Coal Worker’s Pneumoconiosis (Black Lung Disease)

Coal Worker’s Pneumoconiosis (Black Lung Disease)

Coal workers' pneumoconiosis (CWP), commonly known as "black lung disease," occurs when coal dust is inhaled. Over time, continued exposure to the coal dust causes scarring in the lungs, impairing your ability to breathe. Considered an occupational lung disease, it is most common among coal miners.

Learn About Coal Worker’s Pneumoconiosis - Key Facts

• Coal worker’s pneumoconiosis, or black lung, is one of over 200 types of pulmonary fibrosis and is classified as an interstitial lung disease. Your doctor may refer to your disease by any of these terms.
  • Fibrosis - the development of fibrous connective tissue as a reparative response to injury or damage
  • Interstitial Lung Disease - Interstitial lung disease (ILD) is an umbrella term used for a large group of diseases that cause scarring (fibrosis) of the lungs. The scarring causes stiffness in the lungs which makes it difficult to breathe and get oxygen to the bloodstream. Lung damage from ILDs is often irreversible and gets worse over time. 
• An estimated 16% of coal workers are affected and after decades of improvement, the number of cases of black lung disease is on the rise again.
• There is no cure for coal worker’s pneumoconiosis, but treatment can help manage symptoms and improve quality of life.
• The Occupational Safety and Health Administration (OSHA) has safety standards to help workers employers and workers take steps to prevent black lung disease.

What Causes Coal Worker’s Pneumoconiosis?

Black lung disease can develop when coal dust is inhaled over a long period of time. Coal dust is made of dangerous carbon-containing particles that coal miners are at risk of inhaling, which is why it is mostly considered an occupational (workplace) disease. Coal miners may also be exposed to silica-containing dust because coal mining may involve some drilling into silica-containing rock.
However, not all workers will develop the disease. Recent studies have found that about 16% of coal miners in the U.S. will contract the disease. This number has been increasing in recent years, which may be linked to changes in mining technology that allow for higher volumes of coal to be extracted in a given time period and changes in the mineral content of the coal that make it more hazardous.

How It Affects Your Body

When the coal dust is inhaled, the particles can travel through the airways all the way into the alveoli (air sacs) that are deep in the lungs. After the dust particles land and settle in the lung, lung tissue may try to get rid of the dust particles, causing swelling as the body tries to fight the foreign particles. In some cases, the swelling is severe enough to cause scar tissue to form. The damaging effects of the inhaled coal dust may not show up for many years, and many patients don’t develop symptoms until long after their initial exposure.
For coal worker’s pneumoconiosis, the scarring can be separated into two types: simple or complicated. In simple pneumoconiosis, a chest X-ray or CT scan will reveal small amounts of scar tissue, seen as tiny, circular nodules on the lungs. Complicated pneumoconiosis, also called progressive massive fibrosis, involves more severe scarring over a larger area of the lung tissue. In both types, your breathing will be negatively affected.

Coal Worker’s Pneumoconiosis Symptoms and Diagnosis - Symptoms of Coal Worker’s Pneumoconiosis

Symptoms of black lung disease can take years to develop. In early stages, the most common symptoms are cough, shortness of breath and chest tightness. Sometime the coughing may bring up black sputum (mucus). These symptoms may initially occur after strenuous activity, but as the disease progresses, they may become present at rest as well. If the scaring is severe, oxygen may be prevented from easily reaching the blood. This results in low blood oxygen levels which puts stress on other organs, such as the heart and brain, and can cause additional symptoms.

How Coal Worker’s Pneumoconiosis Is Diagnosed

There is no specific test for black lung disease. If you are concerned about your symptoms, your doctor will first want to take a detailed medical history, asking about your job history in detail to determine the likelihood of exposure. It may be a good idea to prepare the following information in advance:

• Your symptoms and the time they started
• Treatments given before for the symptoms and how they helped
• The work you have done over your entire career; the length of time you spent in each job; the nature of the work you performed.
• The products you were in contact with at work and whether or not you wore protective equipment
• Smoking history
• Any old medical records, including chest X-rays or CT scans

Your doctor will also want to perform a physical exam and breathing tests to measure your lungs’ ability to breathe and move oxygen. Imaging tests such as chest X-ray or CT scan may be suggested, to look for nodules and areas of swelling. The Federal Mine Safety and Health Acts requires that surveillance programs be offered to all coal miners and include breathing tests and/or chest X-rays every year or periodically to look for irregular areas.

