Pneumoconiosis

Background

Pneumoconiosis is a chronic inflammatory lung disease caused by inhalation of particles, typically occupationally related, that typically results in pulmonary fibrosis and eventually restrictive lung disease. The following is a list of different types of pneumoconiosis related to different inhaled particles:

• Asbestosis: shipping, roofing, plumbing
• Berylliosis: aerospace, fluorescent bulbs
• Byssinosis: cotton
• Silicosis: foundries, sandblasting, mines
• Coal worker's lung: coal
• Siderosis: iron
• Stannosis: tin

Clinical Features

• May be asymptomatic, with normal PFTs, especially initially
• Dyspnea
• Crackles on exam
• Features of restrictive and/or obstructive pulmonary dysfunction
• If severe, clubbing, cyanosis

Evaluation

• Evaluate for and treat for reversible causes of symptoms or exacerbation of symptoms
• CXR:
  • Coal workers': diffuse nodular opacities, especially prominent in upper lung
  • Silicosis: Large conglomerate densities in upper lung
  • Asbestosis: linear streaking at bases, opacities, honeycomb changes if advanced
• CT Chest
  • Best imaging for asbestosis, can detect parenchymal fibrosis and characterize pleural plaques
• TB testing
  • Increased incidence of TB in patients with silicosis

Management

• Treatment is supportive

References

• Meyer KC. Beryllium and lung disease. Chest. Sep 1994;106(3):942-6.
• Kreiss K, Miller F, Newman LS, Ojo-Amaize EA, Rossman MD, Saltini C. Chronic beryllium disease--from the workplace to cellular immunology, molecular immunogenetics, and back. Clin Immunol Immunopathol. May 1994;71(2):123-9.