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Coal worker’s pneumoconiosis (COPD), more commonly known as black lung disease, is a condition that affects people who’ve worked in mines — specifically, coal mines.

According to the U.S. Department of Labor, black lung disease has continued to increase in the United States since the 1990s. In most cases, miners must work in the mines for decades to get this disease because it relates to exposure to coal dust. Several of the elements that make up coal can cause lung injury, including carbon-containing particles.

Elizabeth Lendermon, MD, practices at UPMC Presbyterian, an affiliate of University of Pittsburgh Physicians, Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine. Dr. Lendermon is a specialist in transplant pulmonology. Here, she answered some questions about black lung disease, including what you should know if you or a loved one is at risk.

What Are the Different Types of Black Lung Disease?

There’s a simpler type of black lung disease, and then there’s a major form that creates the most morbidity and mortality, called progressive massive fibrosis.

Early indicators of black disease include:

• Breathlessness.
• Coughing.
• Minor changes in chest images (x-rays or CT scans).

With progressive massive fibrosis, which is the more severe and worrisome form of coal worker’s pneumoconiosis, there’s extensive damage to the lungs. In the center of the chest, where the lungs attach to the center of your heart and your main airway, there’s a lot of scarring.

Oftentimes, there are two large masses of scarring, known as fibrosis, in the center of the chest. These masses grow over time and impair your ability to breathe effectively. It can also cause other downstream problems, like high blood pressure in the lungs (pulmonary hypertension) and right-sided heart failure. 

What Are the Symptoms of Black Lung Disease?

Black lung disease symptoms are very similar to those found with any form of lung disease. In the beginning stages of coal worker’s pneumoconiosis, people will have shortness of breath just from exertion.

For example, you may feel normal sitting down. But after going up a couple of flights of stairs, you’ll notice you’re having to catch your breath for a little bit longer than a friend or colleague.

Shortness of breath and coughing are the two main hallmark features of early lung disease.

How Is Black Lung Disease Diagnosed?

Workers can participate in the Coal Workers’ Health Surveillance Program (CWHSP). This program was established following a federal act in 1969 called the Federal Coal Mine Health and Safety Act, or the Coal Act.

Coal workers who choose to participate in this federally guided screening program have chest x-rays at certain intervals. They also have a pulmonary function test called spirometry.

Many coal workers receive a diagnosis of black lung disease through this program. People can also meet with their primary care doctor and explain their symptoms. The PCP can then order the necessary tests for a COPD diagnosis.

Who Is at the Highest Risk for Black Lung Disease?

The amount of time spent in mines is a major risk factor for black lung disease. But location can also pose a threat, as there has been an increasing incidence of this disease in Appalachia especially. Miners in this region have a much higher rate of getting coal worker’s pneumoconiosis, and even progressive massive fibrosis, the more feared form of the disease.

In addition, there seems to be a genetic tendency to develop the disease.

Aside From Transplantation, What Does Care Look Like for Black Lung Disease?

Treatment is primarily done through supportive care. In the pulmonary world at large — regardless of what lung disease you have — that’s oxygen. People should have tests to see if their oxygen saturation levels drop when they’re walking. If needed, they’ll benefit from oxygen.

We also use the same types of inhalers as for asthma and COPD to try to help open the airways, followed by pulmonary rehabilitation. However, this may not be quite as effective. With black lung disease, some of the airway obstruction relates to those masses in the center of the chest that are compressing the airway.

There are also formal types of programs that help to exercise people with advanced lung disease, and they have proven very helpful. They don’t necessarily change your lungs, but they change what your body is able to do with the lungs that you have. As a result, it increases your exercise endurance and quality of life.

Because people with black lung are at higher risk, it’s crucial to act aggressively when they come down with a common cold virus. This may require coming into the hospital to receive steroids and antibiotics.

Why Should People Choose UPMC?

At UPMC, experts from the Comprehensive Lung Center and the Lung Transplant Program will work together to create a treatment plan specific to your needs. They’ll also support you through each stage in your journey at UPMC. To learn more about lung transplantation at UPMC or to make an appointment, visit our website or call 412-648-6202.