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Current Concepts in Pathogenesis, Diagnosis, and Management of Silicosis and Its Subtypes


Purpose of Review

Pneumoconiosis due to silicosis is still present due to modern industries such stone carving, garment industry, and road construction. We aim to discuss how to accurately diagnose silicosis, appropriately risk stratify patients with silicosis, and discuss potential new pharmacotherapies that may be of potential use in the future.

Recent Findings

Acute silicosis, chronic silicosis, and accelerated silicosis are 3 distinct clinical categories. Acute silicosis is the least common form and occurs with high exposures of silica dust in a short time frame. Patients with prolonged exposures at low concentrations have the highest risk of developing chronic silicosis. Chronic silicosis is the classic presentation of silicosis with a slow onset of symptoms. Accelerated silicosis has an earlier onset than chronic silicosis and presents within 5 to 10 years of exposure. Chronic silicosis and accelerated silicosis can lead to progressive massive fibrosis, which is silica nodules merging together with associated fibrosis. Based on cumulative dose, patients with silica exposure had an independent increased risk of developing lung cancer, with an additional cumulative risk among smokers. Lung transplant should be considered in patients with silicosis who develop severe lung disease. There is no current role for any pharmacological agents in silicosis; however, there is ongoing research to identify possible pharmacological agents.


The diagnosis of silicosis is made based on occupational history, appropriate radiographic findings, and exclusion of other potential etiologies. Prevention of silica dust exposure remains crucial to reduce damage to the lungs.

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Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. 1.

    Barnes H, Goh NSL, Leong TL, Hoy R. Silica-associated lung disease: an old-world exposure in modern industries. Respirology. 2019;24(12):1165–75.

    PubMed  Article  Google Scholar 

  2. 2.••

    Leung CC, Yu IT, Chen W. Silicosis. Lancet. 2012;379(9830):2008–18.

    CAS  PubMed  Article  Google Scholar 

  3. 3.

    Merget R, Bauer T, Kupper HU, et al. Health hazards due to the inhalation of amorphous silica. Arch Toxicol. 2002;75(11-12):625–34.

    CAS  PubMed  Article  Google Scholar 

  4. 4.

    McLaughlin JK, Chow WH, Levy LS. Amorphous silica: a review of health effects from inhalation exposure with particular reference to cancer. J Toxicol Environ Health. 1997;50(6):553–66.

    CAS  PubMed  Article  Google Scholar 

  5. 5.

    Adverse effects of crystalline silica exposure. American Thoracic Society Committee of the Scientific Assembly on Environmental and Occupational Health. Am J Respir Crit Care Med. 1997;155(2):761–8.

    Article  Google Scholar 

  6. 6.

    Castranova V, Vallyathan V. Silicosis and coal workers' pneumoconiosis. Environ Health Perspect. 2000;108(Suppl 4):675–84.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  7. 7.

    Ozkan M, Ayan A, Arik D, Balkan A, Onguru O, Gumus S. FDG PET findings in a case with acute pulmonary silicosis. Ann Nucl Med. 2009;23(10):883–6.

    PubMed  Article  Google Scholar 

  8. 8.

    Nakladalova M, Stepanek L, Kolek V, Zurkova M, Tichy T. A case of accelerated silicosis. Occup Med (Lond). 2018;68(7):482–4.

    CAS  Article  Google Scholar 

  9. 9.

    Barber CM, Fishwick D, Carder M, van Tongeren M. Epidemiology of silicosis: reports from the SWORD scheme in the UK from 1996 to 2017. Occup Environ Med. 2019;76(1):17–21.

    PubMed  Article  Google Scholar 

  10. 10.

    Kreiss K, Zhen B. Risk of silicosis in a Colorado mining community. Am J Ind Med. 1996;30(5):529–39.

    CAS  PubMed  Article  Google Scholar 

  11. 11.

    Thomas CR, Kelley TR. A brief review of silicosis in the United States. Environ Health Insights. 2010;4:21–6.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  12. 12.

    Centers for Disease, C. and Prevention, Silicosis mortality, prevention, and control--United States. MMWR. Morb Mortal Wkly Rep, 2005. 1968-2002;54(16):401–5.

    Google Scholar 

  13. 13.

    Deslauriers JR, Redlich CA. Silica exposure, silicosis, and the new occupational safety and health administration silica standard. What pulmonologists need to know. Ann Am Thorac Soc. 2018;15(12):1391–2.

    PubMed  Article  Google Scholar 

  14. 14.••

    Krefft S, Wolff J, Rose C. Silicosis: an update and guide for clinicians. Clin Chest Med. 2020;41(4):709–22.

    PubMed  Article  Google Scholar 

  15. 15.

    Hoy RF, Chambers DC. Silica-related diseases in the modern world. Allergy. 2020;75(11):2805–17.

    PubMed  Article  Google Scholar 

  16. 16.

    Pascual Del Pobil YFMA, Sevila RG, Rodenas MDMG, Medel EB, Reos EF, Carbonell JG. Silicosis: a former occupational disease with new occupational exposure scenarios. Rev Clin Esp. 2019;219(1):26–9.

