Reduced exposure, early detection key in treatment of black lung disease

Wednesday, July 15, 2020

MORGANTOWN, W.Va. – Pneumoconiosis, commonly known as black lung, has long been an issue for West Virginians. The WVU Medicine Pulmonary Medicine Multidisciplinary Interstitial Lung Disease Clinic includes pulmonologists, thoracic surgeons, occupational therapists, and other professionals who provide an integrated approach to the treatment of the condition. 

Rafia Zulfikar, M.D.
Rafia Zulfikar, M.D.

Common symptoms of pneumoconiosis include shortness of breath, coughing, and the production of phlegm. The condition is diagnosed using chest x-rays; CT scans; pulmonary function studies, including blood gasses; and biopsy.

“There are multiple causes for the increase in complicated pneumoconiosis in coal miners,” Rafia Zulfikar, M.D., WVU Medicine pulmonologist, said. “Miners are accessing thinner coal seams and taking more rock with the coal, leading to a change in the composition of the dust in the mine.”

Pneumoconiosis rates have increased in West Virginia, Kentucky, and Virginia since 2000. Modern mechanical coal mining creates more dust than earlier methods by releasing more fractured silica-containing rock. 

According to Dr. Zulfikar, research has found that silica is more toxic than pure coal dust when inhaled, causing inflammation, fibrosis, and a higher risk of cancer. Additionally, bituminous coal mined in the Appalachian Mountains has been found to lead to higher rates of black lung than the non-bituminous coal mined in other places in the United States.

“People often think of coal dust as just coal, but it has numerous components other than just coal,” Zulfikar said. “Modern coal dust contains 40 to 90 percent silica in addition to coal, asbestos, diesel exhaust, and other elements.”

This changed composition combined with improper use of personal protective equipment and smaller mines with larger concentrations of mine dust has led to higher rates of pneumoconiosis in younger miners. 

According to Zulfikar, the best treatment for the condition is reduced or eliminated exposure to coal dust. While lung damage from exposure to coal mining dust is difficult to reverse, therapies can be provided to treat the symptoms of the disease.

Studies on other potential treatments are underway, but are years from completion. 

“We have worked with researchers at NIOSH to replace the old standard x-ray films from the 1960s and replace them with digital images to improve the early detection of black lung,” Zulfikar said. “Still, the best way to early detection is for miners to have regular chest x-rays while working in the mines so the condition can be caught before it reaches a stage that is more difficult to manage.”

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