Coalworker's pneumoconiosis
From Wikipedia, the free encyclopedia
| Coalworker's pneumoconiosis Classification and external resources |
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| ICD-10 | J60. |
|---|---|
| ICD-9 | 500 |
| DiseasesDB | 10145 |
| MedlinePlus | 000130 |
| eMedicine | med/398 |
Black lung disease, also known as coal workers' pneumoconiosis (CWP), is caused by long exposure to coal dust. It is a common affliction of coal miners and others who work with coal, similar to both silicosis from inhaling silica dust, and to the long term effects of tobacco smoking. Inhaled coal dust progressively builds up in the lungs and is unable to be removed by the body, leading to inflammation, fibrosis, and in the worst case necrosis.
Full blown coal workers' pneumoconiosis develops after the initial, milder form of the disease known as anthracosis (anthrac - coal, carbon). This is often asymptomatic and is found to at least some extent in all urban dwellers[1] due to air pollution. Prolonged exposure to large amounts of carbon dust results in progression to the more serious forms of the disease, simple coal workers' pneumoconiosis and complicated coal workers' pneumoconiosis.
There are currently about 42,000 underground coal miners actively working in the United States. The mining and production of coal is an important part of countries such as the United States that depend on coal for their economy. However, as countries continue to mine coal, the mining industries must understand how to protect their miners from this devastating and deadly disease of CWP. In the past 10 years, over 10,000 American miners have died from CWP. Although this disease is entirely preventable, it is an undeniable fact that many miners are still developing advanced and severe cases.
In the 25 years since the Federal Coal Mine Health and Safety Act of 1969 became law, the proportion of miners with black lung disease has gone down by about 90%. But the downward trend of this disease in coal miners has stopped. Rates of black lung are on the rise and have almost doubled in the last 10 years. From 2000 to 2004, over 4,000 miners died from black lung disease in the United States.
The National Institute for Occupational Safety and Health (NIOSH), with support of the Mine Safety and Health Administration (MSHA), has started a Mobile Health Screening Program. This Mobile Unit travels to mining regions around the United States. Miners who participate in the Program receive health evaluations once every five years, at no cost to themselves. Chest x-rays can detect the early signs of and changes in CWP, often before the miner is aware of any lung problems. The screening program is only available to current miners.
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[edit] Pathogenesis
Coal dust that enters the lungs can neither be destroyed nor removed by the body. The particles are engulfed by resident alveolar or interstitial macrophages and remain in the lungs, residing in the connective tissue or pulmonary lymph nodes. Aggregations of carbon-laden macrophages can be visualised under a microscope as granular, black areas. In serious cases, the lung may grossly appear black. These aggregations can cause inflammation and fibrosis, as well as the formation of nodular lesions within the lungs. The centres of dense lesions may become necrotic due to ischaemia, leading to large cavities within the lung
[edit] Appearance
Simple CWP is marked by the presence of 1-2mm nodular aggregations of anthracotic macrophages, supported by a fine collagen network, within the lungs. Those 1-2mm in diameter are known as coal macules, with larger aggregations known as coal nodules. These structures occur most frequently around the initial site of coal dust accumulation - the upper regions of the lungs around respiratory bronchioles[1].
Continued exposure to coal dust following the development of simple CWP may result in its progression to complicated CWP, which generally requires a number of years to develop. Large, black, fibrotic scars 2-10cm in diameter are present, with accompanying decreased lung function. The lung itself appears blackened. A minority of these cases progresses to progressive massive fibrosis (PMF), the most serious form of CWP.
[edit] Symptoms
Both CWP and mild complicated CWP are often unsymptomatic or only affect lung function slightly. Shortness of breath and pain may be felt. However, progression to PMF is marked by lung dysfunction, pulmonary hypertension, and cor pulmonale.
[edit] See also
[edit] References
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Additional Resources
NIOSH Coal Workers' Health Surveillance Program http://www.cdc.gov/niosh/topics/surveillance/ORDS/CoalWorkersHealthSurvProgram.html
American College of Radiology (ACR) http://www.acr.org
Black Lung Benefits Act (BLBA) http://www.dol.gov/dol/compliance/comp-blba.htm
Black Lung Clinics Program http://bphc.hrsa.gov/blacklung/default.htm
Campaign to End Black Lung Now and Forever http://www.msha.gov/S&HINFO/BLUNG/HOMEPAGE.HTM
Federal Mine Safety & Health Act of 1977 http://www.msha.gov/Regs/Act/Acttc.htm
Mine Safety and Health Administration http://www.msha.gov
42CFR27 Specifications of Medical Examinations of Underground Coal Miners http://www.access.gpo.gov/nara/cfr/waisidx_02/42cfr37_02.html
The Courier-Journal (Louisville, Ky): Black Lung Chronicles http://www.courier-journal.com/cjextra/blacklung/index.html
