Approach
Treatment of chronic silicosis, coal workers' pneumoconiosis, and chronic beryllium disease is the same as for other chronic lung diseases. Depending on the degree of impairment, patients may benefit from oxygen therapy, pulmonary rehabilitation, and, if obstruction is present, bronchodilator and possibly inhaled corticosteroid therapy. Oral corticosteroid therapy is used in the treatment of chronic beryllium disease. No clinical trials have been conducted of anti-fibrotic medications such as nintedanib and pirfenidone, and they are not approved for the treatment of any pneumoconioses in the US.
Acute secondary alveolar proteinosis (acute silicosis) or acute berylliosis is rare in developed countries. Acute secondary alveolar proteinosis is treated with lung lavage, and acute berylliosis with oral corticosteroid therapy.
Chronic silicosis, coal workers' pneumoconiosis, and chronic beryllium disease: general interventions
Important measures that are specific to people with pneumoconiosis include:
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Occupational measures to remove patients from further exposure and ensure a review of workplace controls
In the US, some states require cases of pneumoconiosis to be reported to the state health department.
The other interventions are the same as those for any patient with chronic lung disease. Given the increased severity of lung disease and the risk of cancer associated with the interaction between cigarettes and mineral dusts, the most important physician intervention is to ensure that the patient stops smoking. Progressive reduction in exercise capacity is observed, and pulmonary rehabilitation is recommended for patients who develop exertional dyspnoea.[50] This is a structured exercise programme that aims to improve exercise capacity, reduce dyspnoea, and improve quality of life.[50][51]
Patients with pneumoconiosis with a PaO₂ of 55 mmHg or less, or an oxygen saturation of 89% or less, are candidates for continuous oxygen therapy. Oxygen may just be used at night if desaturation only occurs during sleep. There are no studies concerning continuous oxygen that are specific to pneumoconiosis patients. Oxygen therapy improves exercise tolerance and reduces the risk of developing pulmonary hypertension and cor pulmonale.[52]
Complications require specific management. One of the most common complications is COPD. Treatment with bronchodilators and inhaled corticosteroids should be started as appropriate. See Chronic obstructive pulmonary disease.
Patients with chronic end-stage lung disease who have a high risk of death (>50%) within 2 years without lung transplant and a high likelihood of 5-year survival (>80%) following lung transplant are potential transplant candidates.[53] Absolute contraindications include active TB infection,active substance abuse (including use of tobacco and electronic cigarettes), progressive cognitive impairment, and repeated episodes of non-adherence.[53] Relative contraindications include age >70 years and extremes of weight (BMI <16 kg/m² or >35 kg/m²).[53] The indications, complications, and contraindications are the same as for other chronic lung diseases. Major complications include graft failure and development of bronchiolitis obliterans. There is an increased risk of hypertension, diabetes, dyslipidaemia, renal dysfunction, and infection from the immunosuppressive medication.
Chronic beryllium disease: oral corticosteroids
The use of corticosteroids or other immunosuppressants is not recommended for management of silicosis or coal workers' pneumoconiosis, but oral corticosteroids are used in the treatment of chronic beryllium disease. Follow-up should occur at 3-month intervals to assess changes in pulmonary function results and radiographic studies. Doses are titrated in response to symptoms, pulmonary function, and radiographic test results over many years. There are no clinical trials on the use of oral corticosteroids in chronic beryllium disease. However, there are case series data.[54] Bisphosphonates have been used in patients taking long-term corticosteroid therapy, for the prevention of osteoporosis.
Acute berylliosis and acute secondary alveolar proteinosis (acute silicosis)
These conditions are rare in the US. Acute berylliosis presents with an acute pneumonitis and should be managed with oral corticosteroid therapy (same doses as for chronic beryllium disease). The dose can gradually be tapered as the patient's condition improves. Acute secondary alveolar proteinosis (acute silicosis) can occur within weeks to months of extremely high exposure and causes severe life threatening symptoms. It is managed with lung lavage.[55]
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