Coal Worker's Pneumoconiosis Clinical Presentation

  • Author: Amit Dhingra, MD; Chief Editor: Zab Mosenifar, MD   more...
 
Updated: May 10, 2012
 

History

Taking a good history is perhaps the most important step in evaluating for coal worker’s pneumoconiosis. Ask patients what their specific job entails in order to determine exposure to respirable coal dust. The length of time spent underground and the age at first exposure are important in determining the risk of progressing to progressive massive fibrosis. Determine the type of coal mined, its rank, and, if possible, its silica content. Obtain a smoking history because miners who smoke have more symptoms than miners who do not smoke.

Treatment for coal worker’s pneumoconiosis is palliative and preventive. Most miners are not receptive to recommendations to change career. If their respiratory status worsens, or if they are at risk for progression to progressive massive fibrosis, suggest changing to a job within the mine that requires less exposure to respirable dust.

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Physical

Miners with simple coal worker’s pneumoconiosis are usually asymptomatic. They may report cough or sputum production, but this is generally secondary to industrial bronchitis or smoking and not to the body's reaction to coal.[13] Complicated coal worker’s pneumoconiosis produces cough, dyspnea, and lung function impairment. If the disease is advanced, cor pulmonale may be found with associated right ventricular heave, large A waves, hepatomegaly, and peripheral edema. These late physical findings are rare in the United States.[13]

Coal worker’s pneumoconiosis results from mechanical and architectural destruction of the lungs. Fever, night sweats, and other constitutional symptoms suggest a secondary infective process.

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Causes

The following factors increase the risk of coal worker’s pneumoconiosis:

  • Type of dust: More silica increases the risk of fibrosis. Coal rankings are as follows[3] :
    • High: This coal is older and has the least amount of volatile matter (eg, anthracite coal [hard and shiny]).
    • Medium: This coal is of moderate age and has a greater amount of volatile matter (eg, bituminous coal).
    • Low: This coal is younger and has the greatest amount of volatile matter (eg, lignite coal [brown and crumbly]).
  • Age at first exposure
  • Length of time spent underground
  • Smoking
  • Size of dust particles
  • Type of job: Certain jobs require more exposure to respirable dust. Most dust is found at the coal face; therefore, individuals who work directly on the cutting of the coal have the highest exposure. The following list details dust exposure related to job title, beginning with the highest exposure[1] :
    • Cutting-machine operator: This worker cuts coal directly at the face. Respirable dust levels are highest here.
    • Roof bolters: These individuals drill through rock and thus are also exposed to silica. The continuous mine operator, loading machine operator, and shot firer are also exposed to higher amounts of respirable dust.
    • Train operators: They drop sand onto the tracks for traction and may therefore develop silicosis.
    • Motormen, brakemen, drivers, and shuttle car operators: These individuals have less dust exposure because the coal has already been cut by the time they work with it, thus decreasing their exposure to respirable dust.
    • Mechanics, electricians, and maintenance personnel: They have the least amount of dust exposure.
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Contributor Information and Disclosures
Author

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

Disclosure: Nothing to disclose.

Coauthor(s)

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

Richard A Obenour, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Chest Physicians, American College of Physicians, and American Thoracic Society

Disclosure: Nothing to disclose.

Specialty Editor Board

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

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, and World Medical Association

Disclosure: Nothing to disclose.

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

Disclosure: Medscape Salary Employment

Timothy D Rice, MD  Associate Professor, Departments of Internal Medicine and Pediatrics and Adolescent Medicine, St Louis University School of Medicine

Timothy D Rice, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Physicians

Disclosure: Nothing to disclose.

Chief Editor

Zab Mosenifar, MD  Director, Division of Pulmonary and Critical Care Medicine, Director, Women's Guild Pulmonary Disease Institute, Professor and Executive Vice Chair, Department of Medicine, Cedars Sinai Medical Center, University of California, Los Angeles, David Geffen School of Medicine

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

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author, Julia Richards van Zyl, MD, to the development and writing of this article.

References

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Gross specimen demonstrating simple coal worker's pneumoconiosis.
Gross specimen demonstrating progressive massive fibrosis in a coal miner.
 
 
 
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