Coal workers’ pneumoconiosis

A 62-year-old former coal miner with a diagnosis of coal workers’ pneumoconiosis presents for a routine follow-up. He reports stable but persistent dyspnoea on exertion and a chronic cough. He has no recent exacerbations and is compliant with his treatment regimen, which includes bronchodilators and home oxygen therapy at night. Spirometry shows a FVC of 55% predicted and an FEV1/FVC ratio of 65%.

What is the most appropriate next step in the management of this patient?

A 50-year-old man who has worked in coal mining for 25 years presents for an occupational health check-up. He is asymptomatic and has no significant past medical history. He has never smoked. On examination, his vital signs are normal, and there are no abnormal findings on chest auscultation.

What is the most appropriate preventive measure to reduce the risk of developing coal workers’ pneumoconiosis?

A 65-year-old man with a history of coal workers’ pneumoconiosis presents with increasing shortness of breath and fatigue over the past year. He has a chronic productive cough and has noticed swelling in his legs and abdomen. On examination, he has bilateral pitting edema, jugular venous distension, and hepatomegaly. His oxygen saturation is 90% on room air. A chest X-ray shows progressive massive fibrosis.

What is the most likely complication contributing to his current symptoms?

A 58-year-old man who worked as a coal miner for 30 years presents with a 6-month history of chronic cough and shortness of breath. He denies hemoptysis, fever, or weight loss. He has a 20-pack-year smoking history but quit 10 years ago. On examination, his respiratory rate is 18 breaths/min, and there are fine crackles at the lung bases bilaterally. A chest X-ray shows diffuse small rounded opacities primarily in the upper lung zones.

What is the most appropriate investigation to confirm the diagnosis of coal workers’ pneumoconiosis?