding or result from a screening test), or alternatively have a gradual onset of dyspnoea on exertion, with progression to more severe shortness of breath. Cough and wheezing may be present. Acute silicosis or beryllium pneumonitis, due to particularly heavy exposure to silica or beryllium, rarely occur in developed countries.
Diagnosis is usually made by the typical chest x-ray appearance and history of exposure. The availability of beryllium lymphocyte proliferation test for identification of sensitisation to beryllium is important for early diagnosis and 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.
The pneumoconioses are a group of interstitial lung diseases, mostly of occupational origin, caused by the inhalation of mineral or metal dusts. This topic will cover 3 of the major diseases in this category: silicosis, coal workers' pneumoconiosis (black lung disease), and chronic beryllium disease. Asbestosis, another major type of pneumoconiosis, is covered in a separate topic. There are many other less-common pneumoconioses, including siderosis (associated with iron) and talcosis.
History and exam
Key diagnostic factors
- presence of risk factors
Other diagnostic factors
- dyspnoea on exertion
- 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
- 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)
- 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
1st investigations to order
- chest x-ray (posteroanterior and lateral)
- 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
acute secondary alveolar proteinosis (acute silicosis)
chronic silicosis, coal workers' lung, or chronic berylliosis
Kenneth D. Rosenman, MD
Professor of Medicine
Division of Occupational and Environmental Medicine
Michigan State University
KDR is an author of several references cited in this topic.
Ware G. Kuschner, MD
Associate Professor of Medicine
US Department of Veterans Affairs
Palo Alto Health Care System
WGK declares that he has no competing interests.
Harman Paintal, MBBS
Division of Pulmonary and Critical Care Medicine
Veterans Affairs Palo Alto Health Care System (VAPAHCS)
HP declares that he has no competing interests.
Francis Thien, MD, FRACP, FCCP
Box Hill Hospital and Monash University
FT declares that he has no competing interests.
Edward L. Petsonk, MD
Professor of Medicine
Section of Pulmonary and Critical Care Medicine
West Virginia University School of Medicine
ELP declares that he has no competing interests.
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