Learn About Pneumoconiosis
Pneumoconiosis is a general term given to any lung disease caused by dusts that are breathed in and then deposited deep in the lungs, causing damage. Pneumoconiosis is considered an occupational lung disease because exposure to the dusts that can cause pneumoconiosis occurs in the workplace.
- Pneumoconiosis is caused by workplace exposure to airborne dusts that are breathed into the lung.
- Exposure to asbestos, silica, and coal dust are the most common causes of pneumoconiosis.
- There is no cure for pneumoconiosis, but it can be prevented with appropriate respiratory protection.
What Is Pneumoconiosis?
Pneumoconiosis can happen when airborne dusts, particularly mineral dusts, are inhaled at work, and dust particles remain in the lung where they can cause inflammation or fibrosis (scarring). The effects of damage from inhaled mineral dusts may not show up for many years, so patients may not develop symptoms until long after they are no longer exposed to these dusts. The most common cause of pneumoconiosis is inhalation of asbestos, silica (sand or rock dust), or coal dust. Only some workers exposed to these dusts will develop pneumoconiosis. Preventing inhalation of harmful dusts make pneumoconiosis a preventable disease.
How Pneumoconiosis Affects Your Body
When mineral dusts are inhaled, dust particles can land in the airways (bronchial tubes) or all the way in the alveoli (air sacs) that are deep in the lungs. How far into the lungs the dust particles can get depends on characteristics like the size and shape of the particles. After the dust particles land and settle in the lung, the lung tissue may try to get rid of the dust particles, or try to surround them to prevent them from doing damage. Cells from our immune system travel to these affected areas of lung, and inflammation develops. In some cases, the inflammation is severe enough to cause scar tissue to form. The formation of scar tissue is called fibrosis. If the inflammation or fibrosis is severe enough or involves a large enough area of lung tissue, breathing will be affected.
How Serious Is Pneumoconiosis
The severity of pneumoconiosis varies widely depending on the type of dust, how much of the lungs are affected, and how intense the dust exposure was. Pneumoconiosis sometimes causes no symptoms and is diagnosed during workplace surveillance programs that test workers to find early signs of pneumoconiosis using chest x-rays and/or spirometry (a breathing test to check lung capacity). In other cases, pneumoconiosis can be very severe and can even cause death in some patients. The Centers for Disease Control reported that in 2010 there were more than 2,000 deaths in the United States related to pneumoconiosis. There are many more people living with pneumoconiosis.
Pneumoconiosis Symptoms, Causes, and Risk Factors
The most common symptoms of pneumoconiosis are cough and shortness of breath, and risk is generally higher when people have been exposed to mineral dusts in high concentrations and/or for long periods of time. Inadequate or inconsistent use of personal protective equipment (PPE) such as respirators is another risk factor since preventing dusts from being inhaled will also prevent pneumoconiosis. Pneumoconiosis does not generally occur from environmental (non-workplace) exposures since dust levels in the environment are much lower.
Patients with pneumoconiosis may have no symptoms at all, particularly early in the disease. Symptoms can include cough, with or without mucous (sputum) production, or chest tightness. Many patients complain of shortness of breath. Patients may first notice getting more breathless or winded with activity, like walking or climbing stairs. Some patients may feel breathless even when they are at rest.
If pneumoconiosis involves a large amount of the lungs or causes a lot of scarring, oxygen may be prevented from easily reaching the blood during breathing. This results in hypoxemia (low blood oxygen levels). Hypoxemia may only be present during activity or while sleeping, but if pneumoconiosis is severe or progresses, then hypoxemia may be present all the time. Many patients with hypoxemia do not know that their oxygen levels are low because hypoxemia itself does not always cause symptoms like breathlessness. Oxygen in the blood delivers oxygen to all the internal organs, so recognizing hypoxemia is important to prevent stress on other organs, like the heart and brain.
What Causes Pneumoconiosis?
There are many dusts that can cause pneumoconiosis. The most common workplace mineral dusts that are known to cause pneumoconiosis are asbestos, silica, and coal dust.
What Are Risk Factors?
Pneumoconiosis includes asbestosis, silicosis, and coal workers’ pneumoconiosis (CWP). CWP is sometimes called “black lung disease” because the charcoal dust in the lungs can turn them black in color. Below are the dusts that cause these diseases.
Asbestos fibers are very durable and resistant to heat leading to their use in insulation and fireproofing, as well as in textile manufacturing. Examples of workers who might be exposed to asbestos include plumbers, roofers, mechanics, and shipyard workers including naval officers. People are at higher risk of developing asbestosis if they have higher levels of exposure over longer periods of time, although the disease may not develop for 10 or 20 years after first exposure.
