Researchers at the National Institute of Occupational Safety and Health (NIOSH) and staff from some lung clinics in Virginia have reported the largest cluster of severe black lung disease ever described in the scientific literature[i].
Black lung disease is also known as coal workers’ pneumoconiosis, and the severe disease found in these workers, defined by the size of the damaged areas of the lung and features visible in chest X-rays, is referred to as progressive massive fibrosis (PMF)[ii]. Early detection of black lung disease is critical, in order to prevent its progression to the most severe and disabling form.
The study was undertaken after the director of three black lung clinics in Virginia requested assistance from NIOSH in determining the burden of severe black lung disease among the patients served by the clinics. Data, including chest X-rays, from 11,200 patients served by the clinics between January 2013 and February 2017 were analysed. There were 416 coal miners who met the definition of progressive massive fibrosis. The mean age was 61.8 years, with a range from 38.6 to 88.7 years. The time spent working in coal mining ranged from 8 to 64 years, with an average of 27.9 years. 80 of the miners (22.7%) reported working in mines for 20 years or less, which suggests that the disease has progressed rapidly in these patients. 42 of the patients were still working as miners at the time the X-ray was taken. The actual number of miners in this region with PMF is likely to be much higher, as this study only included three clinics.
These findings reflect a failure to protect these coal miners from work-related exposure to coal mine dust. The Coal Workers’ Health Surveillance Program, founded in 1970, offers periodic chest X-rays to miners as screening for signs of black lung disease. The proportion of screened miners with the disease reached the lowest levels in the late 1990s, and then began to increase. Efforts have been made in recent years to increase the protection given to miners; for example, in 2014 the amount of respirable coal dust permitted in mines was reduced, changes in monitoring airborne dust levels were implemented, and the Coal Workers’ Health Screening Program was expanded.
In the UK, the Mines Regulations 2014 include the requirements to perform risk assessments for inhalable dust, to sample levels of respirable dust, and to place any worker who may be exposed to dust under suitable health surveillance. The Health and Safety Executive provides Guidance on the Regulations[iii].
[i] Inside NIOSH: Severe Black Lung Disease Found in Many Former Coal Miners. NIOSH Research Rounds, Vol 3 No 8, February 2018. https://www.cdc.gov/niosh/research-rounds/resroundsv3n8.html (Accessed 23 February 2018)
[ii] Blackley, D. J. et al. Progressive Massive Fibrosis in Coal Miners From 3 Clinics in Virginia. JAMA 319, 500–501 (2018). https://jamanetwork.com/journals/jama/article-abstract/2671456?redirect=true (Accessed 23 February 2018)