There are three key elements to the diagnosis of silicosis. First, the patient history should reveal exposure to sufficient silica dust to cause this illness. Second, chest imaging (usually chest x-ray) that reveals findings consistent with silicosis. Third, there are no underlying illnesses that are more likely to be causing the abnormalities. Physical examination is usually unremarkable unless there is complicated disease. Also, the examination findings are not specific for silicosis. Pulmonary function testing may reveal airflow limitation, restrictive defects, reduced diffusion capacity, mixed defects, or may be normal (especially without complicated disease). Most cases of silicosis do not require tissue biopsy for diagnosis, but this may be necessary in some cases, primarily to exclude other conditions.
Pulmonary complications of silicosis also include Chronic Bronchitis and airflow limitation (indistinguishable from that caused by smoking), non-tuberculous Mycobacterium infection, fungal lung infection, compensatory emphysema, and pneumothorax. There are some data revealing an association between silicosis and certain autoimmune diseases, including nephritis, Scleroderma, and Systemic Lupus Erythematosus, especially in acute or accelerated silicosis.
Silicosis (particularly the acute form) is characterized by shortness of breath, cough, fever, and cyanosis (bluish skin). It may often be misdiagnosed as pulmonary edema (fluid in the lungs), pneumonia, or tuberculosis.
Silicosis resulted in 46,000 deaths globally in 2013 down from 55,000 deaths in 1990.[3]
Silica occurs in 3 forms: crystalline, microcrystalline (or cryptocrystalline) and amorphous (non-crystalline). "Free" silica is composed of pure silicon dioxide, not combined with other elements, whereas silicates (e.g. talc, asbestos, and mica) are SiO2 combined with an appreciable portion of cations.
When small silica dust particles are inhaled, they can embed themselves deeply into the tiny alveolar sacs and ducts in the lungs, where oxygen and carbon dioxide gases are exchanged. There, the lungs cannot clear out the dust by mucous or coughing.
exists in 7 different forms (polymorphs), depending upon the temperature of formation. The main 3 polymorphs are quartz, cristobalite, and tridymite. Quartz is the second most common mineral in the world (next to feldspar).[14]
Primary prevention of silicosis through exposure control is important, because no effective medical treatment exists for this disease, which continues to progress even after a person is removed from further exposure. To achieve this, a sustained effort must be made to increase awareness of silicosis.
The respiratory protection program should be evaluated regularly by the employer.
Immunosuppressive therapies have yielded varying results. A study using corticosteroids reported a 300-mL improvement in forced vital capacity (FVC); however, there was no sustained improvement or reduction in mortality. [ 49] Improvement in symptoms of dyspnea and cough also occurred, although the benefits were related to longer duration of silica exposure. [ 49] Animal model studies using Infliximab have shown a reduction in inflammation and fibrosis histopathologically; however, these findings have yet to be translated into human studies. [ 50]
Lung transplantation remains the only treatment option for end-stage silicosis. However, based on available data, patients with silicosis who underwent lung transplantation (4.9%) showed a nonstatistically significant survival advantage (hazard ratio: 0.6) compared to those undergoing lthe procedure for idiopathic pulmonary fibrosis (IPF).
Whole-lung lavage has previously been used for silicoproteinosis. Although the presence of dust particles, macrophages, and cytokines on bronchoalveolar lavage analyses decrease with whole-lung lavage, long-term outcomes, including mortality and pulmonary function parameters, have not demonstrated sustained improvement. [ 48]
Nintedanib, an antifibrotic therapy used in idiopathic pulmonary fibrosis (IPF), have been studied in animal models, but it has yet to be studied in human trials. [ 53] The Nintedanib in Progressive Pneumoconiosis Study (NiPPS), a prospective clinical pilot study evaluating occupational progressive pneumoconiosis (silicosis, coal pneumoconiosis, and asbestosis) with nintedanib 150 mg twice daily for 3 years, has not yet begun recruiting but has an expected start date of February 2020.
Once your doctor determines the degree of lung damage that has been done, they will be able to provide you with a treatment plan. This may include: 1 Using a bronchodilator to help relax your air tubes and decrease inflammation. 2 Quitting smoking as soon as possible. Smoking can increase the damage done by silica and speed up the progression of the disease. The American Lung Association offers proven-effective smoking cessation programs to give people trying to quit the support they need. 3 Supplemental oxygen may be prescribed to help you get more air into your lungs when needed. Though you may need it only while exercising at the beginning, as the disease progresses you may need it at all times. Learn more about oxygen therapy. 4 Pulmonary rehabilitation is an exercise program designed to help all patients with chronic lung conditions maintain optimal activity levels. 5 In very severe situations, your doctor may suggest surgery and refer you to a lung transplant specialist.
Quitting smoking as soon as possible. Smoking can increase the damage done by silica and speed up the progression of the disease. The American Lung Association offers proven-effective smoking cessation programs to give people trying to quit the support they need.
There is no cure for silicosis and once the damage is done it cannot be reversed. Treatment is focused on slowing down the progression of the disease and relieving symptoms. Avoiding further exposure to silica and other irritants such as cigarette smoke is crucial. Testing for tuberculosis is important because the disease tends to be more severe in ...
Managing Silicosis. To keep the disease from getting worse, all silicosis patients need to eliminate any more exposure to silica. Other lung irritants, such as indoor and outdoor air pollution, allergens and smoke, should also be avoided.