Crystalline silica is a main component of sand and rock. Examples of workers who might be exposed to silica include miners, sandblasters, stonemasons, and foundry workers. Risk factors for developing silicosis include higher levels of silica exposure and longer time of exposure. Lower levels of exposure over many years most commonly lead to “chronic simple silicosis” in which many small nodules of inflammation form in the lungs. This is the most common form of silicosis. In a small percentage of cases, simple silicosis develops into a more severe form of silicosis called “progressive massive fibrosis” (PMF) when many small nodules “grow” together into large masses. In PMF, patients have more severe respiratory symptoms because these masses limit the function of normal lung. If exposure to silica is very intense over a shorter period of time, patients may develop “accelerated” or “acute silicosis.” Acute silicosis is rare and generally occurs only after extremely high exposures, but it causes death in most cases.
Coal dust is made of carbon-containing particles, and coal miners are at risk of inhaling this dust. Coal miners may also be exposed to silica-containing dust because coal mining may involve some drilling in to silica-containing rock. Workers exposed to graphite dust can also develop pneumoconiosis similar to CWP. Just like with silicosis, CWP is most commonly “simple” disease with nodules of inflammation forming in the lungs, but it can become PMF in a small percentage of patients.
Chronic beryllium disease (also called berylliosis) is another work-related lung disease that may be considered a pneumoconiosis. Beryllium is a very strong and lightweight metal that is used in the electronics, aerospace, and nuclear power industries. Chronic beryllium disease is caused by inhalation of airborne beryllium during its processing such as in melting or grinding it. There are other less common mineral dusts that might also cause pneumoconiosis including cobalt, talc, and aluminum oxide.
When to See Your Doctor
If you have been exposed to asbestos, silica, coal dust, or other toxic dusts and have respiratory symptoms such as cough or shortness of breath, you should consult your health-care provider.
Diagnosing and Treating Pneumoconiosis
Pneumoconiosis may be diagnosed by routine workplace surveillance in exposed workers, or it may be diagnosed because symptoms develop in a person previously exposed to mineral dusts. Workplace surveillance programs may involve workers having breathing tests and/or chest x-rays every year or periodically looking for abnormalities.
What to Expect
Your health-care provider will ask you about your symptoms and also about your past exposures to dusts like asbestos or silica. It is common that you would be referred to a pulmonologist (lung doctor) for your evaluation. You may also be referred to an occupational medicine provider to find out more about your past exposures and to evaluate you further.
How It’s Diagnosed
Pneumoconiosis is diagnosed using several pieces of information:
- Your history, including the details about your symptoms and exposures
- A physical examination
- Pulmonary function tests (breathing tests)
- Chest x-ray or other radiographic imaging like a CT scan (“CAT scan”) of the chest
Radiographic imaging may show your health-care provider abnormalities in the lungs or the tissues surrounding the lungs; these can include nodules (“spots”) or masses, areas of inflammation, pneumonia, or excess fluid in or around the lungs. Pulmonary function tests may show your health-care provider how well you are able to fill and empty your lungs, and how well oxygen travels from your alveoli (the small air sacs deep in your lungs) to your blood.
Sometimes additional, more invasive testing is necessary to diagnose pneumoconiosis. This might include bronchoscopy in which a thin tube with a camera is inserted into your trachea (windpipe) to look at your airways, to get a fluid sample to look for infection, or to take small biopsies of lung tissue. If more lung tissue is needed, surgery may be necessary to take a larger biopsy. While invasive procedures and biopsies are generally not necessary to diagnose pneumoconiosis, these tests may be necessary to exclude other diagnoses.
How Pneumoconiosis is Treated
There are no specific treatments or medications for pneumoconiosis. There is no cure for pneumoconiosis. Most treatments for patients with pneumoconiosis are thus aimed at limiting further damage to the lung, decreasing symptoms, and improving quality of life.
Patients may be treated with inhaled medications (inhalers) if they have symptoms of asthma or chronic obstructive pulmonary disease (COPD) like chronic bronchitis or emphysema. A pulmonary rehabilitation program may be recommended to improve a patient’s exercise capacity (the ability to tolerate activity). Oxygen is prescribed if patients have a low oxygen level. Some patients need to wear oxygen all the time while others only need it when they are active or while they sleep.
In some select cases, your health-care provider may refer you for a lung transplant. You would have many tests to find out if you are healthy enough to undergo a lung transplant, and if it would improve or prolong your life.
