Pneumoconiosis

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at November 5, 2016
StartDiseasesPneumoconiosis

Pneumoconiosis is a term used to classify any lung disease that is caused by dust that is inhaled and then deposited in the lungs and causes damage. The condition is typically considered an occupational lung disease and includes many common conditions, such as asbestosis, silicosis, and coal workers’ pneumoconiosis (CWP) or black lung disease. While there is currently no known cure for pneumoconiosis, the condition can be prevented with protective measures so it is important to understand the common risk factors and symptoms.

Contents

Definition & Facts

Pneumoconiosis in its many forms develops as airborne dust, especially mineral dust, is inhaled in the workplace or environment. The dust particles inter the lung cavity and settle on the lining of the lungs, causing irritation, inflammation, and scarring known as fibrosis. The effect of the damage from inhaling mineral dust and particles may not present itself for several years, so many patients do not develop symptoms until long after they have been exposed to the dust and particulates.

While there are different types of environmental dust that cause pneumoconiosis, the most common causes are inhalation of silica (sand or rock dust), asbestos, and coal dust. Only some individuals exposed to the dust will develop the condition. In any case, though, it is important to prevent inhalation of hazardous dusts, making pneumoconiosis a preventable disease.

Symptoms & Complaints

Individuals with the condition may have no symptoms at all, especially early on in the disease. The risk is typically higher for individuals who have been exposed mineral dust in high concentrations over long time periods. Likewise, ineffective use of protective equipment, such as respirators, is another risk factor.

Once the disease has started to progress, the most common symptoms are cough and shortness of breath. Individuals may also experience mucus production and chest tightness. Individuals affected by the condition often feel breathless or winded after everyday activities, such as walking or climbing the stairs, while others feel breathless even while they are at rest.

If the condition involves a large part of the lungs or a great deal of scarring, oxygen may be restricted from flowing to the blood effectively while breathing. This restriction results in hypoxemia or low blood oxygen levels. This can result in a number of serious complications such as tachypnea, sweating, and cyanosis.

It is important to evaluate an individual with pneumoconiosis for hypoxemia because identifying and treating hypoxemia early can help reduce the risk of damage to the other organs of the body, including the heart and brain.

Causes

Pneumoconiosis is caused by the inhalation of dust and mineral particles, particularly at work. The most common workplace dusts that have been found to cause the condition include asbestos, coal dust, and silica rock and sand dust. Asbestos fibers are extremely durable and heat resistant, so they are often used in insulation and fireproofing. Individuals who may be at risk for asbestos exposure include roofers, plumbers, mechanics, and shipyard workers who are exposed to asbestos dust for extended periods of time.

Coal dust is comprised of carbon-containing particles that can get into the lungs and may even turn the organs black in color. Coal miners are often exposed to this dust as well as silica-containing dust. Dust from sand and rock often contains crystalline silica. Individuals at risk for silicosis are those individuals who are exposed to higher levels of silica for a longer period of time, such as miners, sandblasters, stonemasons, and foundry workers.

Beryllium is another workplace hazard that may cause a type of pneumoconiosis. Beryllium is an extremely strong but lightweight metal that is commonly used in electronics as well as aerospace and nuclear power industries. There are additional mineral dusts that may contribute to pneumoconiosis, including cobalt, talc, and aluminum oxide; however, these are much less common.

Diagnosis & Tests

There are a few different ways that pneumoconiosis is diagnosed. In some cases, the condition is may first be identified during workplace check-ups of those workers know to be exposed to disease-causing dust and particulates. Additionally, the condition may be diagnosed because symptoms common to the disease present in an individual regularly exposed to hazardous dusts.

Specific testing may also be done to establish a diagnosis. Regular testing involves breathing tests and/or chest X-rays that evaluate the lung function as well as the level of oxygen flowing throughout the body and blood.

If a person suspects that they may have the condition, it is important to schedule an appointment with their healthcare provider who will ask about your symptoms as well as past and recent exposure to dusts such as asbestos and silica. They will often then be referred to a pulmonologist for evaluation. To diagnose the condition, several pieces of information/tests will be collected/performed:

These assessments are used to determine if the person has nodules or tumors, inflammation, or excess fluid around the lungs. They will also be tested for pneumonia. In some cases, more invasive testing is completed to evaluate the condition, which might include a bronchoscopy, or scope of the windpipe (trachea), and even surgery if more tissue is needed for a biopsy.

Treatment & Therapy

At present there are no specific treatments or medication for the condition, and there is no known cure. Most treatments are focused on limiting further lung damage, decreasing symptoms, and improving the individual’s quality of life. As such, individuals may be treated in a number of different ways.

Individuals with asthma or chronic obstructive pulmonary disease (COPD) symptoms may be given an inhaler (which could contain bronchidilators or corticosteroids). Others may be treated with supplemental oxygen to increase their oxygen level, while others may be recommended to a pulmonary rehabilitation program to improve their ability to exercise.

In very rare cases, an individual may be referred for a lung transplant. In this case, the individual must undergo several tests to determine if he or she is healthy enough to undergo a lung transplant and to assess if it would indeed improve his or her quality of life. Simple lifestyle treatments may also be recommended, including quitting smoking if the individual is a smoker or avoiding secondhand smoke regardless.

Prevention & Prophylaxis

While the ability to prevent pneumoconiosis in every single case is unlikely, there are a number of precautionary measures an individual can take in the work place. Individuals and their employers who are regularly exposed to known disease-causing dusts should wear/provide for a well-fitting face-mask, take precautions to keep dust levels at a minimum, ensure that the workplace environment is well-ventilated, follow necessary dust removal procedures for clothing and work areas, and avoid transferring dust into the body through food, drink, cigarettes, medicine, etc. Pneumoconiosis is a relatively progressive disease, but it is also preventable in many respects, so effective workplace practices are important to limit exposure and reduce disease.