Occupational health: normative view for the diagnosis of silicosis

Abstract

Silicosis is an occupational lung fibrosis caused by the inhalation of dust containing free crystalline silica. Its prevalence can vary in different countries and regions. In the case of Chile, silicosis has been recognized as a significant occupational health problem. The clinical presentation of silicosis largely depends on the intensity and duration of exposure. Initially, there may be no signs or symptoms. The differential diagnosis is mainly performed with pulmonary tuberculosis, pulmonary aspergillosis, pulmonary metastasis, sarcoidosis, hypersensitivity pneumonitis, and other pneumoconiosis. After confirming the diagnosis, the process of determining the origin of the pathology begins, for which an Occupational History is required to describe occupational exposure to the risk agent (silica) in terms of time, magnitude, and/or intensity sufficient to develop an occupational-related disease. A Chest X-ray using the ILO (International Labour Organization) technique is necessary, classified as category 1 according to the ILO Classification, and should be interpreted by certified readers. The similarity in radiographic readings necessitates a greater emphasis on the differential diagnosis among these conditions. A high- resolution chest computed tomography without contrast and a lung biopsy should be considered in case of comorbidity, if these diagnostic tests are available. Finally, it is suggested that workers diagnosed with silicosis in the early stages should be identified and removed from silica exposure to prevent disability through medical surveillance.