Pneumoconiosis is the most serious occupational health and safety problem in China, which has brought a great burden to the society and patients' families. Pneumoconiosis has a clear etiology and is preventable and controllable, but it has a hidden onset and long duration, which makes a clear early diagnosis and monitoring difficult. Furthermore, even if the patients are out of the dust environment, lung lesions still will continue to progress and deteriorate, and there is currently a lack of effective therapeutic measures and methods of judging fibrosis progression. These problems together restrict the diagnosis and treatment of pneumoconiosis. In this paper, we review the literature on early identification, diagnosis, and treatment of pneumoconiosis in recent years, and discuss the difficulties in diagnosis and treatment of pneumoconiosis and the future development direction based on the existing basic and clinical studies.