silicosis

Florian Tiefenböck studied human medicine at the LMU Munich. In March 2014, he joined as a student and has supported the editorial team with medical articles ever since. After receiving his medical license and practical work in internal medicine at the University Hospital Augsburg, he has been a permanent member of the team since December 2019 and, among other things, ensures the medical quality of the tools.

More posts by Florian Tiefenböck All content is checked by medical journalists.

Silicosis (quartz dust lung) is one of the pneumoconiosis diseases. It occurs when someone breathes quartz dust into their lungs over a long period of time. This scarred the lung tissue. Cough, shortness of breath and a tendency to develop respiratory infections are the consequences. A cure is not possible. Find out here how silicosis develops and how it can be prevented.

ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. J62

Silicosis: description

Silicosis is a scarred change in the lung tissue. It occurs when quartz dust is inhaled and settles in the lungs. Quartz is the main component of the earth's crust. But it can also be found in connection with other substances such as magnesium, iron or aluminum. These so-called silicate salts do not cause silicosis, but can also cause minor lung scarring.

Occupational disease

In some professions you are exposed to increased exposure to quartz dust. Silicosis is therefore one of the occupational diseases. The decisive factor is how long and to what extent a person is / was exposed to the dust. In particular, ore and coal miners are more likely to find so-called mixed dust - that is, lung diseases that result from inhaling different types of dust. Some mixed dust can be traced back to both quartz and iron dust. In addition, other minerals that are rich in silica (e.g. talc) are also a source of danger.

If a worker is diagnosed with silicosis, professional and medical measures are taken to relieve the person's symptoms. If, despite these measures, the sick person has permanent physical impairment and is no longer able to work, a pension is paid.

Progressive forms of silicosis

Doctors differentiate between different forms of silicosis (quartz dust lung) depending on the course:

• chronic silicosis: This is the most common form of quartz dust. The typical symptoms develop here only decades (often ten to 30 years) after the first inhalation of quartz dust.
• Accelerated (accelerated) silicosis: This less common form can occur if a large amount of quartz dust is inhaled. The first signs of silicosis appear after four to nine years. The risk of complications and severe, progressive pulmonary fibrosis is increased.
• Acute silicosis: It can develop if someone inhales an enormous amount of quartz dust in a very short period of time. Symptoms of the disease become noticeable just a few weeks to years later. Thanks to improved occupational health and safety measures, this form of silicosis no longer occurs in Germany.

Silicosis: symptoms

The signs of silicosis can appear within a few months or only after years or decades, depending on the course. In general, the shorter the period between exposure to quartz dust and the onset of the first symptoms, the more severe the symptoms.

Chronic silicosis

Over time, the lung tissue hardens through scarred remodeling processes. The scarred lungs are less flexible and can no longer develop as easily. However, many patients have little or no symptoms for a long time. Unspecific respiratory problems such as coughing appear. Gradually, shortness of breath (dyspnea) also becomes noticeable - at first only during physical exertion, later also at rest. Chest pain is often added.

In the later course of a silicosis, some sufferers complain of a dark sputum. It occurs when the pitted tissue containing quartz dust dies, which softens and is coughed up. The lack of oxygen as a result of impaired lung function can manifest itself in a bluish discoloration of the ends of the fingers and lips.

Accelerated Silicosis

The clinical picture is the same as in chronic silicosis. However, the symptoms develop over a shorter period of time.

Acute silicosis

In this form of silicosis, symptoms such as shortness of breath, exhaustion and weight loss appear within a few weeks or years, and they increase rapidly. There is also a cough and chest pain. As with the other forms - only faster - oxygen deficiency can occur in the body, which is noticeable in a bluish discoloration of the skin and mucous membranes (cyanosis).

Silicosis: causes and risk factors

Silicosis occurs when quartz dust is inhaled and settles in the lung tissue - primarily in the alveoli. The inhaled particles must have a certain size of around 0.5 to five micrometers in order not to be caught by the upper respiratory tract (e.g. nose). In addition, a certain amount of dust in the air is decisive for the development of silicosis.

Ore and hard coal miners, tunnel builders, cast cleaners (cleaning and smoothing of castings), sandblasters, furnace masons, dental technicians and people who extract, process or manufacture metal, glass, stone, clay and glass ceramics are particularly at risk for a quartz dust lung. Activities such as grinding, pouring or scrubbing increasingly release quartz dust into the ambient air and thus considerably increase the risk of developing silicosis.

The inhaled quartz dust activates the cells of the immune system in the lung tissue. White blood cells (leukocytes) such as phagocytes migrate into the tissue and try in vain to break down the quartz dust. The tissue becomes inflamed and the lung tissue becomes scarred.

Silicosis: examinations and diagnosis

If you have any symptoms of SI liqueur, you should contact an occupational or company physician. In an initial conversation, the doctor will collect your medical history (anamnesis) and also try to estimate how likely you are to have silicosis. Among other things, he asks the following questions:

• What complaints do you have and how long have they existed?
• What is your profession? How long have you been working in this job?
• What was your job before your current position?
• Do you have to breathe dust in the workplace?
• Have you carried out any particulate matter measurements at your workplace?
• Are there protective measures in your workplace such as wearing a protective mask or goggles?

