What is Black Lung Disease?

The official medical term for Black Lung Disease is “coal workers’ pneumoconiosis.” There are two types of Black Lung Disease – simple and complicated. Both are caused by exposure to coal dust. Because the body cannot get rid of the dust that is inhaled, it stays in the miner’s lungs and builds up over time. The name comes from the fact that the lungs of people with the disease look black. Because the important issue is exposure to coal dust, people who never worked in an underground mine still may develop Black Lung Disease (including, but not limited to, coal processing plant workers, surface miners, and some coal truck drivers).

Unfortunately, Black Lung Disease is progressive, which means that the condition can develop and worsen over time even after the person has stopped working around coal. In other words, a miner may not have symptoms for many years after he or she has stopped working but, if enough dust is in the person’s lungs, the person’s breathing will become more difficult, the former miner will develop Black Lung Disease, and then the symptoms may continue to get worse each year. Not everyone who has Black Lung Disease is considered disabled but a person may move from being able to function normally to becoming disabled over time.

“Simple” Black Lung Disease is diagnosed when a person has a build-up of coal dust that leads to small areas of damaged lung tissue that show up on a chest x-ray. Most former miners who have Black Lung Disease have the “simple” version. However, as we note below, there are increasing numbers of current and former miners who have “complicated” Black Lung Disease (also called “Progressive Massive Fibrosis” or PMF). People with PMF have larger areas of lung damage.

Black Lung Disease is not the same as emphysema, bronchitis, pneumonia, or chronic obstructive pulmonary disease (COPD). Smoking does not increase the risk of Black Lung Disease or its progression but it can add to the damage to the lungs and, therefore, decrease the quality of life beyond the problems associated with Black Lung Disease.

Progressive Massive Fibrosis / Complicated Black Lung Disease

We are proud of our efforts to document the incidence of Progressive Massive Fibrosis (PMF) and bring the issue to the attention of the public, researchers, and policy-makers. We have collaborated with researchers, including a study with the National Institute of Occupational Safety and Health (NIOSH) documenting 416 Stone Mountain patients who were diagnosed with PMF between January 1, 2013, and February 15, 2017 (see below). We want to note that from July 1, 2016 – June 30, 2017, we had 509 miners with PMF, demonstrating that the numbers are continuing to increase.

The key factors associated with our leadership in this area were the diligence and awareness of Black Lung Clinic staff, who noticed a trend and talked with medical providers and management, who then discussed the issue with colleagues and researchers. At this point, it is standard practice for us to pay attention to the possibility of PMF and we have modified our documentation and ability to track cases accordingly. We are participating in other research- related to PMF to assist with the tracking and treatment of miners with this condition.

The study with NIOSH mentioned above was published in the February 6, 2018, issue of the Journal of the American Medical Association ("Progressive Massive Fibrosis in Coal Miners from 3 Clinics in Virginia”). The results of this study have generated a lot of media attention, including the following articles:

• Black Lung Study Finds Biggest Cluster Ever of Fatal Coal Miners’ Disease (NPR)
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• Findings of Black Lung Disease Growing in Appalachia (Digital Journal)
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• Black Lung Disease Comes Storming Back to Coal Country (New York Times)
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The increase in PMF cases has put financial strains on the SMHS clinics and other Black Lung clinics across the country. Until this year’s Omnibus Appropriations bill, the federal funding for Black Lung clinics had stayed the same for many years and not all the money that could be given out has been authorized by Congress. A recent article discussed these issues:

• As Black Lung Cases Rise, Will Clinic Funding Follow? (Bloomberg / Occupational Safety & Health Reporter)
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However, thanks to the efforts of Representative Bobby Scott (D – VA 3rd) and Representative Morgan Griffith (R – VA 9th) and Virginia Senators Kaine and Warner, the Black Lung clinics across the country received an additional $2.7 million through the Appropriations bill.