Coal Worker's Pneumoconiosis Clinical Presentation

Updated: Dec 16, 2015
  • Author: Farhan J Khan, MD; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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Presentation

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 estimate dust levels. 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. [18] 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. [18]

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 [5] :

    • 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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