Pneumoconiosis

Question 1

Define pneumoconiosis

Answer 1

Group a fibrosing interstitial lung diseases, mostly of occupational origin, that is caused by the inhalation of mineral or metal dusts

Simple: coal worker’s pneumoconiosis or silicosis (symptom-free)
Complicated: results in loss of lung function
Asbestosis: diffuse parenchymal lung fibrosis occurs due to prolonged exposure to asbestosis

Question 2

Aetiology of pneumoconiosis

Answer 2

Inhalation of mineral or metal: silica, coal, beryllium, asbestos

Question 3

Risk factors for pneumoconiosis

Answer 3

Silica exposure: mining, quarrying, iron and steel work, ceramics, cement, hydraulic fracking 
Coal exposure: coal mining 
Beryllium exposure
Cigarette smoke 
TB

Question 4

Symptoms of pneumoconiosis

Answer 4

Long latency period between exposure and expression

Dyspnoea on exertion
Cough 
Chest tightness, wheeze
Haemoptysis, fever, night sweats, weight loss 
Melanoptysis (coal) 
Pleuritic chest pain

Question 5

Signs of pneumoconiosis

Answer 5

Chest exam normal

OR

Barrel chest
Cyanosis 
Clubbing
Areas on dullness on percussion due to pleural effusion (cor pulmonale)
Crackles 
Prolonged expiration 
Wheeze

Question 6

Investigations for pneumoconiosis

Answer 6

Lung function tests: restrictive defect (FEV1/FVC ratio normal, both reduced)

CXR: micronodular mottling (simple), modular opacities in the upper lobes, eggshell calcification of hilar lymph nodes (silicosis),

CT: upper zone interstitial fibrosis, progresses to the whole lung

Bronchoscopy: granulomas (chronic beryllium disease)

Beryllium lymphocyte proliferation test (BeLPT): +ve (beryllium)

Tuberculin skin testing: +ve in TB