Pneumoconiosis, an occupational lung disease that arises from the inhalation of harmful dust, often coexists with multiple chronic diseases that aggravate its prognosis and complicate treatment. These chronic diseases can include pulmonary and cardiovascular conditions, as well as cerebrovascular, renal, endocrine, and rheumatic comorbidities. The underlying pathogenesis, which involves inflammatory responses, blood vessel damage, and immune system compromise, is rooted in the persistent presence of inhaled dust particles within the pulmonary alveoli and the systemic circulation. Management emphasizes preventive measures, notably through regulatory oversight to reduce exposure, and is coupled with vigilant chronic disease monitoring and lifestyle interventions. This article reviews the mechanisms, research status, and management strategies for pneumoconiosis patients complicated by the aforementioned chronic diseases. We aimed to bridge the gap between understanding the complexities of pneumoconiosis combined with chronic conditions and translating this insight into practical and effective management strategies to enhance patient care.