Last reviewed: 24 Feb 2023
Last updated: 26 Jan 2023



History and exam

Key diagnostic factors

  • presence of risk factors
More key diagnostic 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)
Other diagnostic factors

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
More risk factors

Diagnostic investigations

1st investigations to order

  • chest x-ray (posteroanterior and lateral)
  • spirometry
  • beryllium lymphocyte proliferation test (BeLPT)
More 1st investigations to order

Investigations to consider

  • bronchoscopic biopsy and/or lavage
  • high-resolution CT (HRCT) scan chest
  • oxygen saturation
  • arterial blood gases (ABG)
  • lung biopsy
  • test for tuberculosis (TB)
More investigations to consider

Treatment algorithm


acute secondary alveolar proteinosis (acute silicosis)

acute berylliosis


chronic silicosis, coal workers' lung, or chronic berylliosis



Kenneth D. Rosenman, MD

Professor of Medicine

Division of Occupational and Environmental Medicine

Michigan State University

East Lansing



KDR has given expert testimony in the past. He has active grants from Materion to research natural history of beryllium disease and from the National Institute for Occupational Safety and Health to conduct public health surveillance of occupational lung disease. KDR is an author of several references cited in this topic.

Peer reviewers

Ware G. Kuschner, MD

Associate Professor of Medicine

Stanford University

Staff Physician

US Department of Veterans Affairs

Palo Alto Health Care System

Palo Alto



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)

Palo Alto



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.

Christopher M. Barber, BM, BS, BMedSci, FRCP, MD, AFOM

Respiratory Consultant

Sheffield Teaching Hospitals NHS Foundation Trust




CMB declares that he has no competing interests.

Carl J. Reynolds, MBBS, MRCP, BSc, MSc, PhD, DPMSA

Respiratory Consultant

Honorary Senior Clinical Lecturer

North Middlesex University Hospital

Imperial College London



CJR declares that he has no competing interests.

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