Update on respiratory disease from coal mine and silica dust

Excessive exposure to coal, coal mine, and silica dust causes a variety of pathological responses in susceptible hosts, including pulmonary fibrosis or pneumoconiosis and chronic obstructive pulmonary disease and their resultant restrictive, obstructive, or mixed pattern pulmonary function impairments. For many years, much of the discussion on the respiratory health effects of exposure to these dusts was restricted to the fibrosing pulmonary tissue reactions in response to retained dust. It excluded other reactions of the pulmonary parenchyma and airways to the dust, which are extremely important, and can result in significant impairment in sensitive individuals. This article discusses the broad spectrum of pulmonary toxicity to these inorganic dusts, clinical evaluation, and management of patients with respiratory disease from dust exposure, as well as the association between silica exposure and an increased risk of pulmonary malignancy.