When to See Your Doctor

If you have been exposed to coal dust or other toxic dusts and have respiratory symptoms such as cough or shortness of breath, you should consult your healthcare provider.

Treating and Managing Coal Worker’s Pneumoconiosis - How Coal Worker’s Pneumoconiosis is Treated

There is no treatment that can reverse the damage done by coal dust, but certain steps can help slow down progression of the disease, relieve symptoms and improve quality of life.
Once the severity of exposure has been determined, your doctor can determine the best course of action. Medication and breathing treatments may be prescribed to help open your airways and decrease inflammation. In most cases, pulmonary rehabilitation, an exercise program designed to help patients with chronic lung conditions stay active, is recommended to help improve quality of life.
As scarring in the lungs becomes more severe, supplemental oxygen may be prescribed to help you get more air into your lungs when needed. Though you may need it only while exercising at the beginning, as the disease progresses you may need it at all times. In rare, very severe cases, a lung transplant may be recommended.
Avoiding further exposure and avoiding other irritants, such as cigarette smoke, is crucial. If you are a smoker, you will be strongly advised to quit smoking. The American Lung Association offers a number of smoking cessation programs to give people trying to quit the support they need.

Managing Coal Worker’s Pneumoconiosis

If you have black lung disease, you should expect to have regular visits with your health-care provider(s). You may need regular testing, such as a lung function test or chest X-rays to monitor you and your disease closely, as well as check for lung cancer.
Your doctor can help manage your symptoms, but you can also take steps to keep yourself healthy by doing the following:

• Maintain weight and nutrition with a well-balanced diet.
• Stay as active as you can by exercising regularly but be careful not to overexert yourself.
• Prevent respiratory infections that can make your lungs worse. Get vaccinated against the flu every year, and pneumococcal pneumonia as recommended by your doctor.
• Be vigilant about monitoring your condition and watching for the development of infections. See your doctor immediately if one develops.
• Have a plan to manage flare-ups of the disease.

Prevention

Black lung disease is preventable, which is why the Occupational Safety and Health Administration has a set of safety standards to help workers avoid the disease. Under these guidelines, all coal miners should wear a mask, wash any skin that comes in contact with dust, safely remove dust from all clothing and wash their face and hands before eating, drinking or taking medication. In addition, all mines are regulated to limit how much coal dust is in the air.

Finding Support

Ask your healthcare provider about lung disease support groups in your area, or look online for a Better Breathers Club near you. The Lung Association recommends patients and caregivers join our Living with Lung Disease Support Community to connect with others facing this disease. You can also call the Lung Association's Lung HelpLine at 1-800-LUNGUSA to talk to a trained respiratory professional who can help answer your questions and connect you with additional support. Learn More

For More Information:

There are a number of resources available for coal workers who have contracted black lung disease. Under the Black Lung Benefits Act coal miners who are disabled by pneumoconiosis are entitled to worker’s compensation and other benefits. Health Resources and Service Administration’s (HRSA) Black Lung Clinics can be found nationwide, and are focused on providing black lung disease patients and their families with education, primary care, and other services. The Black Lung Center of Excellence supports these Black Lung Clinics Programs and provides additional services as well.

Questions to Ask Your Doctor About Coal Workers' Pneumoconiosis

Making notes before your visit, as well as taking along a trusted family member or friend, can help you through an appointment with your doctor.

• How advanced is my disease?
• What is the best treatment for the severity of my condition?
• What medications will I be given and what are the side effects?
• Would pulmonary rehabilitation be a good idea for me?
• Should I use oxygen?
• How much experience do you have with black lung disease, and should I talk to a specialist?
• Will I need a lung transplant?
• How often do I need to have follow-up appointments? Breathing tests or chest X-rays?

Source: https://www.lung.org/lung-health-diseases/lung-disease-lookup/black-lung