What is Black Lung Disease?

Black lung disease is a type of pneumoconiosis, a condition caused by inhaling certain forms of dust into the lungs. Specifically, this disease is caused by the inhalation of coal dust, which tends to turn the lungs black instead of their normal pink color. It occurs only among workers in coal mines, or those in other work situations that cause high exposure to coal dust. It may be alternately called coal workers pneumoconiosis (CWP). When the disease has progressed significantly, it becomes progressive massive fibrosis (PMF) and it is responsible for the deaths of thousands of coal workers on a yearly basis, even if exposure to coal dust ended years before.

Black lung disease is not chronic obstructive pulmonary disease (COPD), and it is not emphysema. However, having the disease, which may simply show up as a cough in early years makes you more vulnerable to developing either of these conditions. If the condition is caught in early stages, it may be possible to halt progression of the disease, either by employing greater safety practices when around coal dust, or by ceasing work around coal dust. Smoking may worsen other diseases that will make black lung disease more challenging, significantly increasing 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 coal is inhaled, it can combine with white blood cells called macrophages. This combination of dust and blood cells begins to create abnormal tissue in the lungs called nodules. As nodules increase in size, they begin to restrict airflow, causing lower blood oxygen levels and then extreme difficulty in breathing.

Continued exposure to coal dust means more nodules will form, greatly increasing risk that at some point a person will not be able to breathe without assistance, and creating risk for disability and death. Generally if nodules are at least a centimeter (about .4 inches) in size, this disease is considered to have progressed to PMF. There are no cures for PMF, but if the disease does not progress to PMF, it may 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. Usually it takes about 10 years of coal dust inhalation for black lung disease to develop, and since it can be asymptomatic at first, people may not notice it. Chronic coughing developed by a person who works with coal is a reason to see a doctor. However as history has proven to the great disadvantage of many who work with coal, economic concerns may keep people working despite the health risk, hastening development of PMF.

Diagnosis of this disorder is made through taking a medical history and x-raying the lungs, which may show spots where nodules have formed. Information on breathing disruption, breathing difficulties, and chronic cough is also valuable in diagnosis. If in its early stages, affected people may still live quite normal lives, especially if they change their work environment. Some people benefit from supportive treatment like access to oxygen or through using inhalers like asthma inhalers.

Unfortunately, no cure exists for PMF, and it has taken the lives of thousands of coal workers. Safer miner practices, especially in developed countries now significantly decreases risk of exposure to coal dust. Black lung disease still affects many who worked before such safety standards were adopted, and also those who work in developing countries, which don’t have such standards in place.