Black Lung Disease

"Mining is one of the oldest of human occupations. The awareness of occupational illnesses associated with mining, even in ancient times, is evident from the writings of Hippocrates (460-370 BC), Pliny and Elder (AD 23-79), and Galen (AD 131-210). Georgius Agricola (1494-1535), in his De Re Metallica, refers to the diseases of miners and the need for their control through good planning and operating practices and responsible management (Schwerha, 1989). Coal workers' pneumoconiosis (CWP), often called Black Lung disease, is an occupational disease which results from inhalation of coal mine dust which usually contains relatively small amounts of free crystalline silica.A pneumoconiosis is best defined as the accumulation of dust in the lungs and the tissue's reaction to its presence [Lapp and Castranova, 1993]. Silicosis is the name given to the fibrotic disease of the lungs caused by the inhalation of dust containing silicon dioxide, primarily in the free crystalline form. Silicosis is the older and more well known of these mineral pneumoconioses. In contrast, CWP was not recognized as different from silicosis until the pivotal work of Collis and Gilchrist [1928].The U.S. Bureau of Mines (USBM) still regards worker exposure to respirable aerosols in mines as the most serious health problem in mining [USBM, 1994]. The National Institute of Occupational Safety and Health (NIOSH) is considering recommending a reduction in the standard for occupational exposure to respirable coal mine dust from 2 mg/m3 to 1 mg/m3 [NIOSH, 1993]. The Mine Safety and Health Administration (MSHA) may require new criterion for sampling procedures in the mine that would evaluate the ambient dust concentration in the mine atmosphere based on a single sample, instead of the current practice of averaging five samples (MSHA, 1992; Ramat* 1993). Several high-production longwall mining faces currently have extreme difficulty meeting the existing dust standards, and some already operate at reduced production levels to achieve mandated levels [USBM, 1993]. The importance of adequately protecting the miners from high concentrations of coal mine dust, as well as of reducing the incidence and severity of the Black Lung disease, cannot be overemphasized. The importance stems, first and foremost, from the humanitarian viewpoint and, second, from the perspective of the overall welfare of the coal industry.The histopathologic hallmark of CWP is the coal macule (Balaan, Weber and Banks, 1993). Autopsy or open lung biopsy reveals the coal macule to be an amorphous mass of coal particles, dust-laden pulmonary macrophages, reticulin, and collagen. No pathognomonic signs or symptoms identify workers with CWP. A CWP diagnosis requires that the worker experienced the appropriate dust-exposure setting (e.g., underground coal mining) and duration (usually 10 years or more) and, has the characteristic chest radiograph. Based upon the International Labour Organization (ILO, 1980) international classification, pathologists and radiologists have established case definitions for characterizing the pathology and the appearance of CWP on chest radiography (Weeks, 1993). CWP appears in two principal forms: simple, with small opacities, and complicated, with opacities larger than 10 mm in diameter. For all practical purposes, diagnosis of CWP in the living miner is wholly dependent upon the chest radiograph interpretation."