Summary
Definition
History and exam
Key diagnostic factors
- occupational exposure to silica, coal, or beryllium
- history of smoking
Other diagnostic factors
- dyspnea on exertion
- cough
- normal chest exam
- 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
- hemoptysis, 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, edema, 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 B1 chain of the HLA-DP molecule (chronic beryllium disease)
- high cumulative dose of inhaled beryllium
Diagnostic tests
1st tests to order
- chest x-ray (posteroanterior and lateral)
- spirometry
- beryllium lymphocyte proliferation test (BeLPT)
Tests to consider
- bronchoscopic biopsy and/or lavage
- high-resolution CT (HRCT) scan chest
- oxygen saturation
- arterial blood gas (ABG)
- lung biopsy
- test for tuberculosis (TB)
Treatment algorithm
acute secondary alveolar proteinosis (acute silicosis)
acute berylliosis
chronic silicosis, coal workers' lung, or chronic berylliosis
Contributors
Authors
Kenneth D. Rosenman, MD
Professor of Medicine
Division of Occupational and Environmental Medicine
Michigan State University
East Lansing
MI
Disclosures
KDR declares no competing interests.
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
CA
Disclosures
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
CA
Disclosures
HP declares that he has no competing interests.
Francis Thien, MD, FRACP, FCCP
Professor
Box Hill Hospital and Monash University
Victoria
Australia
Disclosures
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
Morgantown
WV
Disclosures
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
Sheffield
UK
Disclosures
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
UK
Disclosures
CJR declares that he has no competing interests.
References
Key articles
Balmes JR, Abraham JL, Dweik RA, et al. An official American Thoracic Society statement: diagnosis and management of beryllium sensitivity and chronic beryllium disease. Am J Respir Crit Care Med. 2014 Nov 15;190(10):e34-59.Full text Abstract
American College of Radiology. ACR Appropriateness Criteria: occupational lung diseases. 2019 [internet publication].Full text
National Institute for Occupational Safety and Health. Health effects of occupational exposure to respirable crystalline silica. Apr 2002 [internet publication].Full text
International Labour Office. Guidelines for the use of the ILO international classification of radiographs of pneumoconioses, revised edition. 2022 [internet publication].Full text
US Occupational Safety and Health Administration (OSHA). Final rule to protect workers from occupational exposure to respirable crystalline silica. Appendix B to §1926.1153 construction standard - medical surveillance guidelines. May 2019 [internet publication].Full text
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
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