Occupational Pneumoconioses

The occupational pneumoconioses are diffuse parenchy-mal lung diseases caused by airborne exposure to inorganic materials such as asbestos, silica, and coal dust. In 1998 and 1999, asbestosis passed coal workers' pneumoconiosis (coal miner's lung) as the leading cause of death from occupational pneumoconiosis in the United States. Men accounted for 98% of these deaths. The rise in deaths caused by asbestosis is illustrated in Figure 18-10 (NIOSH, 2004b). Other occupational lung diseases are linked to heavy metal dust or fumes in specific syndromes such as berylliosis (beryllium) and stannosis (tin). Byssinosis, or brown-lung disease, occurs most often among workers in yarn, thread, and fabric mills from exposure to cotton dust.

Patients with occupational pneumoconioses may first develop symptoms of cough and dyspnea, with signs of small-airway disease or overt airway obstruction on pulmonary function testing. As the disease progresses, patients may also develop spirometric evidence of restrictive lung disease as well as chest x-ray changes. Removing the patient from the exposure or workplace is the most important step for preventing progression of disease. These pneumoconioses respond poorly to corticosteroids. Smoking significantly worsens the progression of occupational pneumoconiosis (Wang and Christiani, 2000).

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