Black lung disease resurges with no signs of slowing

A steady and ongoing increase in progressive massive fibrosis related to coal workers’ pneumoconiosis (CWP) has been recognized in the United States over the last few years through epidemiologic investigations. Drew Harris, MD, FCCP, assistant professor of medicine for pulmonary and critical care medicine at the University of Virginia, and medical director of the Black Lung Program at Stone Mountain Health Services; and Amy M. Ahasic, MD, MPH, FCCP, ATSF, pulmonary and critical care section chief at Norwalk Hospital and Nuvance Health, will share likely reasons for this trend and ways clinicians can help patients in the session Black Lung Disease: A Resurgence of Mining-Related Lung Disease in the 21st Century on Sunday at 7:30 am in room 298 in the convention center. The duo provided a glimpse into their session in this Q&A with Daily News.

What are the epidemiologic stats and trends of CWP?


→ Dr. Harris:Regulatory standards around dust exposures in coalmines were enacted in 1969 as part of the Federal Coal Mine Health and Safety Act, an act that also established the U.S. National Coal Workers X-ray Surveillance Program. While there was a dramatic decrease in the incidence of black lung disease in the United States over the 3 decades after this legislation was passed, that trend has dramatically over the last 15-20 years.

→ Dr. Ahasic:We are now seeing rates of CWP and progressive massive fibrosis at levels not seen for 50 years and with no signs of this trend slowing. Active and retired miners in Central Appalachia (southern West Virginia, southwestern Virginia, and eastern Kentucky) seem to be particularly vulnerable. Also very concerning is a trend toward younger miners with shorter tenures developing disabling lung disease.

What do clinicians need to know to serve patients at-risk and those who develop CWP?

→ Dr. Ahasic: Clinicians need to recognize that black lung is no longer “a disease of historical interest” and can develop in their patients, including those with limited mining tenures. Clinicians should be aware of the multiple subtypes of black lung disease ranging from CWP to diffuse dust fibrosis, chronic bronchitis, and COPD (even without smoking). Each subtype can present differently, with different radiographic and pulmonary function findings, and patients may respond to inhaled medications and pulmonary rehabilitation.

Can you describe the causes of CWP in more detail? Why do you think it’s an ongoing increase?

→ Dr. Harris: Although ongoing research is needed to fully answer this question, preliminary studies suggest that silica exposure/silicosis is in part an explanation for the epidemic of rapidly progressive pneumoconiosis and progressive massive fibrosis. One researcher (Pollock Mining Engineering 2010) stated it this way: “The easy coal of yesterday has already been mined.” The coal seams that remain underground in Appalachia are smaller and surrounded by thick layers of quartz. Mining
these rock layers creates rock dust. Mining rock also rapidly wears down mining bits and leads to grinding of rock and increased rock dust production. Engineering controls including scrubbers, sprayers, and ventilation systems can be overwhelmed by this increased rock dust production and put workers at risk for toxic exposures to silica. In addition to silica exposures, increased mechanization and changes in mining technologies may also lead to differences in the properties of respirable occupational dusts inhaled by those working in mines today.

What measures do you think should be taken to prevent CWP?

→ Dr. Harris: Developing a better understanding of the ongoing mining conditions in the current epidemic is essential in order to target environmental interventions and improve regulations to prevent the development of disease. Early recognition of CWP is needed in order to move patients to less dusty environments and prevent disease worsening.