Background and objective: We recently noted a dramatic increase in the number of patients with accelerated silicosis associated with exposure to artificial stone dust. Therefore, the natural history of artificial stone‐associated silicosis was compared with that of natural stone‐associated silicosis.Methods: A total of 18 patients with artificial stone‐associated silicosis and 63 with natural stone‐associated silicosis were diagnosed sequentially in 2018 and followed up for a period of 6–12 months. Data were collected from clinical charts.Results: The median duration of exposure prior to onset of symptoms of silicosis was shorter for patients who had been exposed to artificial stone dust (6.4 vs 29.3 years, P < 0.01). Four of the 18 patients experienced rapid deterioration in lung function over the follow‐up period, with declines in pre‐bronchodilator FVC of 587 (210–960) mL/year and FEV₁ of 625 (360–860) mL/year. GGO, PMF, emphysema and pulmonary artery widening were more frequently observed on computed tomography scans of patients with artificial stone‐associated silicosis than of those with natural stone‐associated silicosis. Approximately 38.9% of the patients with artificial stone‐associated silicosis were lung transplant candidates and 27.8% died, both rates being significantly higher than in patients with natural stone‐associated silicosis (3.2% and 0%, both P < 0.01).Conclusion: Compared to natural stone‐associated silicosis, artificial stone‐associated silicosis was characterized by short latency, rapid radiological progression, accelerated decline in lung function and high mortality.

Background: Primary Sjögren syndrome (pSS) is a chronic inflammatory autoimmune disease that is characterized by lymphocytic infiltration of the exocrine glands and extraglandular organ systems. Interstitial lung disease (ILD) is common in pSS patients and is one of the independent risk factors for a poor prognosis. The previously reported characteristics and potential risks contributing to pSS-associated ILD have been controversial. Methods: A cohort of 201 newly diagnosed pSS patients were studied over a period of 3 years. Data were from clinical charts. The pSS patients were classified into two groups, namely pSS-ILD or pSS without ILD, according to the lung evaluation. Results: In total, the prevalence of pSS-associated ILD was 78.6%. The pSS patients associated ILD were more likely to be male, older and smokers in comparison to the pSS patients without ILD. There were no significant differences in multiorgan involvement between the two groups. Nonspecific interstitial pneumonia (NSIP) was the most common radiological pattern (45.5%). pSS with ILD was associated with increasing age [odds ratio (OR) =1.073], smoking (OR =8.544) and antinuclear antibody (ANA) positive (OR =3.286). Over a median follow-up period of 24 months (range, 18–30 months), no patients died, experienced acute exacerbation of ILD, or had newly diagnosed pSS-ILD. Conclusions: pSS associated ILD were more commonly in males, older patients and smokers. Aging, cigarette smoking, and ANA positivity may be potential risk factors contributing to ILD in pSS patients.

Regulatory T cells (Tregs) are crucial in maintaining immune tolerance and immune homeostasis, but their role in idiopathic pulmonary fibrosis (IPF) is unclear. This study was designed to explore the role of Tregs in IPF. Percentages of Tregs and their subpopulations in peripheral blood (PB) and bronchoalveolar lavage (BAL) samples were determined by flow cytometry in 29 patients with IPF, 19 patients with primary Sjögren’s syndrome-related interstitial pneumonia (pSS-IP), and 23 healthy controls (HCs). In peripheral blood, no difference was found in CD4+CD25+Foxp3+ Treg percentages among patients with IPF, pSS-IP, or HCs. However, activated Treg (aTreg) fractions among CD4+ T cells increased significantly in IPF compared with pSS-IP or HCs. Being consistent with the result from the PB, aTreg fractions among CD4+ T cells in IPF also increased significantly compared with pSS-IP or HCs, accompanied by increased fraction III compared with HCs in BAL. IPF patients had lower levels of resting Tregs (rTregs) from the thymus than did HCs, whereas aTreg levels originating from the thymus did not significantly differ from HCs. Both rTregs and aTregs proliferated in IPF, with aTregs being more proliferative than rTregs. Both rTregs and aTregs significantly inhibited proliferation of CD4+ T lymphocytes in vitro. The percentage of aTregs was correlated negatively with predicted diffusing capacity values for carbon monoxide and positively with GAP index in IPF. Our study showed the imbalance between subpopulations of Tregs in IPF. Increased aTregs proportion in the peripheral blood correlated inversely with disease severity.

