How can I differentiate between pneumoconiosis and other forms of interstitial lung disease in a patient with a relevant occupational history?

To differentiate pneumoconiosis from other forms of interstitial lung disease (ILD) in a patient with a relevant occupational history, a comprehensive approach integrating clinical, radiological, and occupational exposure data is essential.

First, a detailed occupational history focusing on the type, duration, and intensity of exposure to known causative agents (e.g., silica, asbestos, coal dust) is critical, as pneumoconiosis is directly linked to specific inhaled mineral dusts, unlike many other ILDs which may have idiopathic or autoimmune causes ¹.

Second, high-resolution computed tomography (HRCT) imaging plays a pivotal role. Pneumoconiosis typically shows characteristic radiological patterns such as small, rounded opacities in the upper lung zones for silicosis or coal workers’ pneumoconiosis, and pleural plaques or diffuse pleural thickening in asbestosis, which help distinguish it from other ILDs that may present with more diffuse ground-glass opacities, reticulation, or honeycombing without these occupationally specific features (Champlin et al., 2016; Tandon and Walkoff, 2022).

Third, the temporal relationship between exposure and symptom onset is informative; pneumoconiosis often develops after prolonged exposure with a latency period, whereas other ILDs may have different clinical courses ¹.

Fourth, lung function tests in pneumoconiosis usually reveal a restrictive pattern with reduced diffusion capacity, similar to other ILDs, so they are supportive but not definitive for differentiation ¹.

Finally, multidisciplinary team assessment including occupational medicine, radiology, and respiratory specialists is recommended to integrate clinical, radiological, and exposure data for accurate diagnosis ¹. Recent literature emphasizes the importance of recognizing subtle imaging patterns and emerging occupational ILDs beyond classic pneumoconiosis, suggesting that advanced imaging and exposure assessment tools may further refine differentiation (Spagnolo et al., 2023).