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Pneumoconiosis and Environmentally Induced Lung Diseases

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Pathology of Lung Disease

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Abstract

Pneumoconiosis is characterized by an inhalation of foreign nonliving material in the widest sense but is usually restricted to inorganic matter. Inhalation causes a tissue reaction, which can be any kind of pneumonia, granulomatosis, or similar. Primarily when thinking about pneumoconiosis, silicosis and asbestosis will immediately come into one’s mind; however, there are many more agents causing pulmonary diseases. As in many other diseases in all kinds of pneumoconiosis, there is a dose-effect relationship: this means there is a threshold dose required to induce disease (amount of a mineral) and duration of exposure. In addition, the dimension of the particles is important too: particles larger than 10 μm are deposited in the larger airways; particles below 2–5 μm will reach the alveolar periphery. But there is another factor, aerodynamic diameter: particles are within the airstream and will orient themselves along the axis of the airflow; therefore, asbestos fibers although 100–200 μm in length are less than 5 μm thick, which means they are oriented within the airstream and might reach small bronchioles before being trapped at bifurcations. Another quality of inhaled mineral dust is durability: some metals are easily dissolved in extracellular fluids and can be absorbed and removed by macrophages. Other minerals such as quartz and asbestos fibers are long lasting and resist degradation by macrophages for months. Finally also the chemical composition plays a role: highly toxic compounds will cause acute injury to the lung, whereas other minerals cause injury only in huge quantities, as example for both is chromates versus titanium oxides. On the other hand, our lung has developed many clearance and defense mechanisms during evolution. We all inhale some amount of quartz, but usually do not develop silicosis, because quartz is cleared. There are several mechanisms: The evolutionary oldest mechanism is the mucus escalator system; mucus is produced by goblet cells and moved toward the larynx. Particles deposited within the mucus are transported with it and expectorated or coughed out. Another evolutionary old mechanism is clearance by macrophages; these cells of the innate immune system patrol through the lungs, phagocytose, and degrade foreign particles, thus preventing toxic injury. Finally there is also a chemical defense system. The epithelial cells of the airways and the pneumocytes produce two different enzyme systems: oxidizing enzymes such as the cytochromes and detoxifying enzymes such as the (de)aminidases, glutathione synthases and glutathione transferases, etc. [1–5]. All these form together an efficient defense against inhaled mineral particles.

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    Helmut Popper

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Popper, H. (2017). Pneumoconiosis and Environmentally Induced Lung Diseases. In: Pathology of Lung Disease. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-50491-8_13

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