Objectives: Occupational dust exposure may induce various lung diseases, including pneumoconiosis and chronic obstructive pulmonary disease (COPD). The features of combined COPD and pneumoconiosis have not been well described, and this may hamper the management. This study aimed to describe the prevalence and characteristics as well as the risk factors of the combined diseases. Design: A cross-sectional study. Setting and participants: 758 patients with pneumoconiosis were recruited at a single-medical centre. Of these, 675 patients with pneumoconiosis, including asbestosis, silicosis, coal workers’ pneumoconiosis and other pneumoconiosis, was eligible for analysis. Primary outcome measures: COPD was diagnosed based on clinical features and/or history of exposure to risk factors and post bronchodilator forced expiratory volume in 1 s (FEV ₁ )/forced vital capacity (FVC) ratio <0.7. Clinical data were collected from predesigned medical reports. The patients underwent both chest radiograph and high-resolution CT scans. Risk factors for combined COPD and pneumoconiosis were analysed using regression analysis. Results: COPD prevalence overall was 32.7% (221/675) and was the highest in silicosis (84/221) and coal workers’ pneumoconiosis (100/221). COPD prevalence increased with smoking pack-years, dust exposure duration and pneumoconiosis stage. Patients with combined diseases had lower body mass index, higher smoking index and worse pulmonary function. Risk factors for combined diseases included heavy smoking, silica or coal exposure and advanced pneumoconiosis. The interaction between dust exposure and smoking in COPD was also identified. The risk of combined COPD significantly increased with heavy smoking and silica or coal exposure (OR 5.49, 95% CI 3.04 to 9.93, p<0.001). Conclusions: COPD is highly prevalent in patients with pneumoconiosis, especially patients with silicosis and coal workers’ pneumoconiosis. Occupational dust exposure as well as heavy smoking is associated with an increased risk of combined COPD and pneumoconiosis, which demands an effective preventive intervention.

Pneumoconiosis is the most widely distributed occupational disease worldwide. China is currently the largest coal producer and consumer and the country with the most coal miners and cases of coal workers' pneumoconiosis (CWP). Despite more than 70 years of effort, the problem of CWP and silicosis remains serious. There is a lack of analysis of direct data on coal miners’ pneumoconiosis from all over the country. This study aimed to describe the epidemiology of coal miners’ pneumoconiosis and reveal some important clues regarding its social determinants. The annual incidence rate, 20-year prevalence rate, and incidence rate of coal miners’ pneumoconiosis per million tons in China from 1949 to 2021 were calculated by using the data of annual number of coal miners’ pneumoconiosis diagnosed and reported from the coal mining and dressing industry, the number of coal miners, and the raw coal production, and the relationship between the incident cases of coal miners’ pneumoconiosis and the death toll from coal mine safety accidents was analyzed using Pearson correlation analysis, with the aim of exploring the relationship between the incident cases of coal miners’ pneumoconiosis and its social determinants with an ecological study. From 1949 to 2021, there have been more than 462,000 patients with coal miners’ pneumoconiosis in China, showing double U-shaped distributions with an increasing trend, accounting for about 50.5% (462,000/915,000) of all diagnosed pneumoconiosis in China, while the incidencet rate of coal miners’ pneumoconiosis presents a large W shaped distribution with three peaks over a time span of more than 50 years. From 1949 to 1986, there was a strong correlation between the incident cases of coal miners’ pneumoconiosis and raw coal production, the number of coal miners, and the number of deaths from coal mine accidents (r = 0.849, P < 0.001; r = 0.817, P < 0.001; r = 0.697, P < 0.001, respectively), but there was no such correlation found from 1987 to 2006. It was estimated that the annual incidence rate of coal miners’ pneumoconiosis in China from 2016 to 2020 was 3.4‰ (95% CI: 2.6–4.3‰), and the prevalence rate across the recent 20-year observation period was 4.8% (95% CI: 4.6–4.9%), both measured at the peak or around the peak over the 70 years. In particular, 1963, 1986, 2006, and 2009 were the four important turning points in time. There was a sustained high level of incident cases of coal miners’ pneumoconiosis with double U-shaped curve in China, which may be affected by a variety of social determinants and risk factors.