Strategies for the Treatment of Pneumoconiosis

"The aggressive industrialization of America, the development of powered tools which generated massive amounts of respirable-sized dust particles, a latency period which may mask the relationship between exposure and development of disease, inadequate (or perhaps even careless) understanding of the relationship between dust exposure and disease, and respiratory protection which has later proven to be inadequate have resulted in a series of epidemics of silicosis which have caused the premature death of many workers.1-11 Emphasis on the regulatory control of dust levels in the workplace has greatly reduced the development of pneumoconiosis in the United States and in other developed as well as underdeveloped countries, yet the prevention of silicosis or coal workers' pneumoconiosis has not come close to being accomplished. Despite the public health perspective that pneumoconiosis arc totally preventable illnesses, there appears to be little evidence that this is the case.Cases of pneumoconiosis continue despite aggressive enforcement policies by regulatory agencies, attempts at dissemination of very readable materials aimed at workers and management 12.13 and respiratory dust exposure standards which are in place and appear, for the most part, protectivc.14- 16 It is more than frustrating for all parties associated with advocating workers' health to see reports of workers with aggressive silicosis. On another level, both the physician and the affected worker are helpless when a diagnosis of silicosis or coal workers' pneumoconiosis is made. Both realize that there is no proven way to affect the natural history of these progressive inflammatory and fibrotic processes. Neither is there any ""compassionate use"" therapy. What must be developed, at the very least, is a ""salvage therapy"" which has the potential to reverse, or at least dramatically lessen, the aggressive natural history of silicosis which develops over relatively short time periods. Because of the aggressive nature of silicosis (compared to coal workers' pneumoconiosis) attempting to develop a therapy for this illness should be a priority."