    Article  Google Scholar 

  17. 17.

    Barber CM, Fishwick D, Seed MJ, Carder M, van Tongeren M. Artificial stone-associated silicosis in the UK. Occup Environ Med. 2018;75(7):541.

    PubMed  Article  Google Scholar 

  18. 18.

    Akgun M, Ergan B. Silicosis in Turkey: is it an endless nightmare or is there still hope? Turk Thorac J. 2018;19(2):89–93.

    PubMed  PubMed Central  Article  Google Scholar 

  19. 19.

    Jindal SK. Silicosis in India: past and present. Curr Opin Pulm Med. 2013;19(2):163–8.

    CAS  PubMed  Article  Google Scholar 

  20. 20.

    Souza TP, Watte G, Gusso AM, Souza R, Moreira JDS, Knorst MM. Silicosis prevalence and risk factors in semi-precious stone mining in Brazil. Am J Ind Med. 2017;60(6):529–36.

    PubMed  Article  Google Scholar 

  21. 21.

    Rimal B, Greenberg AK, Rom WN. Basic pathogenetic mechanisms in silicosis: current understanding. Curr Opin Pulm Med. 2005;11(2):169–73.

    PubMed  Article  Google Scholar 

  22. 22.

    Dostert C, Petrilli V, Van Bruggen R, Steele C, Mossman BT, Tschopp J. Innate immune activation through Nalp3 inflammasome sensing of asbestos and silica. Science. 2008;320(5876):674–7.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  23. 23.

    Thakur SA, Beamer CA, Migliaccio CT, Holian A. Critical role of MARCO in crystalline silica-induced pulmonary inflammation. Toxicol Sci. 2009;108(2):462–71.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  24. 24.

    Vacek PM, Glenn RE, Rando RJ, Parker JE, Kanne JP, Henry DA, et al. Exposureresponse relationships for silicosis and its progression in industrial sand workers. Scand J Work Environ Health. 2019;45(3):280–8.

    CAS  PubMed  Article  Google Scholar 

  25. 25.••

    Mossman BT, Churg A. Mechanisms in the pathogenesis of asbestosis and silicosis. Am J Respir Crit Care Med. 1998;157(5 Pt 1):1666–80.

    CAS  PubMed  Article  Google Scholar 

  26. 26.••

    Chong S, Lee KS, Chung MJ, Han J, Kwon OJ, Kim TS. Pneumoconiosis: comparison of imaging and pathologic findings. Radiographics. 2006;26(1):59–77.

    PubMed  Article  Google Scholar 

  27. 27.

    Steenland K, Ward E. Silica: a lung carcinogen. CA Cancer J Clin. 2014;64(1):63–9.

    PubMed  Article  Google Scholar 

  28. 28.

    Salih M, Aljarod T, Ayan M, Jeffrey M, Shah BH. Pulmonary silicosis presents with pleural effusion. Case Rep Med. 2015;2015:543070.

    PubMed  PubMed Central  Article  Google Scholar 

  29. 29.

    Ng TP, Chan SL. Lung function in relation to silicosis and silica exposure in granite workers. Eur Respir J. 1992;5(8):986–91.

    CAS  PubMed  Google Scholar 

  30. 30.

    Moreira VB, Ferreira AS, Soares PJ, Gabetto JM, Rodrigues CC. The role of bronchoalveolar lavage in quantifying inhaled particles in silicosis. Rev Port Pneumol. 2005;11(5):457–75.

    PubMed  Article  Google Scholar 

  31. 31.

    Hnizdo E, Murray J. Risk of pulmonary tuberculosis relative to silicosis and exposure to silica dust in South African gold miners. Occup Environ Med. 1998;55(7):496–502.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  32. 32.••

    Cowie RL. The epidemiology of tuberculosis in gold miners with silicosis. Am J Respir Crit Care Med. 1994;150(5 Pt 1):1460–2.

    CAS  PubMed  Article  Google Scholar 

  33. 33.

    Mielke S, Taeger D, Weitmann K, Bruning T, Hoffmann W. Influence of quartz exposure on lung cancer types in cases of lymph node-only silicosis and lung silicosis in German uranium miners. Arch Environ Occup Health. 2018;73(3):140–53.

    CAS  PubMed  Article  Google Scholar 

  34. 34.

    Liu Y, Steenland K, Rong Y, Hnizdo E, Huang X, Zhang H, et al. Exposure-response analysis and risk assessment for lung cancer in relationship to silica exposure: a 44-year cohort study of 34,018 workers. Am J Epidemiol. 2013;178(9):1424–33.

    PubMed  Article  Google Scholar 

  35. 35.

    Shtraichman O, Blanc PD, Ollech JE, Fridel L, Fuks L, Fireman E, et al. Outbreak of autoimmune disease in silicosis linked to artificial stone. Occup Med (Lond). 2015;65(6):444–50.

    CAS  Article  Google Scholar 

  36. 36.

