[Diagnosis and assessment of the occupational silica dust lung disease (silicosis) - Clinical Practical Guidelines - On behalf of the German Society of Pneumology and Ventilatory Medicine].

The current revision of the guideline incorporates scientific evidence published since 2016, as well as insights gained from its application in clinical and medico-legal practice. It is specifically intended for medical experts involved in the assessment of quartz dust-induced pneumoconiosis as occupational disease No. 4101, as listed in Annex 1 of the German Ordinance on Occupational Diseases (BKV). The guideline supports expert evaluations regarding the causal relationship between occupational crystalline silica exposure and disease onset, potential functional impairments, and the degree of reduction in earning capacity (MdE).Updated diagnostic criteria, relevant differential diagnoses, and the necessary clinical, functional, and imaging investigations - including their interpretation in the context of expert evaluation - are systematically presented. Radiological and histopathological hallmark findings, as well as typical progression patterns and severity gradings of silicosis affecting the lung parenchyma, hilar structures, and mediastinal lymph nodes, are described in accordance with current evidence and international recommendations.The guideline also addresses the specific entity of lymph node silicosis and outlines its criteria for recognition as an insured occupational disease (No. 4101 and 4112), even in the presence of minimal pulmonary involvement. New sections provide guidance on acute silicoproteinosis and accelerated silicosis - conditions associated with intense or very high exposure to respirable crystalline silica over relatively short period of time.A comprehensive review of the current literature further highlights potential associations between prior silica exposure and the development of (auto)immune-mediated or inflammatory-rheumatic diseases - even in the absence of manifest silicosis. Consequently, the authors recommend that the Medical Expert Advisory Board on Occupational Diseases at the Federal Ministry of Labour and Social Affairs (BMAS) review the current evidence on this matter.This update also includes significant extensions to the assessment of reduction in earning capacity, based on the newly developed Reichenhall Recommendation 2024, which are appended to the guideline as a proposal - also with a view to their potential integration into future revisions of the Bochum Recommendation.