Secondary spontaneous pneumothorax in rapidly progressive forms of silicosis: Characterization of pulmonary function measurements and clinical patterns

A secondary spontaneous pneumothorax is a complication of an underlying pulmonary disease.
In recent years, there have been only a few scattered reports of patients with silicosis also having a
pneumothorax. Silicosis, a form of disabling pulmonary fibrosis, is a well-known occupational disease
resulting from high-level exposure to silica or silica-containing dusts. The objective of the present study
was to elucidate any associations between the occurrence of a pneumothorax, and pulmonary function tests
and clinical observations performed prior to the pneumothorax; these two factors may be predictors for a
pneumothorax among workers exposed primarily to silica-containing respirable dust. Methods: A diagnosis
of silicosis was made on several factors: silica dust exposure, appropriate interval of time after exposure,
clinical findings, pulmonary function tests and chest radiological findings. A checklist was designed
for collecting data of occupational history, respiratory signs, and symptoms from onset of dust exposure to
the occurrence of a pneumothorax. Spirometery was conducted in accordance to the recommendations of
standard protocols and guidelines posited by the American Thoracic Society. Autopsies were performed in
three cases where the patient had suffered a pneumothorax due to silicosis. Mann–Whitney U-tests and
Fisher’s exact tests were used to determine any associations between pneumothorax and predictor factors.
Results: An association between a progressive decrease in pulmonary function test values and a pneumothorax
was observed. The occurrence of a pneumothorax was associated with complaints of pleuretic
chest pain, resting dyspnea, respiratory distress, paroxysmal nocturnal dyspnea, orthopnea and crackle.
Conclusion: A characteristic decline in pulmonary function test values and the severity of respiratory
impairment may facilitate the occurrence of a pneumothorax in silicosis