Pneumoconioses - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

Pneumonconioses are chronic lung diseases caused by exposure to a mineral dust or metal. Therefore, a complete occupational and environmental history is an important part of the diagnostic approach.
Patients may be asymptomatic or have progressive shortness of breath. Cough and wheezing may be present.
Diagnosis is usually made by the typical chest x-ray appearance and history of exposure. The beryllium lymphocyte proliferation test is important for early diagnosis and to confirm the diagnosis of chronic beryllium disease.
Cigarette smoking cessation is important to reduce the risk of lung cancer and the development of COPD.
Depending on the degree of impairment, patients may benefit from oxygen therapy and pulmonary rehabilitation. Oral corticosteroid therapy is used in the treatment of chronic beryllium disease.

CXR showing changes consistent with simple silicosis or coal workers' pneumoconiosis

From the personal collection of Kenneth D. Rosenman, Michigan State University

Quick Reference

History & Exam
- Key Factors
- Other Factors
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Diagnostics Tests
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Treatment Options
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Definition

Epidemiology

Etiology

Pathophysiology

Images

CXR showing changes consistent with simple silicosis or coal workers' pneumoconiosis
CXR of chronic beryllium disease
Hands demonstrating Raynaud phenomenon
Fingers demonstrating sclerodactyly with finger curling, shiny skin at the fingers, and telangiectasias
CXR of progressive massive fibrosis due to silica or coal exposure
CXR of asbestosis
CXR demonstrating pleural thickening (indicated by arrows)
Sarcoidosis: CXR demonstrating bilateral hilar lymphadenopathy plus pulmonary infiltrates

Citations

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.[Abstract][Full Text]
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]

Other Online Resources

National Institute for Occupational Safety and Health: pneumoconioses
National Institute for Occupational Safety and Health: silica
National Institute for Occupational Safety and Health: beryllium
ATS/ERS: standardization of spirometry 2019 update
US DoL: health benefits, retirement standards, and state workers' compensation programs: black lung compensation

Referenced Articles

1. Bell JL, Mazurek JM. Trends in pneumoconiosis deaths - United States, 1999-2018. MMWR Morb Mortal Wkly Rep. 2020 Jun 12;69(23):693-8.[Abstract][Full Text]
2. UK Health and Safety Executive. Silicosis and coal workers' pneumoconiosis statistics in Great Britain, 2022. Nov 2022 [internet publication].[Full Text]
3. Liu W, Liang R, Zhang R, et al. Prevalence of coal worker's pneumoconiosis: a systematic review and meta-analysis. Environ Sci Pollut Res Int. 2022 Dec;29(59):88690-8.[Abstract]
4. Blackley DJ, Halldin CN, Laney AS. Continued increase in prevalence of coal workers' pneumoconiosis in the United States, 1970-2017. Am J Public Health. 2018 Sep;108(9):1220-2.[Abstract][Full Text]
5. Zosky GR, Hoy RF, Silverstone EJ, et al. Coal workers' pneumoconiosis: an Australian perspective. Med J Aust. 2016 Jun 20;204(11):414-8.[Abstract]
6. De Matteis S, Heederik D, Burdorf A, et al. Current and new challenges in occupational lung diseases. Eur Respir Rev. 2017 Dec 31;26(146):170080.[Abstract][Full Text]
7. Chen S, Liu M, Xie F. Global and national burden and trends of mortality and disability-adjusted life years for silicosis, from 1990 to 2019: results from the Global Burden of Disease study 2019. BMC Pulm Med. 2022 Jun 21;22(1):240.[Abstract][Full Text]
8. Cullinan P, Muñoz X, Suojalehto H, et al. Occupational lung diseases: from old and novel exposures to effective preventive strategies. Lancet Respir Med. 2017 May;5(5):445-55.[Abstract][Full Text]
9. Li J, Yin P, Wang H, et al. The burden of pneumoconiosis in China: an analysis from the Global Burden of Disease Study 2019. BMC Public Health. 2022 Jun 3;22(1):1114.[Abstract][Full Text]
10. Casey ML, Mazurek JM. Silicosis prevalence and incidence among Medicare beneficiaries. Am J Ind Med. 2019 Mar;62(3):183-91.[Abstract]
11. Hoy RF. Artificial stone silicosis. Curr Opin Allergy Clin Immunol. 2021 Apr 1;21(2):114-20.[Abstract]
12. Newman LS, Mroz MM, Balkissoon R, et al. Beryllium sensitization progresses to chronic beryllium disease: a longitudinal study of disease risk. Am J Respir Crit Care Med. 2005 Jan 1;171(1):54-60.[Abstract][Full Text]
13. 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.[Abstract][Full Text]
14. Cloeren M, Dement J, Gaitens J, et al. Beryllium disease among construction trade workers at Department of Energy nuclear sites: A follow-up. Am J Ind Med. 2022 Sep;65(9):708-20.[Abstract]
15. Schubauer-Berigan MK, Couch JR, Petersen MR, et al. Cohort mortality study of workers at seven beryllium processing plants: update and associations with cumulative and maximum exposure. Occup Environ Med. 2011 May;68(5):345-53.[Abstract]
16. Antao VC, Petsonk EL, Sokolow LZ, et al. Rapidly progressive coal workers' pneumoconiosis in the United States: geographic clustering and other factors. Occup Environ Med. 2005 Oct;62(10):670-4.[Abstract][Full Text]
17. Blackley DJ, Reynolds LE, Short C, et al. Progressive massive fibrosis in coal miners from 3 clinics in Virginia. JAMA. 2018 Feb 6;319(5):500-1.[Abstract][Full Text]
18. McCanlies EC, Kreiss K, Andrew M, et al. HLA-DPB1 and chronic beryllium disease: a HuGE review. Am J Epidemiol. 2003 Mar 1;157(5):388-98.[Abstract][Full Text]
19. Centers for Disease Control and Prevention. Pneumoconiosis and advanced occupational lung disease among surface coal miners - 16 States, 2010-2011. MMWR Morb Mortal Wkly Rep. 2012 Jun 15;61(23):431-4.[Abstract]
20. Laney AS, Petsonk EL, Attfield MD, et al. Pneumoconiosis among underground bituminous coal miners in the United States: is silicosis becoming more frequent? Occup Environ Med. 2010 Oct;67(10):652-6.[Abstract][Full Text]
21. Fontenot AP, Falta MT, Kappler JW, et al. Beryllium-induced hypersensitivity: genetic susceptibility and neoantigen generation. J Immunol. 2016 Jan 1;196(1):22-7.[Abstract][Full Text]
22. Vanka KS, Shukla S, Gomez HM, et al. Understanding the pathogenesis of occupational coal and silica dust-associated lung disease. Eur Respir Rev. 2022 Sep 30;31(165):210250.[Abstract][Full Text]
23. Pérez-Alonso A, Córdoba-Doña JA, Millares-Lorenzo JL, et al. Outbreak of silicosis in Spanish quartz conglomerate workers. Int J Occup Environ Health. 2014 Jan-Mar;20(1):26-32.[Abstract][Full Text]
24. Rosenman KD. Hydraulic fracturing and the risk of silicosis. Clin Pulm Med. 2014 July;21(4):167-72.
25. Kuempel ED, Wheeler MW, Smith RJ, et al. Contributions of dust exposure and cigarette smoking to emphysema severity in coal miners in the United States. Am J Respir Crit Care Med. 2009 Aug 1;180(3):257-64.[Abstract]
26. Rushton L. Chronic obstructive pulmonary disease and occupational exposure to silica. Rev Environ Health. 2007 Oct-Dec;22(4):255-72.[Abstract]
27. Rossman MD. Chronic beryllium disease: a hypersensitivity disorder. Appl Occup Environ Hyg. 2001 May;16(5):615-8.[Abstract]
28. Kreiss K, Fechter-Leggett ED, McCanlies EC, et al. Research to practice implications of high-risk genotypes for beryllium sensitization and disease. J Occup Environ Med. 2016 Sep;58(9):855-60[Abstract][Full Text]
29. American College of Radiology. ACR Appropriateness Criteria: occupational lung diseases. 2019 [internet publication].[Full Text]
30. Silicosis and Silicate Disease Committee. Disease associated with exposure to silica and nonfibrous silicate minerals. Arch Pathol Lab Med. 1988 Jul;112(7):673-720.[Abstract]
31. Ross MH, Murray J. Occupational respiratory disease in mining. Occup Med (Lond). 2004 Aug;54(5):304-10.[Abstract]
32. Rosenman KD, Reilly MJ, Gardiner J. Results of spirometry among individuals in a silicosis registry. J Occup Environ Med. 2010 Dec;52(12):1173-8.[Abstract]
33. Ehrlich RI, Myers JE, te Water Naude JM, et al. Lung function loss in relation to silica dust exposure in South African gold miners. Occup Environ Med. 2011 Feb;68(2):96-101.[Abstract]
