Pneumoconiosis

Question 1

Define pneumoconiosis

Answer 1

Fibrosing interstitial lung disease caused by chronic inhalation of mineral dusts
Types:
Simple: Coalworker’s pneumoconiosis or silicosis (symptom free)

Complicated: pneumoconiosis results in
loss of lung function

Asbestosis: a pneumoconiosis in which diffuse parenchymallung fibrosis occurs as a result of prolonged exposure to asbestos

Question 2

Explain the aetiology/risk factors of pneumoconiosis

Answer 2

Caused by inhalation of
particles of:
Coal dust
Silica
Asbestos

Risk Factors
Occupational exposure (coal mining, quarrying, iron and steel foundries, stone cutting, sandblasting, insulation industry, plumbers, ship builders)
Risk is dependent on extent of exposure and the size
/shape of particles

Individual susceptibility is also important
Co-factors such as smoking and TB also contribute

Question 3

Summarise the epidemiology of pneumoconiosis

Answer 3

Incidence is increasing in developing countries

Disability and mortality from asbestosis will continue to increase for the next 20-30 yr

Question 4

Recognise the presenting symptoms of pneumoconiosi

Answer 4

OCCUPATIONAL HISTORY is very important
Asymptomatic
picked up on routine CXR

Symptomatic
Insidious onset shortness of breath
Dry cough
Black sputum (melanoptysis) produced occasionally in coalworker’s pneumoconiosis
Pleuritic chest pain (due to acute asbestos pleurisy) in patients exposed to asbestos

Question 5

Recognise the signs of pneumoconiosis on physical examination

Answer 5

Examination may be NORMAL
Coalworker’s pneumoconiosis and silicosis:
Decreased breath sounds

Asbestosis:
End inspiratory crepitations
Clubbing
Signs of pleural effusion or right heart failure (cor pulmonale)

Question 6

Identify appropriate investigations for pneumoconiosis

Answer 6

CXR
Simple:
micronodular mottling

Complicated:
Nodular opacities in upper lobes
Micronodular shadowing
Eggshell calcification of hilar lymph nodes (characteristic of silicosis)
Bilateral lower zone reticulonodular shadowing and pleural plaques (in asbestosis)

CT Scan-
fibrotic changes can be visualised early

Bronchoscopy-
allows visualisation and bronchoalveolar lavage

Lung Function Tests- restrictive pattern