In brief
Pneumoconiosis is a group of occupational diseases that develop when inhaled mineral dust accumulates in the lungs and leaves permanent damage; the best known is silicosis, caused by crystalline silica. Because the disease can progress for years without symptoms, early detection relies on regular comparison of chest X-rays in line with the ILO classification and pulmonary function tests. Under the Regulation on Dust Control, the workplace physician determines the frequency of these tests; a worker with a finding of ILO category 1 or above is referred to a health care provider authorised by SGK.
What is pneumoconiosis and how does it develop?
Pneumoconiosis is the collective name for diseases that develop when inhaled mineral dusts accumulate in the lungs and leave permanent damage in lung tissue, i.e. fibrosis. It is popularly called “dust lung” or dust lung disease. A construction worker cutting concrete, a foundry worker knocking out moulds or a stonemason often pays the price of the dust breathed over the years after leaving the job.
Three things determine how the disease develops:
- Type of dust: Crystalline silica, asbestos and coal dust are among the dusts that cause the most damage in the lungs.
- Fineness of the dust: Coarse dust visible to the eye is trapped in the nose and upper airways. The real danger is the fine, “respirable” fraction that can reach the deepest parts of the lungs.
- Intensity and duration of exposure: Low-intensity exposure over many years or very high-intensity exposure over a short period can cause the disease.
Defence cells try to clear dust particles reaching the lungs; some dusts damage these cells and start continuous inflammation and the formation of scar tissue. This damage is irreversible and, in some types, can progress even after exposure has ended. This is why prevention and early detection matter more than treatment in pneumoconiosis.
Silicosis and other types of pneumoconiosis
| Type | Causative dust | Examples of jobs where it occurs | Note |
|---|---|---|---|
| Silicosis | Crystalline silica: quartz, cristobalite, tridymite | Cutting, crushing and drilling concrete, stone and brick; sandblasting; foundries; ceramics and glass; quarries and tunnels | Increases the risk of tuberculosis; crystalline silica is also a cause of lung cancer |
| Coal workers’ pneumoconiosis | Coal dust | Underground and open-cast coal mining, coal preparation and loading | Silica in coal dust can make the picture worse |
| Asbestosis | Asbestos fibres | Demolition and stripping in old buildings, removal of old insulation materials | Asbestos can also cause cancer of the lining of the lungs; removal work is governed by a separate regulation |
| Siderosis | Iron oxide dust and fumes | Welding, grinding, iron casting | Usually mild, but requires attention if combined with silica |
Silicosis appears in three forms depending on its course: the chronic form, which develops over years, usually with more than 10 years of exposure; the accelerated form, which appears within 5–10 years with more intense exposure; and the acute form, which can develop within months to a few years in those exposed to very high concentrations of silica. The acute and accelerated forms are seen in very dusty work such as dry cutting, sandblasting and grinding in enclosed spaces.
Coal workers’ pneumoconiosis is mainly associated with mining. In jobs such as construction, casting, ceramics and stone processing, the dust that really requires attention is crystalline silica. Art. 4 of the Regulation on Dust Control defines crystalline silica as quartz, tridymite and cristobalite, and asbestos as six fibrous silicates.
Pneumoconiosis symptoms: why is it noticed late?
Pneumoconiosis symptoms often appear in the advanced stage of the disease. In the first years the worker may report no complaints at all, but changes may have begun on the chest X-ray. Symptoms usually develop in this order:
- Early fatigue and shortness of breath when climbing stairs or doing heavy work,
- A long-lasting dry cough, with phlegm over time,
- A feeling of tightness in the chest,
- In the advanced stage, shortness of breath at rest as well and complaints related to strain on the heart.
These symptoms may be put down to smoking, asthma or “age” and dismissed. When someone who has worked in a dusty job describes these complaints, their occupational history must always be explored.
Prevention in dusty work: sources of silica in construction
On construction sites in Bursa and neighbouring provinces too, the main sources of silica dust are cutting concrete and stone, chasing channels, breaking concrete with a breaker, drilling, sanding and dry sweeping. Art. 5 of the Regulation on Dust Control requires measures in this order: substitution, collective protection and prevention at source, engineering methods that keep dust at source, sufficient fresh air and, where these are not enough, personal protective equipment suited to the nature of the dust. On site this is applied as follows:
- Wet cutting: Use water-fed systems on cutting and grinding tools.
- On-tool extraction: If working dry is unavoidable, use a dust extractor with a suitable filter connected to the extraction port on the tool.