34. Go LHT, Almberg KS, Rose CS, et al. Prevalence and severity of abnormal lung function among US former coal miners with and without radiographic coal workers' pneumoconiosis. Occup Environ Med. 2022 Aug;79(8):527-32.[Abstract]
35. National Institute for Occupational Safety and Health. Health effects of occupational exposure to respirable crystalline silica. Apr 2002 [internet publication].[Full Text]
36. Cohen RA, Petsonk EL, Rose C, et al. Lung pathology in US coal workers with rapidly progressive pneumoconiosis implicates silica and silicates. Am J Respir Crit Care Med. 2016 Mar 15;193(6):673-80.[Abstract]
37. teWaterNaude JM, Ehrlich RI, Churchyard GJ, et al. Tuberculosis and silica exposure in South African gold miners. Occup Environ Med. 2006 Mar;63(3):187-92.[Abstract][Full Text]
38. Corbett EL, Churchyard GJ, Clayton TC, et al. HIV infection and silicosis: the impact of two potent risk factors on the incidence of mycobacterial disease in South African miners. AIDS. 2000 Dec 1;14(17):2759-68.[Abstract]
39. Tjoe Nij E, Burdorf A, Parker J, et al. Radiographic abnormalities among construction workers exposed to quartz-containing dust. Occup Environ Med. 2003 Jun;60(6):410-7.[Abstract]
40. Samuel G, Maier LA. Immunology of chronic beryllium disease. Curr Opin Allergy Clin Immunol. 2008 Apr;8(2):126-34. [Abstract]
41. Blum T, Kollmeier J, Ott S, et al. Computed tomography for diagnosis and grading of dust-induced occupational lung disease. Curr Opin Pulm Med. 2008 Mar;14(2):135-40.[Abstract]
42. Rosenman KD, Reilly MJ. Asbestos-related x-ray changes in foundry workers. Am J Ind Med. 1998 Aug;34(2):197-201.[Abstract]
43. Makol A, Reilly MJ, Rosenman KD. Prevalence of connective tissue disease in silicosis (1985-2006): a report from the state of Michigan surveillance system for silicosis. Am J Ind Med. 2011;54:255-62.[Abstract]
44. International Labour Office. Guidelines for the use of the ILO international classification of radiographs of pneumoconioses, revised edition. 2022 [internet publication].[Full Text]
45. National Institute for Occupational Safety and Health. About radiographic screening and B readers. Jan 2024 [internet publication].[Full Text]
46. 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]
47. US Occupational Safety and Health Administration (OSHA). Final rule to protect workers from beryllium exposure. General industry standard: §1910.1024 beryllium. May 2017 [internet publication].[Full Text]
48. US Mine Safety and Health Administration (MSHA). Final rule for lowering miners' exposure to respirable coal mine dust, including continuous personal dust monitors. May 2014 [internet publication].[Full Text]
49. Health and Safety Executive. Health surveillance for those exposed to respirable crystalline silica (RCS) - Guidance for occupational health professionals. Jan 2016 [internet].[Full Text]
50. Rochester CL, Alison JA, Carlin B, et al. Pulmonary rehabilitation for adults with chronic respiratory disease: an official American Thoracic Society clinical practice guideline. Am J Respir Crit Care Med. 2023 Aug 15;208(4):e7-26.[Abstract][Full Text]
51. Spruit MA, Singh SJ, Garvey C, et al. An official American Thoracic Society/European Respiratory Society statement: key concepts and advances in pulmonary rehabilitation. Am J Respir Crit Care Med. 2013 Oct 15;188(8):e13-64.[Abstract][Full Text]
52. Wijkstra PJ, Guyatt GH, Amrosino N, et al. International approaches to the prescription of long-term oxygen therapy. Eur Respir J. 2001 Dec;18(6):909-13.[Abstract][Full Text]
53. Leard LE, Holm AM, Valapour M, et al. Consensus document for the selection of lung transplant candidates: An update from the International Society for Heart and Lung Transplantation. J Heart Lung Transplant. 2021 Nov;40(11):1349-79.[Abstract][Full Text]
54. Marchand-Adam S, El Khatib A, Guillon F, et al. Short- and long-term response to corticosteroid therapy in chronic beryllium disease. Eur Respir J. 2008 Sep;32(3):687-93.[Abstract]
55. Huizar I, Kavuru MS. Alveolar proteinosis syndrome: pathogenesis, diagnosis, and management. Curr Opin Pulm Med. 2009 Sep;15(5):491-8.[Abstract]
56. World Health Organization International Agency for Research on Cancer. IARC monographs on the evaluation of carcinogenic risk to humans. Mar 2014 [internet publication].[Full Text]
57. Occupational Safety and Health Administration. Occupational exposure to respirable crystalline silica - review of health effects literature and preliminary quantitative risk assessment. Docket OSHA-2010 0034. 2010 [internet publication].[Full Text]
58. Gómez-Puerta JA, Gedmintas L, Costenbader KH. The association between silica exposure and development of ANCA-associated vasculitis: systematic review and meta-analysis. Autoimmun Rev. 2013 Oct;12(12):1129-35.[Abstract][Full Text]
59. Steenland K. One agent, many diseases: exposure-response data and comparative risks of different outcomes following silica exposure. Am J Ind Med. 2005 Jul;48(1):16-23.[Abstract]
60. Millerick-May ML, Schrauben S, Reilly MJ, et al. Silicosis and chronic renal disease. Am J Ind Med. 2015 Jul;58(7):730-6.[Abstract]
61. Vupputuri S, Parks CG, Nylander-French LA, et al. Occupational silica exposure and chronic kidney disease. Ren Fail. 2012;34(1):40-6.[Abstract][Full Text]
62. Jensen PA, Lambert LA, Iademarco MF, et al. Guidelines for preventing the transmission of Mycobacterium tuberculosis in health-care settings, 2005. MMWR Recomm Rep. 2005 Dec 30;54(RR-17):1-141.[Abstract][Full Text]
63. Centers for Disease Control and Prevention. Adult immunization schedule by age: recommendations for ages 19 years or older, United States, 2024. Nov 2023 [internet publication].[Full Text]