Pneumoconioses

Last reviewed: 28 Feb 2023
Last updated: 26 Jan 2023

Summary

Definition

History and exam

Key diagnostic factors

  • occupational exposure to silica, coal, or beryllium
  • history of smoking
More key diagnostic factors

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)
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

acute secondary alveolar proteinosis (acute silicosis)

acute berylliosis

ONGOING

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 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

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.

  • Pneumoconioses images
  • Differentials

    • Asbestosis
    • Idiopathic pulmonary fibrosis
    • Sarcoidosis
    More Differentials
  • Guidelines

    • Medical surveillance guidelines: silica
    • ACR Appropriateness Criteria: occupational lung diseases
    More Guidelines
  • Patient leaflets

    COPD: what is it?

    COPD: what treatments work?

    More Patient leaflets
  • padlock-lockedLog in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer