NP Medical News about Silicosis

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A tile factory worker presenting with breathlessness and dry cough
Australian Family Physician, 10/07/09

Khajotia R et al. – This case is a pertinent reminder that ‘all that wheezes is not asthma’. Occupational exposures are particularly important in respiratory disease. Factors in assessment include: duration of exposure (eg. years, days per week), type of activity/exposure, use of personal protective equipment (particularly mask, respirators and filters) and workplace air monitoring for particulate matter. Management of chronic nodular silicosis includes changing occupation to prevent further exposure to silica dust, immunisation against influenza and pneumococcal pneumonia, and monitoring for tuberculosis (silica appears to interfere with immunity). There are no specific therapies although some studies show improved spirometry with corticosteroids. Treatment of complications such as airway obstruction, cor pulmonale and respiratory failure is also important, and lung transplant has been successful.

Exclusive Author Commentary
Rumi Khajotia, 10/11/09

Silicosis is an occupational lung disease which usually presents with reticular shadowings and small nodular lung opacities, particularly in the upper and middle lung zones. Multiple, large, calcific nodules showing the typical "egg-shell" calcification (calcification at the rim of the nodes) is a rare radiological finding. Moreover, these patients may present with multiple non-specific symptoms such as slowly progressive breathlessness and dry cough. Clinical examination in such patients may also not be indicative of a specific diagnosis. Hence, history of occupational exposure is particularly vital in arriving at an accurate diagnosis in respiratory diseases, particularly if the patient also has atypical chest radiographic findings.

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