Silicosis: Causes, Signs, Prevention

Pneumoconiosis: Description

Doctors refer to pneumoconiosis (Greek pneuma = air, conis = dust) as pneumoconiosis. Pneumoconiosis occurs when the lung tissue is pathologically altered by inhaled inorganic (mineral or metallic) dust. If the connective tissue of the lungs scars and hardens, experts speak of fibrosis.

Many occupational groups are exposed to harmful dust. Dust lung is therefore one of the most common occupational diseases. Depending on the type of dust inhaled, a distinction is made between benign and malignant dust lung diseases, which differ in terms of their danger.

Benign dust lung

Some dusts are only deposited in the lung tissue, but do not initially trigger an inflammatory reaction. In contrast to malignant dusts, the lung function of benign pneumoconiosis only deteriorates over time in individual cases.

Benign dusts	Dust lung disease
Soot, graphite, coal dust	anthracosis
Iron dust	Siderosis, welder’s pneumoconiosis
Barium dust	barytosis
Tin dust	stannose
Kaolin (white clay for porcelain production)	Silicatose (aluminose)
Antimony (mineral e.g. for lead alloys)	antimonose
Talc (hydrous magnesium silicate, e.g. as the main component of soapstone)	talcose

Malignant pneumoconiosis

Malignant dusts often lead to dangerous lung changes. The lung tissue becomes increasingly scarred, which can significantly restrict oxygen uptake. As the disease progresses, the lung tissue hardens due to fibrosis.

Malignant dusts	Dust lung disease
Quartz dust (cristobalite, tridymite)
asbestos
beryllium	Berylliosis
Hard metals (tungsten, titanium, chromium, molybdenum)	Hard metal pneumoconiosis
Mixed dental plug dust	Dental technician pneumoconiosis
Aluminum	Aluminose

Dusting (caused by inorganic dusts) is contrasted with lung diseases caused by organic substances (such as bird droppings, cereal mold). These fall under the term exogenous allergic alveolitis. This is an inflammation of the alveoli as a result of an allergic reaction to inhaled animal proteins or fungal spores. Farmers (farmer’s lung) or bird breeders (bird farmer’s lung) are usually affected.

Dust lung: frequency

Silicosis

Silicosis is one of the most common occupational diseases of the lungs and is mainly found in miners. You can read everything you need to know about the development, course, treatment and prognosis of this form of pneumoconiosis in the article Silicosis!

Asbestosis

Another well-known type of pneumoconiosis is caused by inhaling asbestos fibers, which used to be used on a large scale for fireproof insulation materials, facade cladding and fireproof protective clothing – until their lung-damaging and carcinogenic effects were discovered. Read more about asbestosis!

Dust lung: symptoms

The signs of dust lung can vary greatly. Patients usually have no symptoms, particularly when benign dust is deposited in the lungs. Only after years do coughing and shortness of breath occur during physical exertion. If the lung tissue has changed as a result of inhaling toxic substances, the symptoms of pneumoconiosis depend on the extent of the inflammation or fibrosis. Common symptoms are

bronchitis
Dry cough that can last for years
Weakness and weight loss
pneumonia
shortness of breath

Dust lung: causes and risk factors

Those affected are usually exposed to harmful dusts for years – often in the workplace. Important activities or occupational fields that increase the risk of dust lung are, for example

dust	Risky activities or occupations
Soot, graphite, coal dust	Mining (especially hard coal), residents of industrial cities more at risk than rural residents
Iron dust	Welding work
Barium sulfate dust	Barite extraction (degradable mineral), deep drilling technology (barium as drilling fluid), use in the automotive industry in plastic and insulating mats and as a component of heavy concrete
Tin dust	especially in the glass industry
kaolin	Extraction of white clay, porcelain production
Antimony	Mining (antimony extraction, ore mines); production of cable insulation, building materials (e.g. foils), electrical appliances, fireproof textiles and plastics; flame retardants for paints
Talc (hydrous magnesium silicate, e.g. as the main component of soapstone)	Tire industry
Quartz dust (cristobalite, tridymite)	Gravel and sand industry, sandblasting, cement production, ore and coal mining
Asbestos	Processing of insulation material, asbestos cement, refractory material; plastic reinforcement; construction work
Beryllium
Hard metals (tungsten, titanium, chromium, molybdenum)	mainly hard metal work such as grinding, sintering, casting (e.g. tool manufacture)
Tooth cutter dust	dental technology
aluminum	Mechanical engineering, packaging industry, construction industry; train, automobile, aircraft construction; aerated concrete production, paint and varnish industry; rockets and explosives; hazards in particular during aluminum welding work and aluminum powder production

Decisive factors for the development of dust lung are

the period of exposure to the dust
the amount of dust inhaled
the size of the dust particles: Larger dust particles are retained in the nasopharynx. In contrast, particles with a diameter of less than 2.5 micrometers can penetrate into the alveoli and be deposited there.

