Approach Considerations

There is no cure for coal workers’ pneumoconiosis (CWP) (black lung disease). Treatment for both simple (SCWP) and complicated CWP (CCWP) is symptomatic. Supportive care also includes good general respiratory management. Patients should receive influenza and pneumococcal vaccinations. Encourage smoking cessation.

Medical Care

Supportive therapies include bronchodilators for airflow limitation, antibiotics for respiratory infections, and supplemental oxygen to manage hypoxemia.

Caplan syndrome is treated similarly to progressive massive fibrosis. Oxygen and bronchodilators are administered as needed. The rheumatoid component is treated separately, per rheumatologic protocol.

The possibility of superimposed mycobacterial infection should be considered in any patient with unexplained weight loss, chronic cough, fever, or night sweats.

Surgical Care

Lung transplantation has increased as a treatment modality for individuals with end-stage coal workers’ pneumoconiosis (CWP) (black lung disease), with an estimated posttransplant survival of up to 4 years.^[49]

A retrospective study (1999-2009) noted good clinical outcomes after lung transplantation in a small group of patients with CWP.^[50]Removal of native lungs was not problematic, and no complications were found during the perioperative and postoperative periods. Furthermore, no pulmonary complications due to the native lung in patients who underwent single lung transplantation were reported.^[50] In contrast, other investigators observed lower rates of survivability compared with transplants for chronic obstructive pulmonary disease (COPD), idiopathic pulmonary fibrosis (IPF), and silicosis.^[51]

Nevertheless, given the lack of other options for miners with CWP and end-stage lung disease, those caring for such miners who are appropriate candidates for transplantation should consider referring them for transplant evaluation.

Prevention

Coal workers' pneumoconiosis (CWP) (black lung disease) is a completely preventable disease, with the key and primary goal of minimizing exposure to dust particles.^[14] Consequently, the Coal Mine Health and Safety Act of 1969 limited miners' exposure to respirable dust to below 1 mg/m³.^[1] In addition, undeground coal miners who have been diagnosed with pneumoconiosis have the legal right to request for transfer to a new position with lower dust job exposure, if available. Miners are encouraged to have an initial chest radiograph on the date of hire and at 5-year intervals thereafter.

Long-Term Monitoring

No evidence supports the hypothesis that removing a miner with coal workers’ pneumoconiosis (CWP) (black lung disease) from the mining environment arrests the disease once progression to progressive massive fibrosis (PMF) has begun.^[52] Therefore, serially monitoring the chest radiographs of miners to prevent the development of complicated CWP (CCWP) is prudent. Once a baseline radiograph has been established, patients should have follow-up radiographs every 5 years—more often if symptoms worsen.

Advise workers who develop evidence of simple CWP (SCWP) to transfer to jobs with low dust exposure. Also, miners are encouraged to have repeat spirometry every 1-3 years to monitor any decline with their pulmonary function.^[14]

Encourage smoking cessation to miners who smoke.

Medication

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Media Gallery

Coal workers' pneumoconiosis (black lung disease). Gross specimen demonstrating simple coal worker's pneumoconiosis.
Coal workers' pneumoconiosis (black lung disease). Gross specimen demonstrating progressive massive fibrosis in a coal miner.

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Author

Fatima J Wong, DO Fellow in Pulmonary Critical Care, University of Tennessee Graduate School of Medicine

Fatima J Wong, DO is a member of the following medical societies: American College of Chest Physicians, American College of Physicians

Disclosure: Nothing to disclose.

Coauthor(s)

Tina M Dudney, MD Associate Professor of Medicine, University of Tennessee Health Science Center College of Medicine; Active Staff Physician, University of Tennessee Medical Center

Tina M Dudney, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Medical Association, American Sleep Disorders Association, Knoxville Academy of Medicine, Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Michael T McCormack, MD Physician, University Pulmonary/Critical Care Group, PA

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Zab Mosenifar, MD, FACP, FCCP Geri and Richard Brawerman Chair in Pulmonary and Critical Care Medicine, Professor and Executive Vice Chairman, Department of Medicine, Medical Director, Women's Guild Lung Institute, Cedars Sinai Medical Center, University of California, Los Angeles, David Geffen School of Medicine

Zab Mosenifar, MD, FACP, FCCP is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Federation for Medical Research, American Thoracic Society

Disclosure: Nothing to disclose.

Additional Contributors

Sat Sharma, MD, FRCPC Professor and Head, Division of Pulmonary Medicine, Department of Internal Medicine, University of Manitoba Faculty of Medicine; Site Director, Respiratory Medicine, St Boniface General Hospital, Canada

Sat Sharma, MD, FRCPC is a member of the following medical societies: American Academy of Sleep Medicine, American College of Chest Physicians, American College of Physicians-American Society of Internal Medicine, American Thoracic Society, Canadian Medical Association, Royal College of Physicians and Surgeons of Canada, Royal Society of Medicine, Society of Critical Care Medicine, World Medical Association

Disclosure: Nothing to disclose.

Farhan J Khan, MD Staff Intensivist, ICC Health Care, Core Teaching Faculty, Internal Medicine Residency Program, Brandon Regional Hospital; Staff Intensivist, ICC Health Care, Oak Hill Hospital

Farhan J Khan, MD is a member of the following medical societies: American College of Chest Physicians, Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Acknowledgements

Amit Dhingra, MD Fellow in Pulmonary Disease, University of Tennessee Medical Center at Knoxville

Disclosure: Nothing to disclose.

Richard A Obenour, MD (Retired) Professor and Vice-Chair, Department of Medicine, University of Tennessee Graduate School of Medicine

Disclosure: Nothing to disclose.

Julia Richards van Zyl, MD Staff Physician, Knoxville Inpatient Physicians, Department of Internal Medicine/Hospitalist, University of Tennessee Medical Center

Julia E Richards is a member of the following medical societies: American College of Physicians-American Society of Internal Medicine and American Medical Association

Disclosure: Nothing to disclose.