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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...

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.

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.

Differential Diagnoses
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