Coal Workers' Pneumoconiosis (Black Lung Disease) Clinical Presentation

Updated: Dec 19, 2019
  • Author: Fatima J Wong, DO; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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Presentation

History

Taking a detailed history is perhaps the most important step in evaluating patients for coal workers' pneumoconiosis (CWP) (black lung disease). Ask patients what their specific job entails to estimate dust levels. The length of time spent underground and the age at first exposure are important in determining the risk of progression to progressive massive fibrosis (PMF). 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 CWP is palliative and preventive. Many miners are not receptive to recommendations to changing their career. Thus, if their respiratory status worsens, or if they are at risk for progression to PMF, it may be helpful to suggest they change to a job within the mine that requires less exposure to respirable dust.

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Physical Examination

Miners with simple coal workers' pneumoconiosis (SCWP) (black lung disease) 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. Complicated CWP (CCWP) produces cough, dyspnea, and lung function impairment. In advanced disease states, cor pulmonale may be found, with an associated right ventricular heave, large a waves, hepatomegaly, and peripheral edema.

CWP 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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