- Cleaning: Wetting or a vacuum with a suitable filter instead of dry sweeping and cleaning with compressed air.
- Segregation: Separate dusty work from other teams; minimise cutting in enclosed spaces.
- Respiratory protection: In addition to technical measures, a mask suited to the dust and concentration, with its fit checked.
Dust measurement shows whether exposure is below the limit value; for quartz, the limit value is calculated according to the silica content of the dust. We plan measurements with authorised laboratories and record the results in the risk assessment. For details of measurement and limit values, see our articles on the Regulation on Dust Control and workplaces where workplace measurements are mandatory, and for site-specific planning, our construction sector page.
Early detection: chest X-ray and PFT follow-up
The Regulation on Dust Control sets health surveillance within the following framework:
Each test plays a different role:
| Test | What does it show? | When? |
|---|---|---|
| Occupational history and symptom questioning | Duration and severity of exposure, cough and shortness of breath | At every examination |
| Chest X-ray (to ILO standard) | Density and distribution of small opacities in the lungs | On recruitment as a baseline; then at the frequency set by the physician |
| Pulmonary function test (PFT) | Reduction in lung capacity and airflow | Baseline value on recruitment; then at the interval set by the physician |
| High-resolution computed tomography | Differential diagnosis for suspicious findings | When considered necessary, at hospital level |
There is no fixed frequency for PFT in the legislation; the workplace physician decides according to the risk. The greatest value of PFT is comparison: without a baseline value from recruitment, a single test carried out years later may not show a slight loss. In early silicosis the PFT may be normal; so the X-ray and PFT are interpreted together.
The workplace physician determines protective measures, including, where necessary, the worker not being employed in work involving dust exposure (Art. 10). We plan tests with authorised health institutions and follow the results comparatively for each worker. For details, see our health surveillance and workplace physician pages, and for the general logic of tests, our article on periodic medical examinations and tests.
When a diagnosis is made: the occupational disease process
Under Art. 20 of the Regulation on Procedures for Determining Loss of Working Capacity and Loss of Earning Capacity in the Profession, for pneumoconiosis to be accepted as an occupational disease, the person must have worked for a total of at least three years in workplaces whose air contains dust at concentrations capable of causing pneumoconiosis. In rapidly progressing, severe cases developing with high-concentration dust, this period may be reduced by decision of the Social Insurance High Health Board; assessments are made taking ILO standards into account. You can find the liability period applying to each disease in our article on the list of occupational diseases.
What the employer must do:
- The occupational disease is notified to SGK within 3 working days of becoming known (Art. 14 of Law No. 6331 on Occupational Health and Safety).
- An occupational disease is one of the situations requiring the risk assessment to be renewed regardless of its validity period.
- Surveillance of other workers in the same job is reviewed; if necessary, the test interval is shortened.
- Moving the worker to dust-free work is considered to prevent the disease progressing.
For details of the diagnosis and notification process, see our article on occupational disease diagnosis and notification.
Frequently Asked Questions
Can pneumoconiosis be treated?
The scar tissue formed in the lungs is irreversible; in some types it can progress even after exposure has ended. Treatment aims to relieve complaints and prevent complications such as tuberculosis. So the main goal is to prevent dust exposure and detect the disease at an early stage.
Should workers in dusty jobs have a chest X-ray every year?
The legislation sets no fixed interval. Under the Regulation on Dust Control, the workplace physician determines the frequency of X-rays, taking into account the risk assessment, dust measurement results, the type of dust and the worker’s state of health. The X-ray must be taken in line with the ILO standard.
If the PFT is normal, can it be said that there is no pneumoconiosis?
No. In the early stage the PFT may be normal; changes may appear first on the chest X-ray. So the PFT is assessed together with an X-ray taken to the ILO standard and the occupational history, and the most meaningful information comes from comparison with the baseline value from recruitment.
In which jobs does silicosis occur?
It can occur in any job where material containing crystalline silica is cut, crushed, drilled or abraded: cutting concrete and stone, sandblasting, mould and core work in foundries, ceramics and glass production, quarries and tunnel excavation are the main ones.
An exposure-based test plan, pre-employment and periodic examinations, confidential health files and an examination schedule tracked per person.
Bursa SİSTEMER OSGB Technical Team — written from the field experience of our OHS specialists and workplace physicians. Legal information is valid as of the publication/update date; contact us for an assessment specific to your business.