    Vihlborg P, Bryngelsson IL, Andersson L, Graff P. Risk of sarcoidosis and seropositive rheumatoid arthritis from occupational silica exposure in Swedish iron foundries: a retrospective cohort study. BMJ Open. 2017;7(7):e016839.

    PubMed  PubMed Central  Article  Google Scholar 

  37. 37.

    Beijer E, Meek B, Kromhout H, van Es HW, Seldenrijk K, Drent M, et al. Sarcoidosis in a patient clinically diagnosed with silicosis; is silica associated sarcoidosis a new phenotype? Respir Med Case Rep. 2019;28:100906.

    PubMed  PubMed Central  Google Scholar 

  38. 38.

    Rosenman KD, Moore-Fuller M, Reilly MJ. Kidney disease and silicosis. Nephron. 2000;85(1):14–9.

    CAS  PubMed  Article  Google Scholar 

  39. 39.

    Millerick-May ML, Schrauben S, Reilly MJ, Rosenman KD. Silicosis and chronic renal disease. Am J Ind Med. 2015;58(7):730–6.

    CAS  PubMed  Article  Google Scholar 

  40. 40.

    Goodman GB, Kaplan PD, Stachura I, Castranova V, Pailes WH, Lapp NL. Acute silicosis responding to corticosteroid therapy. Chest. 1992;101(2):366–70.

    CAS  PubMed  Article  Google Scholar 

  41. 41.

    Sidney-Filho, L.A., G. Watte, P.A.R. Dos Santos, et al., What is expected in lung function after lung transplantation due to end-stage pulmonary silicosis? Clin Transplant, 2017. 31(11).

  42. 42.••

    Hayes D Jr, Hayes KT, Hayes HC, Tobias JD. Long-Term survival after lung transplantation in patients with silicosis and other occupational lung disease. Lung. 2015;193(6):927–31.

    CAS  PubMed  Article  Google Scholar 

  43. 43.

    Sun J, Song P, Wang Y, Chen Y. Clinical efficacy of acetylcysteine combined with tetrandrine tablets in the treatment of silicosis and the effect on serum IL-6 and TNF-alpha. Exp Ther Med. 2019;18(5):3383–8.

    CAS  PubMed  PubMed Central  Google Scholar 

  44. 44.

    Miao RM, Sun XF, Zhang YY, Wu W, Fang ZH, Zhao R, et al. Clinical efficacy of tetrandrine combined with acetylcysteine effervescent tablets in treatment of silicosis. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi. 2013;31(11):857–8.

    CAS  PubMed  Google Scholar 

  45. 45.

    Burmeister R, Rhoderick JF, Holian A. Prevention of crystalline silica-induced inflammation by the anti-malarial hydroxychloroquine. Inhal Toxicol. 2019;31(7):274–84.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  46. 46.

    Guo J, Yang Z, Jia Q, Bo C, Shao H, Zhang Z. Pirfenidone inhibits epithelial-mesenchymal transition and pulmonary fibrosis in the rat silicosis model. Toxicol Lett. 2019;300:59–66.

    CAS  PubMed  Article  Google Scholar 

  47. 47.

    Cruz FF, Horta LF, Maia Lde A, et al. Dasatinib reduces lung inflammation and fibrosis in acute experimental silicosis. PLoS One. 2016;11(1):e0147005.

    PubMed  PubMed Central  Article  CAS  Google Scholar 

  48. 48.

    Carneiro PJ, Clevelario AL, Padilha GA, et al. Bosutinib therapy ameliorates lung inflammation and fibrosis in experimental silicosis. Front Physiol. 2017;8:159.

    PubMed  PubMed Central  Article  Google Scholar 

  49. 49.

    Biswas R, Trout KL, Jessop F, Harkema JR, Holian A. Imipramine blocks acute silicosis in a mouse model. Part Fibre Toxicol. 2017;14(1):36.

    PubMed  PubMed Central  Article  CAS  Google Scholar 

  50. 50.

    Wierenga KA, Wee J, Gilley KN, Rajasinghe LD, Bates MA, Gavrilin MA, et al. Docosahexaenoic acid suppresses silica-induced inflammasome activation and IL-1 cytokine release by interfering with priming signal. Front Immunol. 2019;10:2130.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  51. 51.

    Bandeira E, Oliveira H, Silva JD, Menna-Barreto RFS, Takyia CM, Suk JS, et al. Therapeutic effects of adipose-tissue-derived mesenchymal stromal cells and their extracellular vesicles in experimental silicosis. Respir Res. 2018;19(1):104.

    PubMed  PubMed Central  Article  CAS  Google Scholar 

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Correspondence to Sujith V. Cherian.

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Salahuddin, M., Cawasji, Z., Kaur, S. et al. Current Concepts in Pathogenesis, Diagnosis, and Management of Silicosis and Its Subtypes. Curr Pulmonol Rep 10, 135–142 (2021).

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  • Silicosis
  • Industry
  • Occupational exposure
  • Progressive massive fibrosis
  • N-acetylcysteine