Black lung disease, caused by inhaling coal dust, can lead to progressive massive fibrosis (PMF) and is responsible for the deaths of thousands of coal workers annually. While there is no cure for PMF, early diagnosis and prevention can help halt the disease’s progression. Safer mining practices have reduced the risk of exposure to coal dust, but the disease still affects many workers.
Black lung disease is a type of pneumoconiosis, a condition caused by breathing certain forms of dust into the lungs. Specifically, this disease is caused by inhaling coal dust, which tends to turn the lungs black instead of their normal pink color. It occurs only among coal mine workers or those in other occupational situations that cause high exposure to coal dust. It may alternatively be called coal workers’ pneumoconiosis (CWP). When the disease has progressed significantly, it becomes progressive massive fibrosis (PMF) and is responsible for the deaths of thousands of coal workers on an annual basis, even if exposure to coal dust ended years earlier.
Black lung disease is not chronic obstructive pulmonary disease (COPD) and it is not emphysema. However, having the disease, which can simply manifest as a cough in the early years, makes you more vulnerable to developing one of these conditions. If the condition is contracted in its early stages, it may be possible to halt the progression of the disease, either by adopting increased safety practices when around coal dust or by stopping work around coal dust. Smoking can make other diseases worse which will make black lung disease more difficult, significantly increasing the risk of COPD, emphysema and lung cancer.
The condition can only be caused if people work around coal dust, and the specific mechanism of the disease makes this understandable. When charcoal is inhaled, it can combine with white blood cells called macrophages. This combination of dust and blood cells starts creating abnormal tissue in the lungs called nodules. As the nodules increase in size, they begin to restrict airflow, causing lower blood oxygen levels and therefore extreme difficulty in breathing.
Continued exposure to coal dust means that more nodules will form, greatly increasing the risk that at some point a person will be unable to breathe without assistance and creating the risk of disability and death. Generally if the nodules are at least one centimeter (about 4 inches) in size, this disease is considered to have progressed to PMF. There is no cure for PMF, but if the disease doesn’t progress into PMF, it can have minimal effects on daily life.
However, not all people with the disease will progress to PMF, especially if they are no longer exposed to coal dust. It usually takes about 10 years of inhaling coal dust to develop black lung disease, and because it can be asymptomatic at first, people may not notice it. Chronic cough developed by a person working with coal is an occasion to consult a doctor. However, as history has shown to the great detriment of many who work with coal, economic worries can keep people working despite the health risk, accelerating the development of PMF.
Diagnosis of this disorder is made through the history and x-rays of the lungs, which may show spots where nodules have formed. Information about breathing interruption, difficulty breathing, and chronic cough is also invaluable in the diagnosis. Though in its early stages, those affected can still live quite normal lives, especially if they change their working environment. Some people benefit from supportive treatment such as access to oxygen or the use of inhalers such as asthma inhalers.
Unfortunately, there is no cure for PMF and it has taken the lives of thousands of coal workers. Safer mining practices, especially in developed countries, now significantly reduce the risk of exposure to coal dust. Black lung disease still affects many who worked before those safety standards were in place, and even those working in developing countries, who lack such standards.
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