Coal Workers Pneumoconiosis

Coal workers' pneumoconiosis (CWP, black lung) is a pneumoconiosis caused by inhalation of coal mine dust, containing coal, silica and silicates.

After 10 to 20 years underground (or surface) mining exposure; prevalence has risen again in some regions (Appalachia, rapidly progressive disease with silica rich seams and machine mining).

Simple CWP: small rounded opacities (coal macules and nodules). Complicated CWP (progressive massive fibrosis): large conglomerate masses over 1 cm, upper lobes.

Coal mine dust lung disease also includes emphysema, chronic bronchitis, small airways disease, mixed dust pneumoconiosis, silicosis, and airflow obstruction.

Complications: respiratory failure, cor pulmonale, tuberculosis, Caplan syndrome (rheumatoid pneumoconiosis nodules), lung cancer (modest), cavitation of masses.

• Simple CWP asymptomatic; cough with black sputum (melanoptysis), dyspnoea, wheeze, chronic bronchitis.
• Progressive massive fibrosis: severe dyspnoea, cough, respiratory failure, cor pulmonale.
• Rheumatoid arthritis with lung nodules (Caplan).

• Exposure history and mining occupation.
• Chest radiograph (ILO classification), HRCT: small centrilobular and perilymphatic nodules in upper zones, PMF, emphysema.
• Spirometry, DLCO; exercise testing.
• Exclude tuberculosis, lung cancer, rheumatoid disease (RF, anti CCP).
• Biopsy rarely required (coal macules with dust laden macrophages).
• Medical surveillance programmes (chest radiograph and spirometry every 3 to 5 years).

• Removal from dust exposure; occupational notification and compensation (black lung benefits).
• No specific therapy; supportive: bronchodilators (tiotropium, long acting beta agonists), inhaled corticosteroids for obstruction, pulmonary rehabilitation, oxygen, influenza and pneumococcal vaccination, smoking cessation.
• Tuberculosis screening and treatment of latent or active disease.
• Treat complications: cor pulmonale diuretics, infections, rheumatoid arthritis therapy.
• Lung transplantation for end stage.
• Prevention: dust suppression, ventilation, respirators, limits on respirable dust and silica, health surveillance.
• Lung cancer risk assessment and surveillance if smoking history.