Silicosis overview

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Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Silicosis from other Diseases

Epidemiology and Demographics

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Natural History, Complications and Prognosis

Diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

  • Silica is the second most common mineral on earth. It is found in sand, many rocks such as granite, sandstone, flint and slate, and in some coal and metallic ores. The cutting, breaking, crushing, drilling, grinding, or abrasive blasting of these materials may produce fine silica dust. It can also be in soil, mortar, plaster, and shingles. Inhalation of one of the forms of crystalline silica, most commonly quartz causes silicosis. It is due to the deposition of fine dust (less than 1 micrometre in diameter) in the lungs.
  • Silicosis is seen among sandblasters, underground miners, foundry and quarry workers, and in other dust-exposed trades.
  • The induction period between initial silica exposure and development of radiographically detectable nodular silicosis is usually 10 years. Shorter induction periods are associated with intense exposures, and acute silicosis may develop within 6 months to 2 years following massive silica exposure.

Historical Perspective

Pathophysiology

Classification

Silicosis is classified into five categories: Simple chronic, Complicated chronic, Interstitial Pulmonary Fibrosis, Acclerated silicosis, and Acute silicosis.

Causes

  • Silicosis is caused by the inhalation of crystalline silica, including quartz, cristobalite, and trimidite.
  • Of all three, quartz is most abundant and is frequently associated with the development of silicosis upon prolonged exposure and/or exposure at extremely high concentrations

Differential Diagnosis

Silicosis must be differentiated from other diseases that cause cough, dyspnea, pulmonary nodules and fibrosis seen on chest x-ray such as asbestosis, tuberculosis, aspergillosis and pulmonary malignancy.

Epidemiology and Demographics

  • Protective measures such as respirators have brought a steady decline in death rates due to silicosis in Western countries. Unfortunately, this is not true of less developed countries where work conditions are poor and respiratory equipment is seldom used.

Risk Factors

Natural History, Complications and Prognosis

  • Silicosis develops very slowly in most cases. Often decades elapse in progression to clinical disease from the beginning. Usually starts as Simple silicosis and progress further after not less than 10 years of exposure to silica. Accelerated silicosis is a variant of silicosis occurred due to intense exposure to silica for 5-10years. All forms of silicosis can progress in the absence of continued exposure.
  • Tuberculosis, mycosis , pneumothorax are the complications of silicosis.

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

Other Diagnostic Studies

  • Other diagnostic studies, such as Pulmonary function tests, spirometry, bronchoscopy and lung biopsy, are not always necessary but may be required for the diagnosis of silicosis in the minority of patients, with no significant history of exposure and to differntiate silicosis from other diseases.

Treatment

Medical Therapy

Primary Prevention

  • Prevention of silicosis is by identification of work-place activities with high concentrations of crystalline silica dust and elimination or control of the exposure. Early intervention with the control or cessation of adverse exposures may result in reversal of symptoms and airflow limitation.

References

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