The reaction of the lung to mineral dusts depends on many variables, including size, shape, solubility, and reactivity of the particles. For example, particles greater than 5 to 10 μm are unlikely to reach distal airways, whereas particles smaller than 0.5 μm move into and out of alveoli, often without substantial deposition and injury. Particles that are 1 to 5 μm in diameter are the most dangerous, because they get lodged at the bifurcation of the distal airways. Coal dust is relatively inert, and large amounts must be deposited in the lungs before lung disease is clinically detectable. Silica, asbestos, and beryllium are more reactive than coal dust, resulting in fibrotic reactions at lower concentrations. Most inhaled dust is entrapped in the mucus blanket and rapidly removed from the lung by ciliary movement. However, some of the particles become impacted at alveolar duct bifurcations, where macrophages accumulate and engulf the trapped particulates. The pulmonary alveolar macrophage is a key cellular element in the initiation and perpetuation of lung injury and fibrosis. Many particles activate the inflammasome and induce IL-1 production. The more reactive particles trigger the macrophages to release a number of products that mediate an inflammatory response and initiate fibroblast proliferation and collagen deposition. Some of the inhaled particles may reach the lymphatics either by direct drainage or within migrating macrophages and thereby initiate an immune response to components of the particulates and/or to self-proteins that are modified by the particles. This then leads to an amplification and extension of the local reaction. Tobacco smoking worsens the effects of all inhaled mineral dusts, more so with asbestos than with any other particle.
Positive indications on patient assessment:
Shortness of breath
Chest X-ray may show a characteristic patchy, subpleural, bibasilar interstitial infiltrates or small cystic radiolucencies called honeycombing.
In the classic British film Brief Encounter (1945), derived from a Noël Coward play, housewife Laura (Celia Johnson) and physician Alec (Trevor Howard) begin an affair. She is desperately mesmerized in a train station lounge by his evocation of his passion for pneumoconiosis.
A 2006 documentary film by Shane Roberts features interviews with miners suffering from the disease and footage shot inside the mine
An episode of 1000 Ways to Die featured an incident where two kitchen workers succumb to pneumoconiosis from playing in cocoa powder.
In the puzzle/shooter video game Portal 2, former CEO and founder of Aperture Science Laboratories, Cave Johnson, purportedly contracted and died of lunar pneumoconiosis after prolonged exposure to the moon rocks he was using in teleportation technology research.
In the 2001 film Zoolander, the "black lung" is referenced to after the male model protagonist spends one day working in a coal mine.
In the 2004 BBC miniseries North & South, Bessy Higgins dies from pneumoconiosis from working in the cotton mill in 19th-century England.