Current Concepts in Pathogenesis, Diagnosis, and Management of Silicosis and Its Subtypes

Abstract

Pneumoconiosis due to silicosis is still present due to modern industries such stone carving, garment industry, and road construction. We aim to discuss how to accurately diagnose silicosis, appropriately risk stratify patients with silicosis, and discuss potential new pharmacotherapies that may be of potential use in the future. Acute silicosis, chronic silicosis, and accelerated silicosis are 3 distinct clinical categories. Acute silicosis is the least common form and occurs with high exposures of silica dust in a short time frame. Patients with prolonged exposures at low concentrations have the highest risk of developing chronic silicosis. Chronic silicosis is the classic presentation of silicosis with a slow onset of symptoms. Accelerated silicosis has an earlier onset than chronic silicosis and presents within 5 to 10 years of exposure. Chronic silicosis and accelerated silicosis can lead to progressive massive fibrosis, which is silica nodules merging together with associated fibrosis. Based on cumulative dose, patients with silica exposure had an independent increased risk of developing lung cancer, with an additional cumulative risk among smokers. Lung transplant should be considered in patients with silicosis who develop severe lung disease. There is no current role for any pharmacological agents in silicosis; however, there is ongoing research to identify possible pharmacological agents. The diagnosis of silicosis is made based on occupational history, appropriate radiographic findings, and exclusion of other potential etiologies. Prevention of silica dust exposure remains crucial to reduce damage to the lungs.