Coal workers' pneumoconiosis

Silicosis is a fibrotic occupational lung disease caused by inhaling crystalline silica dust, producing upper-zone nodular opacities and progressive dyspnea in exposed workers. Diagnosis rests on a compatible exposure history plus a characteristic imaging pattern. No agent reverses the fibrosis, so management is supportive: exposure cessation, oxygen for hypoxemia, vaccination, isoniazid prophylaxis for latent tuberculosis, and transplant evaluation for advanced disease.

Asbestos-related lung disease covers a spectrum from calcified pleural plaques and benign pleural effusion to progressive asbestosis (a fibrotic interstitial lung disease) and the malignancies bronchogenic carcinoma and mesothelioma, all following inhalational asbestos exposure with latencies of 10 to 40 years. Diagnosis rests on an occupational exposure history plus imaging showing a lower-lobe usual-interstitial-pneumonia pattern or calcified pleural plaques; management of asbestosis is supportive with smoking cessation and oxygen, while mesothelioma requires pleural biopsy and multidisciplinary oncologic staging.

Chronic beryllium disease is a noncaseating granulomatous lung disease caused by inhaled beryllium in aerospace, nuclear, electronics, ceramics, and dental-material workers, and it mimics sarcoidosis clinically and histologically. The beryllium lymphocyte proliferation test is the initial and diagnostic test. Treatment is removal from exposure plus chronic glucocorticoids, since it is the one interstitial lung disease that reliably responds to steroids.

Rheumatoid arthritis is a chronic systemic autoimmune disease causing symmetric small-joint polyarthritis of the hands and feet that spares the distal interphalangeal joints, with morning stiffness over an hour. Diagnosis combines the ACR/EULAR classification criteria with rheumatoid factor, anti-CCP antibody, and radiographs. Treat-to-target management anchors on methotrexate, escalating to a biologic or targeted synthetic disease-modifying antirheumatic drug when remission is not reached.

Chronic obstructive pulmonary disease is a persistent, usually progressive airflow obstruction driven mainly by cigarette smoke, confirmed by a postbronchodilator FEV1/forced vital capacity (FVC) ratio below 0.70 and staged by GOLD spirometric grade plus symptom/exacerbation group. Maintenance management is a stepwise ladder of smoking cessation, long-acting bronchodilators, add-on inhaled glucocorticoid, roflumilast, or azithromycin for frequent exacerbators, long-term oxygen for resting hypoxemia, and vaccination, with acute exacerbations managed as a separate protocol.

Cor pulmonale is right ventricular structural and functional impairment caused by group 3 pulmonary hypertension from chronic lung disease or hypoxemia. Diagnosis rests on echocardiographic screening confirmed by right heart catheterization, and management centers on treating the underlying lung disease, correcting hypoxemia, and cautious diuresis.

Pulmonary hypertension is a resting mean pulmonary artery pressure of 20 mmHg or greater on right heart catheterization, classified into five WHO groups by mechanism. Diagnosis requires screening echocardiography followed by confirmatory right heart catheterization, and management is group-specific, with PAH-targeted vasodilator therapy reserved for group 1 disease.

Tobacco use is the leading cause of preventable death in the United States, and every smoker should be asked about use at every visit and offered combined behavioral counseling plus pharmacotherapy, since neither alone matches the quit rate of both together. Varenicline is the most effective single agent, combination nicotine replacement therapy (long-acting patch plus a short-acting form) is equally first-line, and bupropion is an alternative, all started before a set quit date and continued for a 7- to 12-week course.

Sarcoidosis is a multisystem granulomatous disease of unknown cause defined by noncaseating granulomas, most commonly involving the lungs and hilar lymph nodes. Most patients are asymptomatic or have a self-limited course staged by chest radiograph; symptomatic organ-threatening disease is treated with systemic glucocorticoids, with methotrexate or another steroid-sparing agent added for glucocorticoid-refractory or glucocorticoid-intolerant disease.

Tuberculosis, caused by Mycobacterium tuberculosis, remains a leading global cause of infectious death and presents as latent infection, primary/secondary pulmonary disease, or extrapulmonary and disseminated (miliary) disease. Diagnosis rests on AFB smear, NAAT, and mycobacterial culture (the gold standard), and drug-susceptible active disease is treated with a four-drug regimen (isoniazid, rifampin, pyrazinamide, ethambutol) for 2 months followed by isoniazid plus rifampin for 4 to 7 months.

Idiopathic pulmonary fibrosis is a chronic, progressive fibrosing lung disease of unknown cause defined by a usual interstitial pneumonia (UIP) pattern, presenting with progressive dyspnea, dry cough, bibasilar Velcro crackles, and clubbing in older smokers. A definite UIP pattern on high-resolution CT confirms the diagnosis without biopsy; management centers on antifibrotic therapy (pirfenidone or nintedanib), oxygen, and early lung transplant referral, since corticosteroids are not indicated and median survival is 3 to 5 years.

Lung cancer is the leading cause of cancer death worldwide, split into non-small cell lung cancer (NSCLC, 80% of cases: adenocarcinoma, squamous cell, large cell) and small cell lung cancer (SCLC, 10-15%), both driven overwhelmingly by cigarette smoking. Diagnosis requires tissue histopathology, staging drives treatment (TNM staging for NSCLC, limited versus extensive stage for SCLC), and management ranges from lobectomy in early-stage disease through concurrent chemoradiation and consolidation immunotherapy in locally advanced disease to targeted tyrosine kinase inhibitors, immune checkpoint inhibitors, or platinum-based chemotherapy in metastatic disease.