Set the right diagnosis in time

Pneumoconiosis is defined as an occupational lung disease caused by the inhalation of dust, commonly found in miners([FOOTNOTE=Kenny LC, Hurley F, Warren ND. Estimation of the risk of contracting pneumoconiosis in the UK coal mining industry. Ann Occup Hyg. 2002; 46 (suppl 1): 257-260.],[ANCHOR=],[LINK=]) and agricultural workers. While dust particles smaller than 0.5μm move freely in and out of alveoli, and particles larger than 10μm cannot make their way deep into the lungs, particles 0.5μm to 10μm in size can get lodged at the bifurcation of the distal airways.([FOOTNOTE=Fishwick, D. Pneumoconiosis, systemic and parenchymal lung diseases. Medicine. 2008; 36(5):258–261],[ANCHOR=],[LINK=]) While most inhaled dust will be removed from the lung through ciliary movement, dust within this size range can become trapped, eventually being engulfed by microphages, leading to fibrosis.

Patients with pneumoconiosis will present symptoms like shortness of breath, tightness in the chest and a chronic cough. 

The disease is given different designations depending on the type of dust inhaled.

Pneumoconiosis Typology3

Pneumoconiosis Typology([FOOTNOTE=https://online.epocrates.com/diseases/111221/Pneumoconioses/Definition],[ANCHOR=],[LINK=])
Coal, carbon Coalworker's lung/ Anthracosis
Aluminium Aluminosis
Asbestos Asbestosis
Crystalline silica dust Silicosis
Bauxite Bauxite fibrosis
Beryllium Berylliosis
Iron Siderosis
Cotton Byssinosis
Tin Oxide Stannosis
Mixed silica/ iron dust Silicosiderosis
Mixed silica/ iron/ asbestos dust Labrador lung (found in miners in Labrador, Canada)

Silica, beryllium and asbestos dusts are more reactive than coal and carbon, and therefore require lower concentrations to produce fibrotic reactions. 

While rates of pneumoconiosis in developed nations are falling([FOOTNOTE=Turner S, McNamee R, Carder M, Agius R: Trends in pneumoconiosis and other lung diseases, as reported to a UK-based surveillance scheme for work-related ill health. J Phys Conference Series 2009;151:1–6.],[ANCHOR=],[LINK=]), the UK’s Health and Safety Executive still estimates that the country sees 20-50 new cases of silicosis and 200-300 new cases of coal worker’s lung every year.([FOOTNOTE=Health and Safety Executive. Silicosis and coal worker’s pneumoconiosis 2017.],[ANCHOR=],[LINK=])

Diagnosis of pneumoconiosis

As the symptoms are like other lung diseases, setting the right diagnosis in time is extremely important. This can be made using the following information:([FOOTNOTE=Petsonk EL, Rose C, Cohen R. Coal mine dust lung disease: New lessons from old exposure. Concise Clinical Review. 2013;187(11):1178-1185.],[ANCHOR=],[LINK=])

  • A patient’s history of symptoms and exposures
  • Physical examination
  • Pulmonary function tests
  • Chest X-ray or CT scan
  • Bronchoscopy
  • Lung biopsy

X-ray and CT scan imaging may show nodules, areas of inflammation, cystic radiolucencies (honeycombing) and excessive fluid in pneumoconiosis patients. While invasive methods are not generally necessary in obtaining an accurate diagnosis of pneumoconiosis, such tests may be required to rule out other diagnoses. 

Treatment of pneumoconiosis

No specific treatment exists for pneumoconiosis, thus the focus is instead on improving the patient’s quality of life by stopping progression and minimising the impact of complications. Sufferers are advised to cease smoking immediately([FOOTNOTE=Alvarez RF, Gonzalez CM, Martinez AQ, et al. Guidelines for the diagnosis and monitoring of silicosis. Arch Bronconeumol. 2015; 51(2):86-93],[ANCHOR=],[LINK=]) and seek annual influenza vaccines, as contracting the flu will seriously exacerbate the condition.

Oxygen therapy, inhalers and steroids may help to manage the condition day-to-day. Short term corticosteroid therapy may be used to treat exacerbations of the condition. In critical care patients with pneumoconiosis that are admitted to the ICU for their first episode of acute respiratory failure, might require non-invasive mechanical ventilation.

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