eMedicine Specialties > Pulmonology > Occupational Lung Diseases

Silicosis: Follow-up

Author: Basil Varkey, MD, FCCP, Professor, Department of Internal Medicine, Division of Pulmonary and Critical Care, Medical College of Wisconsin; Consulting Pulmonologist, Froedtert Memorial Lutheran Hospital
Coauthor(s): Anita B Varkey, MD, Assistant Professor, Department of Medicine, Loyola University Medical Center; Associate Program Director, Internal Medicine Residency; Medical Director, General Internal Medicine Clinic, Loyola Outpatient Center
Contributor Information and Disclosures

Updated: Apr 16, 2008

Follow-up

Deterrence/Prevention

  • Monitoring of air quality and dust concentration in the workplace is essential to prevent silicosis and other pneumoconioses.
  • Limiting exposure to harmful dusts can be achieved further by suppressing dust generation, filtering or capturing dust particles, diluting the concentration with fresh air, and using personal protective respiratory equipment as further possible means of preventing silicosis.
  • The Occupational Safety and Health Administration (OSHA) has set a permissible exposure limit for respirable silica of 10 mg/m3. The National Institute for Occupational Safety and Health (NIOSH) standard is a more stringent exposure limit of 0.05 mg/m3.
  • In addition to the primary prevention measures, secondary methods include monitoring workers with chest radiograph and spirometry to identify early disease and to stop further exposure to silica.

Complications

  • Airflow obstruction
  • Chronic bronchitis
  • Cor pulmonale
  • Respiratory failure
  • Increased incidence of mycobacterial diseases
  • Increased risk of lung cancer (see the Medscape Lung Cancer Resource Center)
  • Association with connective-tissue disorders (eg, rheumatoid arthritis, systemic lupus erythematosus, mixed connective-tissue disease,5 systemic vasculitis6

Prognosis

  • The clinical presentation at the time of diagnosis is somewhat predictive of the prognosis, but the rate of progression varies.
  • Silicoproteinosis worsens quickly, and death may occur in months.
  • Complicated silicosis shows gradual worsening of symptoms, deterioration of lung function, and increasing disability.
  • On the other hand, patients with simple silicosis may be asymptomatic and may remain stable for many years both clinically and radiographically.

Patient Education

  • Prevent further exposure to silica dust.
  • Strongly advise patients to quit smoking and provide help in smoking cessation efforts.

Miscellaneous

Medicolegal Pitfalls

  • Assessment of impairment and disability is difficult and is best left to experienced experts in this area. The degree of impairment demonstrated does not necessarily translate to the same degree of disability. Impairment may be defined as a physiological abnormality of function that persists after treatment. Disability may be defined as an inability to carry out a specific task or job, or the development of undue distress during the performance of the job or task. Therefore, to evaluate disability due to silicosis, one must document a reduction in pulmonary function that is sufficient to prevent the person from engaging in gainful employment or activities of daily living.
  • Early diagnosis of other diseases emerging in patients with silicosis is important so that treatment can be started. Mycobacterial disease and lung cancer in patients with silicosis are examples of this scenario. Diagnosis is difficult because the symptoms of cough, malaise, and weight loss and the chest radiographic appearance of nodules and masses may not be discernibly different from that of complicated silicosis.
  • Diagnosis of silicosis is based on exposure history of sufficient intensity and/or duration, chest radiograph and/or CT scan showing abnormalities consistent with silicosis, and absence of other diseases to account for the observed radiographic abnormalities.
 


More on Silicosis

Overview: Silicosis
Differential Diagnoses & Workup: Silicosis
Treatment & Medication: Silicosis
Follow-up: Silicosis
References
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References

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  2. Centers for Disease Control and Prevention. Silicosis in dental laboratory technicians--five states, 1994-2000. MMWR Morb Mortal Wkly Rep. Mar 12 2004;53(9):195-7. [Medline].

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

  4. Sharma SK, Pande JN, Verma K. Effect of prednisolone treatment in chronic silicosis. Am Rev Respir Dis. Apr 1991;143(4 Pt 1):814-21. [Medline].

  5. Rosenman KD, Moore-Fuller M, Reilly MJ. Connective tissue disease and silicosis. Am J Ind Med. Apr 1999;35(4):375-81. [Medline].

  6. Mulloy KB. Silica exposure and systemic vasculitis. Environ Health Perspect. Dec 2003;111(16):1933-8. [Medline].

  7. American Thoracic Society. Targeted tuberculin testing and treatment of latent tuberculosis infection. This official statement of the American Thoracic Society was adopted by the ATS Board of Directors, July 1999. This is a Joint Statement of the American Thoracic Society (ATS) and the Centers for Disease Control and Prevention (CDC). This statement was endorsed by the Council of the Infectious Diseases Society of America. (IDSA), September 1999, and the sections of this statement. Am J Respir Crit Care Med. Apr 2000;161(4 Pt 2):S221-47. [Medline].

