Pneumoconiosis

Background

  • Permanent alteration of lung structure due to inhalation of (inorganic) mineral dust, excluding bronchitis and emphysema.
  • Can be classified by the type of particle causing disease:

Asbestosis

Coal workers pneumoconiosis

  • caused by prolonged exposure/inhalation of coal dust
  • dust-laden macrophages group to form macules around the pulmonary lobule; fibrosis occurs resulting in discreet fibrotic lesions scattered throughout the lobule
  • can be classified as
    • simple (small nodules in asymptomatic patients; no impairment of lung function; rarely deteriorates once exposure has ceased)
    • progressive massive fibrosis (PMF) (larger masses of dust lesions usually in the upper lobe, which can cavitate; usually associated with cough and sputum (can be black), and breathlessness; can be mistaken for cancer/TB by appearance on X-ray; can progress even after exposure cessation)

Silicosis

  • Quite rare- found in people exposed to silica/quartz dust e.g. stone workers; usually 10-20 years after but accelerated may appear much more quickly
  • Radiological features include multiple well-circumscribed nodular opacities (similar to CWP), predominantly in mid- and upper lobes; also classical hilar lymphadenopathy with ‘egg-shell’ pattern of calcification
  • Silicosis is highly fibrogenic and PMF may occur later in disease

Caplan’s syndrome

  • Concomitant rheumatoid arthritis and CWP.

Rarer diseases

  • Siderosis (iron exposure e.g. welding/iron foundry workers); Berylliosis (beryllium exposure e.g. air fuel, dentistry); Baritosis (barium exposure); Stannosis (tin exposure)

Management

  • Most management is symptomatic and prophylactic e.g. oxygen for chronic hypoxia; vaccinations; smoking cessation to reduce risk of cancer
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