What are the key clinical features to consider when diagnosing pneumoconiosis in a patient with occupational exposure to dust?

Key clinical features to consider when diagnosing pneumoconiosis in a patient with occupational dust exposure include:

• History of occupational exposure: A detailed occupational history identifying prolonged or intense exposure to dusts such as coal, silica, or asbestos is essential, as pneumoconiosis is directly related to inhalation of mineral dusts NICE NG12 Hua et al. 2023.
• Respiratory symptoms: Patients commonly present with progressive exertional dyspnoea and chronic cough, often without sputum production, reflecting the fibrotic lung changes NICE NG12 Kim et al. 2001.
• Physical examination findings: May reveal bibasal crackles on auscultation and, in advanced cases, signs of cor pulmonale such as peripheral oedema NICE NG12 Flors et al. 2010.
• Radiological features: Chest X-ray and high-resolution CT scans typically show small, rounded opacities or nodules predominantly in the upper lung zones for coal workers’ pneumoconiosis and silicosis, or pleural plaques and fibrosis in asbestosis NICE NG12 Kim et al. 2001Flors et al. 2010.
• Pulmonary function tests: Usually demonstrate a restrictive pattern with reduced lung volumes and impaired gas transfer, consistent with interstitial fibrosis NICE NG12 Hua et al. 2023.
• Exclusion of other causes: It is important to exclude other interstitial lung diseases and malignancies, especially in patients with risk factors such as smoking NICE NG12.

Integrating UK guideline recommendations with recent literature emphasizes the importance of combining clinical, occupational, radiological, and functional assessments to establish the diagnosis of pneumoconiosis accurately Kim et al. 2001Hua et al. 2023.