Coal Workers' Pneumoconiosis (Black Lung Disease) Treatment & Management

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

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.

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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.

 

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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.

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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.

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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. 

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