Another inhaled problem you can have causing
interstitial lung disease are the pneumoconiosis.
Now, this is a non-allergic response to an
inhaled substance, and tends to be dose response.
These substances tend to be those that you’re
exposed to by your occupation or industry.
So it is a dust or a mineral exposure. The
responses of fibrotic or an inflammatory response
and the actual disease you develop depends
on what substance you’re inhaling and the
amount of it you’re inhaling so you get
different patterns depending on these elements.
Recognition, again, does require a good occupational
history, and not just the job that the patient
is doing at the moment but also their previous
occupations as well, because patients may
present many years later after the exposure
with lung disease due to previous occupation
exposure. Now, probably the most important
example of pneumoconiosis is asbestosis which
is a pulmonary fibrosis that develops in people
who have inhaled a lot of asbestos. Actually,
clinically, it is identical to pulmonary fibrosis
and very difficult to distinguish but the
history will have--the patient will have
a history of significant asbestos exposure.
Asbestos exposure causes other damage to the
lung such as pleural plaques, pleural thickening
and effusions and an unusual form of pleural
cancer called mesothelioma, as well as increases
your risk of lung cancer. The other major
occupational problem is coal
dust exposure, which causes a COPD pattern,
a chronic obstructive pulmonary disease.
But also on the X-ray, you can see micronodular
infiltrates, and occasionally, this coal dust
to form what we call progressive massive fibrosis
with a destructive fibrotic disease affecting
the upper lobes of both lungs. And there are
many other types of dust inhaled minerals
that can cause lung disease of different patterns.
For example, silicosis can also cause micronodular
infiltrates and progressive massive fibrosis
just like coal dust. Even inhaled beryllium,
you may end up with disease which is relatively
similar to sarcoidosis.
Again, treatment for pneumoconiosis is to remove
the patient from exposure to that inhaled
dust or mineral. Otherwise, actually, treatment
options are limited. Medications do not seem
to help. Importantly, patients with significant
lung damage due to their occupation inhaling
dust and minerals are generally entitled to
financial compensation, and that’s a very
important thing for the patient to explore
as they may make their ability to cope with
their disability much better with a little
bit of financial help.