Managing Silicosis in the United States: How I Do It.

Once considered a disease of the past in developed countries, silicosis is making a worrying comeback as an irreversible and potentially fatal pulmonary disease in the United States. Silicosis has been an unfortunate mainstay of respiratory disease in the developing world, but modern industries, such as stone countertop fabrication, are causing a public health crisis in the United States. This recent uptick in silicosis cases, led by the first recent case in the United States in a stone countertop worker in 2015, may be just the beginning. Because patients seem to present at a younger age with more severe disease than prior cohorts with silicosis, we have found an absence of clear guidelines and standards of care for patients with severe silicosis, particularly for those with end-stage disease. Drawing on experiences from patients with silicosis at the Los Angeles General Medical Center/University of Southern California, we have compiled a clinical review of the topic and provide our institutional approach to screening, examination, diagnosis, management, and, if necessary, referral for lung transplantation. In this "How I Do It," we share our experience from California to equip clinicians with tools to better diagnose silicosis, recognize end-stage disease, and support patients to lower the morbidity and mortality of this entirely preventable pneumoconiosis.