After the consultation with the doctor, there will be a physical examination. Above all, the doctor will hear and knock your lungs. Inflammation - especially in acute silicosis - causes more fluid to collect in the lung tissue. This means that noises can be heard that are reminiscent of bubbles. They occur when the air you breathe flows through accumulations of fluid (mucus, secretion) in the airways.

Imaging of the chest by means of an X-ray examination (chest X-ray) or computed tomography (chest CT) is important for the diagnosis. Characteristic changes in the lungs can be seen in the case of silicosis.

Silicosis is diagnosed when exposure to quartz dust is secured in the workplace and typical changes are visible in the x-ray or computer tomogram of the lungs.

There are also other studies that can be informative:

• Examination of coughed up secretions (sputum): This can help differentiate silicosis from some other diseases (such as cancer).
• Pulmonary function test: It is used to monitor the progress.
• Taking and analyzing a tissue sample from the lungs (lung biopsy): This examination is sometimes necessary to confirm the diagnosis of SIlikosis.
• Blood tests: In some patients, certain autoantibodies (ANA) and rheumatoid factors can be detected in the blood, which can indicate that they may also have a rheumatic connective tissue disease (such as rheumatoid arthritis). Further research is needed to confirm this.

Silicosis: treatment

Silicosis cannot be cured: the progression of the underlying lung scarring (pulmonary fibrosis) cannot be influenced therapeutically. In any case, you should avoid inhaling quartz dust again, especially in the early stages of the disease.

Medicines such as bronchodilators (bronchodilators) can also be used to try to relieve symptoms. Some people with acute or accelerated silicosis do well to take cortisone; with others, however, this remains ineffective.

Sometimes doctors recommend lung lavage (bronchoalveolar lavage). This involves filling the lungs with saline solution and then sucking it off again - together with substances in the airways.

The last treatment option is the insertion of a donor lung (lung transplant).

Additional infections of the respiratory tract caused by bacteria or fungi are treated with antibiotics or antimycotics so that the lung function is not further restricted.

Silicosis: disease course and prognosis

The prognosis for silicosis depends largely on the onset of its symptoms. Acute silicosis usually ends with death. The blame is the rapidly advancing weakness of breath. Chronic silicosis, on the other hand, usually only breaks out decades after exposure to quartz dust. As a result, the underlying pulmonary fibrosis rarely shortens the lives of those affected. However, silicosis usually worsens over time.

Complications and secondary diseases

Various complications and secondary diseases can occur in the context of silicosis.

Silicosis and tuberculosis

Silicosis patients are prone to respiratory infections. They have an approximately 30-fold increased risk of developing tuberculosis (TB). If doctors can detect both silicosis and active tuberculosis, they speak of silicotuberculosis. If the person concerned had a previous TB infection, this can be reactivated by the quartz dust particles.

Chronic obstructive bronchitis and pulmonary emphysema

In addition, quartz dust can cause other clinical pictures that make breathing difficult. Chronic inflammation of the respiratory tract is particularly common among coal miners. The respiratory tract can no longer free itself sufficiently from the quartz dust. This triggers inflammation, as a result of which more mucus is produced. The windpipe narrows (chronic obstructive bronchitis), which is why those affected can no longer breathe out the air properly. As a result, some areas of the lungs remain "over-inflated" (pulmonary emphysema).

Cor pulmonale

Due to the hardened lung tissue in the case of silicosis, the right ventricle has to use more force to pump the blood through the pulmonary vessels. To cope with this increased load, the walls of the right ventricle thicken and the ventricle itself expands. Nonetheless, the right heart is overloaded and damaged in the long run - the result is heart failure (more precisely: right heart failure). Because it is based on an increased flow resistance in the pulmonary circulation, doctors speak of "pulmonary heart" (cor pulmonale).

Signs of a "pulmonary heart" include fluid retention in the legs and protruding neck veins. Because the heart also builds up blood in the liver and other organs, these can also be damaged.

Other secondary diseases

The risk of lung cancer in silicosis patients is twice as high as in people without fumed silica. The risk of connective tissue diseases of the whole body is also increased. The so-called Caplan syndrome is a medical specialty. It is a combination of silicosis and chronic joint inflammation (chronic polyarthritis, rheumatoid arthritis). This clinical picture also occurs more and more among coal miners.

Silicosis: prevention

Due to the lack of therapeutic options for silicosis, prevention is extremely important. As mentioned, the disease is mostly the result of occupational exposure to quartz dust. Therefore, work safety measures must be carefully observed. Moist drilling and well-ventilated mining tunnels with an expanded extraction system reduce the amount of quartz dust in the air we breathe. The latter also plays a major role in the processing industry (e.g. ceramics, glass). In any case, it is crucial to wear protective masks against fine dust. As with all high-risk professions, it is advisable to take part in the preventive medical check-ups. This is the only way to detect and treat silicosis at an early stage.

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