HOW TO DIAGNOSE

PNEUMOCONIOSIS

Faisal Yunus

Department of Pulmonology and Respiratory

Medicine, Faculty of Medicoine University of
Indonesia-Persahabatan Hospital, Jakarta
INTRODUCTION
Pneumoconiosis is is an occupational
lung disease and a restrictive lung
disease caused by the inhalation of
dust, often in mines.
 TYPE OF
PNEUMOCONIOSIS
• Depending upon the type of dust, the
disease is given different names:
• Coalworker's pneumoconiosis (also
known as "black lung" or anthracosis)
- coal, carbon
• Asbestosis - asbestos
• Silicosis (also known as "grinder's
disease") - silica
TYPE OF PNEUMOCONIOSIS
• Bauxite fibrosis - bauxite
• Berylliosis - beryllium
• Siderosis - iron
• Byssinosis - cotton
• Silicosiderosis - mixed dust containing silica
and iron
• Labrador Lung (found in miners in Labrador,
Canada) - mixed dust containing iron, silica
and anthophyllite, a type of asbestos
• Phyriphillitosis - Clay
 DIAGNOSIS
Dificult to establish, because of:
~ Symptoms and sign are simlar to other
pulmonary diseases that ot related to
work
~ Need a long period between exposure
and disease
 DIAGNOSIS
 Anamnesis
 Pysical examination
 Chest Radiograph
 Lung function test
 ANAMNESIS
Should be detailed and complete
 History of work: - type of work
- duration
- previous working
 Agents in he work place
 Personal protection devices
 Other worker’s status of health
 Environmental history
FACTORS OF ENVIRONMENTAL
AND WORKING HISTORY

 Present illness:
~ Symptoms that related to work
~ Other workers with similar symptom
~ Dangerous exposure
~ History of working accident
 Working history: all previous working
 Work place:
~ Ventilation, industrial hygiene
~ Personal protection devices
 Previous working history
~ Exposure
~ Radiation
 Environmental history
~ House
~ Air pollution
~ Other occupation
~ Use of pesticide
~ Dangerous waste
 PHYSICAL EXAMINATION
In the early disease physical examination may
be normal

In advance disease some abnormalities may

be found
~ Dyspnea
~ Cyanosis
~ Clubbing fingers
~ Wheeze
~ Cracles
CYANOSIS AND CLUBBING
FINGER
 CHEST RADIOGRAPH
 ILO Classification
 Can be normal in Byssinosis and
early asbestosis
 Small opacities
 Large opacities
3/3 q/q
A
B
C
 LUNG FUNCTION TEST
• Spirometry is the most common lung
function test: - simple
- easy to perform
- accurate
- reproducible
• Other test if necessary:
- Diffusion lung capacity (DLCO)
- Cardio pulmonary exercise test
(CPX)
Spirometry Flow Volume Curve
OBSTRUCTION
RESTRICTION
 COAL WORKER’s
PNEUMOKONIOSIS

Coal dust inhalation > 10 years

Simple coal workers pneumoconiosis
 Minimal symptoms
 Small opacities
 Normal spirometry or VEP1 
 COAL WORKER’S
PNEUMOKONIOSIS
Complicated coal workers pneumoconiosis
 Progressive Massive Fibrosis

Factors:
 Free silica
 High concentration of dust
 Mycobacterium infection
 Poor immunology
 COMPLICATED COAL
WORKERS PNEUMOKONIOSIS
~ Fibrosis ~ KV  ~ Restriction
~ Emphysema ~ VEP1 ~ Obstruction

Symptoms:
 Melanoptysis
 Cough
 Dyspnea
 Cor pulmonale
 Respiratory failure
 SILICOSIS
 Silica dust inhalation
 The most common pneumoconiosis
disease, because many workplaces
containing of silica dust
3 types : - Chronic Silicosis
- Accelerated Silicosis
- Acute Silicosis
 SILICOSIS
 Silica dust inhalation
~ Coal and metal mine
~ Ceramic and coal industry
~ Stone cutting, sculptor, polisher
~ Tunnel excavation
~ Steel casting
~ Dental enamel establish
~ Cement factory
~ Sandpaper factory
~ Glass maker
~ Miner, potter
 CLINICAL SYMPTOMS
• Dyspnea
• Severe cough
• Wheezing
• Chest pain
• Tachypnea
• Prolong expiration
• Crackles
• Clubbing fingers
• Cyanosis on severe cases
 CHRONIC SILICOSIS
 20 – 45 years of inhalation
 The most common type

~ Spirometry : restriction, obstruction

~ Radiology : Eggshell calcification
~ Tuberculosis infection
silicotuberkulosis
 Proses pemotongan batu
 Dinding beton yg retak
 Pengeboran batu
 Finishing drywall
 Power drilling
 wrecking
SILICOSIS – COAL MINING

SILICOSIS - SANDBLASTING
SILICOSIS – FOUNDY WORK
SILICOSIS – STONE CUTTING
SILICOSIS – TUNNEL CONSTRUCTION
 CHEST RADIOGRAPH

Silikosis simpel kronik Silikosis simpel dengan Konglomerasi di lobus

eggshel Calcification. atas kanan
 HRCT.

Laki-laki 73 tahun bekerja

di industri granit. Penderita
mengeluh sesak.
Pada foto toraks hasil normal.
HRCT menunjukkan gambaran
opasitas dengan perfusi
rendah, dan juga didapatkan
multipel bilateral subpleural
nodul yang tipikal silikosis.
 BYSSINOSIS
 Acute and chronic airway disease
 Cotton, jute workers
 Cest tighness, wheeze and dyspnea
during working
 Monday chest tightness or Monday
fever
 BYSSINOSIS
 Normal chest radiograph
 Spirometry may be normal or obstruction
 Normal diffusion capacity
 Symptoms develop on the first day of
working, the second day and the
following day
 continuing exposure, worsening of
symptoms
 ASBESTOSIS
 Inhalation of asbestos dust :
~ Mining
~ Milling
~ Transportation
~ Packing
Stop exposure disease continoue
Often cause bronvhial cancer, mesothelioma
 ASBESTOSIS
 Symptoms:
~ Progressive dyspnea
~ Cough
~ Loss of body weight
~ Cor pulmonale
 Lung function test :
~ Obstruction
~ Decrease of lung diffusion capacity
 PENYAKIT AKIBAT ASBES
1. Asbestosis.
2. Benign asbestos pleurisy.
3. Pleural plaque.
4. Diffuse pleural thickening.
5. Rounded atelectasis
6. Malignant mesothelioma.
7. Bronchogenic carsinoma.
8. Benign nodule.
 CONCLUSIONS
• Pneumoconiosis is the occupational
pulmonary disease caused by inhalation of
dust in the work place
• Diagnosis of pneumoconiosis is established
based on detailed anamnesis, physical
examination, chest radiograph and lung
finction test
• Signs and symptoms are similar to otjher lung
diseases
• Certain work place that related to specific
agents should be determined
FY