  8. Arakawa H, Honma K, Saito Y, Shida H, Morikubo H, Suganuma N. Pleural disease in silicosis: pleural thickening, effusion, and invagination. Radiology. Aug 2005;236(2):685-93. [Medline].

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  14. Ghio AJ, Kennedy TP, Schapira RM, Crumbliss AL, Hoidal JR. Hypothesis: is lung disease after silicate inhalation caused by oxidant generation?. Lancet. Oct 20 1990;336(8721):967-9. [Medline].

  15. Graham WGB. Quartz and silicosis. In: Banks D, Parker J, eds. Occupational Lung Disease: An International Perspective. New York, NY: Chapman & Hall Medical; 1998:191-212.

  16. Hertzberg VS, Rosenman KD, Reilly MJ, Rice CH. Effect of occupational silica exposure on pulmonary function. Chest. Aug 2002;122(2):721-8. [Medline].

  17. Lapp NL. Pulmonary function and disability. In: Banks D, Parker J, eds. Occupational Lung Disease: An International Perspective. 1998. New York, NY: Chapman & Hall Medical; 1998:17-34.

  18. McDonald JC, McDonald AD, Hughes JM, Rando RJ, Weill H. Mortality from lung and kidney disease in a cohort of North American industrial sand workers: an update. Ann Occup Hyg. Jul 2005;49(5):367-73. [Medline].

  19. National Archives and Records Administration. United States code of federal regulations. 1910.1000. Office of the Federal Register, National Archives and Records Administration; 1994.

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

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  22. Wagner GR. Screening and surveillance of workers exposed to mineral dusts. Geneva, World Health Organization. 1996.

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Further Reading

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Keywords

silicosis, pneumoconiosis, pneumoconioses, fibronodular lung disease, work-related illness, mining illness, mining, tunneling, quarrying, drilling, crushing stone, chipping, grinding, sandblasting, cement manufacturing, building construction, occupational hazard, cutting bricks, manufacturing bricks, silica dust, silica exposure

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Contributor Information and Disclosures

Author

Basil Varkey, MD, FCCP, Professor, Department of Internal Medicine, Division of Pulmonary and Critical Care, Medical College of Wisconsin; Consulting Pulmonologist, Froedtert Memorial Lutheran Hospital
Basil Varkey, MD, FCCP is a member of the following medical societies: American Association of Physicians of Indian Origin, American College of Chest Physicians, American Federation for Clinical Research, American Thoracic Society, and Royal College of Physicians
Disclosure: Nothing to disclose.

Coauthor(s)

Anita B Varkey, MD, Assistant Professor, Department of Medicine, Loyola University Medical Center; Associate Program Director, Internal Medicine Residency; Medical Director, General Internal Medicine Clinic, Loyola Outpatient Center
Anita B Varkey, MD is a member of the following medical societies: American College of Physicians and Society of General Internal Medicine
Disclosure: Nothing to disclose.

Medical Editor

Gregory Tino, MD, Director of Pulmonary Outpatient Practices, Associate Professor, Department of Medicine, Division of Pulmonary, Allergy, and Critical Care, University of Pennsylvania Medical Center and Hospital
Gregory Tino, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and American Thoracic Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Om Prakash Sharma, MD, FRCP, FCCP, DTM&H, Professor, Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Southern California Keck School of Medicine
Om Prakash Sharma, MD, FRCP, FCCP, DTM&H is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American College of Chest Physicians, American College of Physicians, American Federation for Medical Research, American Osler Society, American Thoracic Society, New York Academy of Medicine, and Royal Society of Medicine
Disclosure: Keck School of Medicine, USC None None

CME Editor

Timothy D Rice, MD, Associate Professor, Departments of Internal Medicine and Pediatrics and Adolescent Medicine, Saint Louis University School of Medicine
Timothy D Rice, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Physicians
Disclosure: Nothing to disclose.

Chief Editor

Zab Mosenifar, MD, Director, Division of Pulmonary and Critical Care Medicine, Director, Women's Guild Pulmonary Disease Institute, Executive Vice Chair, Department of Medicine, Cedars Sinai Medical Center; Professor of Medicine, David Geffen School of Medicine at UCLA
Zab Mosenifar, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Federation for Medical Research, and American Thoracic Society
Disclosure: Nothing to disclose.

 
 
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