Pneumoconiosis is lung scarring caused by breathing mineral dust at work, such as coal dust, silica or asbestos. It develops over years and has no cure, so the main tools are stopping exposure, treating symptoms and screening for complications.
Key symptoms
- Shortness of breath that slowly worsens
- Chronic cough, sometimes with dark sputum in coal workers
- Fatigue and less exercise tolerance
- Chest tightness
What you find on exam
- Detailed job history: mining, quarrying, sandblasting, construction, shipyards
- Crackles on lung exam
- Digital clubbing in asbestosis
- Oxygen saturation and signs of right heart strain
Tests
- Chest X-ray: upper lobe nodules (silica, coal) or lower lobe scarring and pleural plaques (asbestos)
- High-resolution CT chest
- Pulmonary function tests: restrictive or mixed pattern, low DLCO
- TB testing in silicosis
Treatment basics
- Stop further dust exposure; workplace dust control and respirators
- Smoking cessation
- Vaccines, pulmonary rehabilitation and oxygen if needed
- Screen for TB in silicosis, and for lung cancer and mesothelioma after asbestos
- Lung transplant referral in severe disease
Red flags
- Coughing up blood or weight loss (cancer or TB)
- New chest pain with a pleural effusion (mesothelioma)
- Low oxygen at rest or right heart failure
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.