Coal Mine Dust Lung Disease: New Lessons from an Old Exposure

This article provides an update on recent advances in the understanding of respiratory health issues in coal miners and focuses on the spectrum of disease caused by inhalation of coal mine dust, termed coal mine dust lung disease (CMDLD).



In addition to the historical interstitial lung diseases (coal worker’s pneumoconiosis, silicosis, and mixed dust pneumoconiosis), coal miners are at risk for dust-related diffuse fibrosis (DDF) and chronic airway diseases including emphysema and chronic bronchitis.



Recent recognition of rapidly progressive pneumoconiosis in younger miners, mainly in the eastern United States, has increased the sense of urgency and the need for vigilance in medical research, clinical diagnosis, and exposure prevention.



Some useful quotes:



“Coal mining remains a sizable industry due to its important role in energy production. Modern

mining technology has improved productivity with the capability to pulverize thousands of tons

of coal per shift. These tasks generate clouds of respirable dust particles with toxic radicals on

their surfaces.”



“Starting in about 2000, surveillance of working U.S. coal miners began to show an unexpected

increase in the proportion of miners with chest radiographic changes consistent with

pneumoconiosis.”



“This increase followed 30 years of decline after enactment of the Federal Coal Mine Health and Safety Act of 1969.”



“Most of the affected coal miners had worked their entire careers after the 1969 dust limits had gone into effect, calling into question the effectiveness of modern dust controls.”



“There is increasing recognition that occupational exposure as well as tobacco smoke plays a

significant role in the development of chronic obstructive lung disease. Perhaps the most compelling evidence comes from the multiple studies of coal miners, confirming a strong,

consistent, and dose-dependent relationship between respirable coal mine dust exposure and

chronic airway diseases (including chronic bronchitis and emphysema).”



“In a landmark study of 722 autopsied coal miners and non-miners, cumulative exposure to respirable coal mine dust, as well as the weight of dust retained in the lungs, were both significant predictors of emphysema severity, after accounting for cigarette smoking, age at death, and race.”



“Coal miners are potentially exposed to a number of lung carcinogens including respirable silica

(quartz), radon progeny and diesel exhaust, the latter introduced into US underground coal

mines in the 1950’s.”



“Recent investigations suggest that coal miners may show excess lung cancer mortality.”



“No specific medical therapy has proven effective in reversing CMDLD.”



“Lung transplantation has been performed for coal miners with very advanced lung disease.”



“Personal Dust Monitors (PDMs) have been approved for use in coal mines to continuously monitor an individual miner’s dust exposure. This electronic device can provide real-time measurements of dust levels, allowing for immediate interventions to reduce harmful exposures. Unfortunately, PDMs are

expensive, and their role in managing individual miners remains to be clarified.”



“The spectrum of lung disease associated with coal mine dust exposure is broader than generally

recognized, and includes classic Coal Workers’ Pneumoconiosis, silicosis, and mixed dust

pneumoconiosis as well as dust-related diffuse fibrosis (which may be clinically

indistinguishable from Idiopathic Pulmonary Fibrosis absent the exposure history or pathologic

evidence).”



“Progression from a normal chest radiograph to advanced pneumoconiosis may be considerably more rapid than the 15 to 25 years previously considered typical. Among coal miners, dust inhalation is also an important cause of emphysema and COPD, and the rate of the associated functional decline is similar for dust exposure and tobacco smoking. Individual miners often present with multiple effects of coal mine dust, including bronchitis, interstitial lung disease, and emphysema, a spectrum of overlapping diseases appropriately categorized as Coal Mine Dust Lung Disease.”



“Coal miners’ lung diseases are not only of historic interest; they are a concern in the 21st

century.”



“The cause of the recent resurgence and severe forms of Coal Mine Dust Lung Disease is likely

multi-factorial. Flaws have been recognized in existing regulations, dust control practices, and

enforcement.”


Nimbin Environment Centre

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