Dust lung: examinations and diagnosis

The doctor responsible for lung diseases is a pulmonologist or an occupational physician. The doctor will first ask you a few questions about your workplace and symptoms in order to establish your medical history (anamnesis). Possible questions include:

How long have you had your symptoms (e.g. cough, shortness of breath)?
Do you have sputum when you cough?
Do you have difficulty breathing?
Do you feel unusually tired and exhausted?
Have you lost weight?
What profession did you have before your current job?
Do you breathe in dust frequently?
Are there any special protective measures at your workplace, such as wearing a protective mask or goggles, and do you adhere to them?
Have measurements of particulate matter been carried out at your workplace?

Physical examination and X-ray

A general physical examination follows the consultation with the doctor. Listening to and tapping the lungs (auscultation and percussion) is an essential part of this.

Your lungs are then x-rayed (chest x-ray): Inflamed areas of the lungs are visible as whitish areas on the X-ray due to increased fluid accumulation. In severe cases, a particularly large amount of fluid collects in the lungs. Doctors refer to this as toxic pulmonary edema.

Pulmonary function test

Blood gas analysis and spiroergometry

To find out the effects of congestive lung disease on your oxygen supply, doctors will take a blood sample for a blood gas analysis. This involves measuring the oxygen and carbon dioxide levels in your blood. In the case of severe pneumoconiosis, oxygen is reduced and carbon dioxide is increased, as the exchange of the two gases in the diseased lungs is only possible to a limited extent.

As gas exchange disorders at the beginning of the disease are mainly noticeable during physical exertion, spiroergometry (on a bicycle ergometer) is also carried out to determine the blood gas values – a very informative examination that is also used for expert opinions to assess cardio-pulmonary performance.

Computer tomography

Computed tomography (CT) provides more detailed images of the lungs than an X-ray examination. However, it is associated with greater radiation exposure for the patient and is therefore usually only used in special cases – for example in cases of suspected lung cancer (possible consequence of quartz dust lung).

Lung biopsy

The tissue sample can be taken from the lungs in various ways, for example as part of a lung endoscopy (bronchoscopy). The sample is then examined more closely in the laboratory. In this way, a connection between occupation/workplace and pneumoconiosis can be established beyond doubt.

Bronchoalveolar lavage

As part of a bronchoscopy, bronchoalveolar lavage (“lung lavage”) can also be carried out together with a lung biopsy. For this purpose, saline solution is dripped into the bronchi via the bronchoscope (a tube-shaped instrument with a light source and camera at the tip) inserted into the lungs. This allows cells and inhaled foreign substances (such as asbestos fibers) to be removed. The rinsing solution (with cells and foreign substances) is then aspirated via the bronchoscope and examined in detail.

This procedure can be used to confirm the diagnosis of asbestosis, for example. In addition, bronchoalveolar lavage – as well as spiroergometry – is suitable for expert opinions.

Dust lung: treatment

Some patients with pneumoconiosis are prescribed so-called bronchodilators – drugs that widen the airways by reducing the muscle tension in the bronchi. This can make it easier for patients to breathe.

In very severe cases, the patient is dependent on a separate oxygen supply (oxygen cylinders). They may need a new lung (lung transplant).

The administration of glucocorticoids (“cortisone”) or immunosuppressants for inflammatory pneumoconiosis or pulmonary fibrosis has proven to be ineffective.

Pneumoconiosis: disease progression and prognosis

The progression of most dust lung diseases can be prevented if the patient no longer inhales the dangerous dust. Inflammations usually heal over the course of several weeks, provided those affected protect themselves sufficiently from massive dust exposure. However, any scarring of lung tissue that has already occurred cannot be reversed.

If the patient continues to be exposed to pollutants for years, the disease can worsen and lead to severe pulmonary fibrosis. In addition, some dusts (such as quartz dust) can lead to cancer.

Occupational disease pneumoconiosis

Dust lung: prevention

To prevent the development of pneumoconiosis or to stop an existing pneumoconiosis from progressing, you should follow these tips:

Avoid inhaling dust.
Adhere to health and safety precautions in the workplace.
Make sure that your employer provides the legally prescribed protective measures such as special clothing, breathing masks, safety goggles or ventilation and extraction equipment.
Take part in occupational health check-ups.
Take advantage of preventive medical check-ups.
Stop smoking (smoking can also severely damage the lungs and further increase the risk of cancer).

See your family doctor, company doctor or a lung specialist in good time if you have symptoms. If dust lung is detected at an early stage, you have the opportunity to take suitable measures (adapting or changing your workplace, etc.) to protect yourself from further exposure. This can prevent or at least delay the serious consequences of dust lung disease (such as lung cancer).