The Forgotten Disease

This story originally appeared in the January/February 2016 issue of West Virginia Focus magazine.

For a time, it seemed black lung was headed the way of smallpox and polio. When Congress passed the Federal Coal Mine Health and Safety Act of 1969, about 35 percent of coal miners with 25 or more years on the job were diagnosed with coal miners’ pneumoconiosis, the disease’s official name. But once the federal government established dust limits for mines, black lung rates began a steady decline that would last for three decades. By 1999, only 5 percent of workers with 25 or more years of service had the disease.

Then the numbers stopped dropping. “It kind of looks like we hit a brick wall,” says Anita Wolfe, public health advisor at the National Institute for Occupational Safety and Health (NIOSH). “For some reason we started noticing the little lines on the graph were starting to go up again. Now they’re back to about 10 percent.”

The folks at NIOSH were perplexed. “This should be a disease that is gone,” Wolfe says. “This should be a disease we should not be seeing anymore.” The agency created a mobile testing unit, visiting different mining communities around the country for in-depth medical screenings and interviews with miners. Their findings were worrisome. New black lung patients were younger than in the past, and the disease seemed to progress faster than it once did. “Instead of it taking 20 years to go from (the early to late stage), some of them were progressing in as little as seven years,” Wolfe says.

Although researchers have not pinpointed the exact causes, there are a few possible explanations for the recent resurgence of black lung and the disease’s newfound aggressiveness. The coal seams mined today are thinner than in the past, so machines cut into lots of rock as well as coal, and rock dust can be even worse for miners’ lungs than coal dust. NIOSH is also seeing more black lung cases in mines with fewer numbers of employees— operations that often have older, dustier equipment and do not have robust safety programs like those at larger mines. Employees also tend to work longer hours than in the past and, as a result, inhale more dust.

Black lung is a brutally simple sickness. “It’s not rocket science,” Wolfe says. “The way you get black lung disease is, you breathe in coal dust.” The body recognizes this dust as a foreign object and tries to expel it by coughing. Much of the dust is unmoved, however. This remaining dust irritates the lungs and creates scar tissue, which inhibits the lungs’ capacity to turn oxygen into carbon dioxide.

Patients sometimes do not show symptoms during the disease’s earliest stages, although the damage can be picked up on x-rays. Scar tissue continues to build up as things progress, however, eventually leading to late-stage black lung known as “progressive massive fibrosis.” By this stage the lungs are almost completely covered in fibrous scar tissue. Patients usually rely on bottled oxygen to help them breathe. Once the disease reaches this final stage, black lung will only continue to grow worse. “There’s no drug that can help this,” says NIOSH epidemiologist Cara Halldin. Some late-stage patients get lung transplants. although the survival rates for that procedure are not promising.

The only thing that will stop the progression of the disease is to stop the patients’ exposure to coal dust while they are still in the disease’s earliest stages. There are measures mines can take to limit miners’ exposure to dust, including curtains, airflow control systems, and water sprayers on machines. But Halldin says sometimes, if a piece of equipment breaks or the production has fallen behind schedule, mines don’t want to take the time for these safety precautions.

The U.S. Mine Safety and Health Administration also offers guaranteed transfers to miners diagnosed with black lung, allowing them to move from the dustiest parts of an operation to somewhere with less exposure. Only about 10 percent of eligible workers use the transfer orders. “We don’t know for sure why that is,” Wolfe says. Anecdotally, Wolfe has heard some workers don’t use the transfer orders because they like their jobs or are worried they will be fired or passed over for promotions, even though federal law protects transferred miners against workplace discrimination.

Some workers also seem to hold onto their transfer order until they are ready to retire, in hopes of working their last few years in an easier assignment. Of course, this completely undermines the idea behind the transfer program. By continuing to breathe harmful coal dust, these diagnosed miners have only helped their ailment to advance.

Wolfe says this is the biggest challenge to combating black lung: making sure employers and employees understand the disease and take appropriate precautions to prevent it, or at least slow its progression. She says mines constantly talk about safety to prevent major catastrophes but there is little focus on preventing disease, even though conditions like black lung are more deadly in the long run.

Many young miners don’t even believe the disease is still around. “They look at me with a blank face and say ‘We didn’t think you could get that anymore,’” Wolfe says. They do not realize every breath brings them closer to their own diagnosis.