Diagnosis of Silicosis

Your work history is a critical piece of information in diagnosing silicosis. Before an appointment, it can help to have the following ready, per the American Lung Association:

• The type of work you’ve done throughout your career, including how long you spent at each job
• The materials and products you worked with and what protective equipment, if any, you used
• Your history of tobacco use, if any
• When your symptoms started and how they’ve changed

Because occupational lung disease isn’t something every doctor sees often, being specific about your work history can make the difference between an accurate diagnosis and a delayed one. In other words, if you work in an industry associated with high silica exposure, such as artificial stone fabrication, you should let your doctor know about it.

Once a doctor has your history, several tests can help confirm silicosis, according to the American Lung Association. In addition to imaging tests, like a chest X-ray or HRCT scan, your doctor may also do the following tests:

• Lung function tests, which measure how well your lungs move air and oxygen
• Sputum culture, examining the mucus you cough up
• Bronchoscopy, using a small camera to look inside your airways and collect tissue samples
• Lung biopsy, collecting a tissue sample for closer examination
• Bronchoalveolar lavage, which rinses the lungs and examines the fluid

Lab tests alone can’t diagnose silicosis, but they help rule out other conditions that cause similar symptoms.

Silicosis symptoms can look like other, more common conditions, which is part of why diagnosis often takes longer than it should. In a study of California engineered stone workers, delayed diagnoses were most often caused by an initial, incorrect diagnosis of:

• Bacterial pneumonia
• Tuberculosis

According to the study published in JAMA Internal Medicine, nearly 40 percent of patients already had advanced disease by the time silicosis was correctly identified.

Accelerated and chronic silicosis actually look the same on a scan. What tells them apart is how long someone was exposed to silica dust, according to the CDC’s National Institute for Occupational Safety and Health:

• Acute silicosis develops after a few weeks or months of very high exposure and can cause severe illness quickly
• Accelerated silicosis develops after 5 to 10 years of high exposure
• Chronic silicosis, the most common type, develops after 10 or more years of lower level exposure

Because accelerated and chronic silicosis can be indistinguishable on imaging, a worker’s exposure history is often what allows a doctor to diagnose the right one.

Once silicosis is diagnosed, treatment focuses on managing symptoms and slowing how the disease progresses. There is no cure. Depending on how advanced the disease is, treatment can include medication, oxygen therapy, pulmonary rehabilitation, and in severe cases, evaluation for a lung transplant.