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Pneumoconioses

Last reviewed: 4 Apr 2025
Last updated: 17 Jan 2025

Summary

Definition

History and exam

Key diagnostic factors

  • occupational exposure to silica, coal, or beryllium
  • history of smoking
Full details

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)
Full details

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
Full details

Diagnostic tests

1st tests to order

  • chest x-ray (posteroanterior and lateral)
  • spirometry
  • beryllium lymphocyte proliferation test (BeLPT)
Full details

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)
Full details

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 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

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

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.
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