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Pneumoconiosis in the Twenty-First Century

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A Clinical Guide to Occupational and Environmental Lung Diseases

Part of the book series: Respiratory Medicine ((RM))

Abstract

While defined pathologically, it is uncommon that the diagnosis of pneumoconiosis necessitates tissue biopsy. The approach initially used by physicians for diagnosis of asbestosis has been extrapolated to all pneumoconioses. This requires meeting criteria of (1) evidence of structural pathology consistent with dust-related disease as documented by imaging, (2) evidence of causation by dust exposure as documented by the occupational and environmental history or markers of exposure, and (3) exclusion of confounders. The first criterion for the diagnosis requires evidence of structural pathology consistent with dust-related disease, and this is most frequently met using chest X-rays interpreted by either a radiologist or a B reader. If there are abnormalities on the chest X-ray, these should be confirmed using a CT scan of the chest. The second criterion requires evidence of causation by dust demanding the physician to obtain a detailed history into all full and part jobs and potential environmental exposures from hobbies. The third and final criterion for the diagnosis of pneumoconiosis requires exclusion of confounders. The most frequent confounders for pneumoconiosis include cigarette smoking, granulomatous disease, aging, and obesity. Therefore, evaluation of the patient for pneumoconiosis must include a history (with emphasis on the history of respiratory illness, past medical history, occupational history, and smoking history), physical examination, pulmonary function tests (including spirometry, lung volumes, and diffusing capacity), and a chest X-ray; a CT scan of the chest may be obtained depending on the interpretation of the posteroanterior film.

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  1. Environmental Public Health Division, Human Studies Facility, US EPA, 7315, 104 Mason Farm Road, Chapel Hill, NC, 27599, USA

    Andrew J. Ghio

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  1. Division of Pulmonary, Allergy and, Critical Care Medicine, Duke University Medical Center, 330 Trent Drive, Hanes House, Rm 105-B, Durham, 27705, North Carolina, USA

    Yuh-Chin T. Huang

  2. , Human Studies Facility, Environmental Public Health Division, 104 Mason Farm Road, Chapel Hill, 27711, North Carolina, USA

    Andrew J. Ghio

  3. Department of Medicine, Division of Environmental and, National Jewish Health, 1400 Jackson, Denver, 80206, Colorado, USA

    Lisa A. Maier

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Ghio, A.J. (2012). Pneumoconiosis in the Twenty-First Century. In: Huang, YC., Ghio, A., Maier, L. (eds) A Clinical Guide to Occupational and Environmental Lung Diseases. Respiratory Medicine. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-62703-149-3_9

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