If you are a smoker, you will be strongly advised to quit smoking. Quitting cigarette smoking (or smoking any other drugs) is very important to prevent further decline in lung function. Your health-care provider may give you counseling and helpful hints for quitting, or they may prescribe you medications or recommend over-the-counter nicotine replacement. You may also be referred to a smoking cessation program or a “quit line” (for example, 1-800-QUIT-NOW).
Smoking with some types of pneumoconiosis can actually increase your chance of developing lung cancer more than just smoking without pneumoconiosis. The Lung Association offers many resources for help quitting smoking. Call our Lung HelpLine at 1-800-LUNGUSA or visit FFSonline.org to learn more.
Living with Pneumoconiosis
Pneumoconiosis is different for every person. Some patients have very mild disease that is stable (does not get worse and worse over time). Other people have more severe disease, or disease that gets much worse over time. Because there is no cure, living with pneumoconiosis involves taking the best care of your lungs and your general health as you can, and following up regularly with your health-care provider to manage your symptoms, to monitor you for worsening of your lung function, and to watch for other diseases that can develop in patients who have pneumoconiosis.
What to Expect
If you have pneumoconiosis, you should expect to have regular visits to your health-care provider(s). You may need to have regular testing, such as pulmonary function tests (“breathing tests”) or chest x-rays to monitor you and your disease closely. You should have a flu shot every year, and you should ask your health-care provider about pneumonia vaccines.
Managing the Disease
Taking care of your heart and lungs is one of the most important things you can do for your health if you are living with pneumoconiosis. This means not smoking cigarettes or other drugs that can be smoked, and avoiding secondhand smoke. You should also avoid any more exposure to harmful dusts. Keeping your weight in a healthy range and exercising regularly helps with symptoms of breathlessness. For people with more severe breathing symptoms, exercising may be difficult, and a pulmonary rehabilitation program can be helpful (see “How It’s Treated” above).
People with pneumoconiosis can have a higher risk of developing some other diseases. Your health-care provider may need to watch for these. For instance, patients with asbestosis are at higher risk of developing lung cancer. This risk is especially high if the patient has been a cigarette smoker. One lung cancer that is related to asbestos exposure but not to cigarette smoking is called mesothelioma. Mesothelioma is rare compared with other types of lung cancer, but asbestos exposure is its only known cause. Your health-care provider may ask you to have a chest x-ray or chest CT scan to check for lung cancer.
Patients with silicosis are at a higher risk of developing tuberculosis. Your health-care provider may do a skin test or a blood test to see if you have been exposed to tuberculosis in the past, or they may ask you about other risk factors for tuberculosis. If you have been exposed to tuberculosis in the past and are carrying the tuberculosis bacteria (latent tuberculosis infection), it may be recommended that you take antibiotics to help prevent you from getting active tuberculosis.
Patients with silicosis are also at higher risk of developing rheumatoid arthritis, a form of arthritis in which the body’s immune system attacks the joints causing pain, swelling, and stiffness. People with silicosis who develop certain symptoms or signs of arthritis may need blood tests or other evaluation to check for rheumatoid arthritis. Patients with rheumatoid arthritis often need special medications to control the symptoms of their arthritis.
Patients with CWP may also be at an increased risk of tuberculosis or rheumatoid arthritis since coal dust can be contaminated with silica.
If you are diagnosed with pneumoconiosis, you may be entitled to workers’ compensation. Contact your state workers’ compensation board for more information about how to file a claim. Ask your health-care provider about lung disease support groups in your area, or look online for a Better Breathers Club near you.
Questions to ask your Doctor about Pneumoconiosis
- What kinds of dusts and other exposures can cause lung problems? How do I avoid these?
- Am I at risk for pneumoconiosis? Do my job and work environment put me at risk?
- If I am at risk for pneumoconiosis, what kind of testing should I have?
- What symptoms should I look for if I am worried about pneumoconiosis?
- If I have pneumoconiosis, how often do I need to come to the doctor? How often do I need to have breathing tests or chest x-rays?
- If I have pneumoconiosis, will I need to be on oxygen?
- How will having pneumoconiosis affect my life expectancy?
- Should I have a pneumonia vaccine? When can I get the flu shot? Where can I get these vaccines?
- I am not very active. What kind of exercise could I do to help me get in better shape?
- Would pulmonary rehabilitation be a good idea for me?
- Am I at a healthy weight? What is a healthy weight for me?
- How can I stop smoking? What treatments or support are available to me?
Amy Ahasic, MD, MPH, FCCP
Date Last Reviewed