Why is Black Lung Back?

About 10 years ago, Edward Petsonk, MD, began to examine coal miners’ lung x-rays for the National Institute for Occupational Safety and Health. An occupational lung disease specialist since 1979 and a WVU Pulmonary and Critical Care faculty member, Dr. Petsonk figured there shouldn’t be any more black lung disease because of laws in place for decades to protect coal miners.

“It was worse than I thought we would ever see. I almost fell off of my chair. I really was that shocked,” he said.

Petsonk found that the number of miners afflicted with black lung disease has been increasing since about the year 2000, when it was at its lowest rate in 30 years. In a clinical review of x-rays and data published in the American Journal of Respiratory and Critical Care Medicine, Petsonk and two other respected lung specialists revealed that young coal miners are getting sicker than older miners, and black lung disease is becoming more deadly.

“Black lung disease is still a big problem. Despite the fact that there are coal mines closing, coal is going to continue to be a big part of West Virginia’s economy, and there’s going to be even more pressure to make coal more competitive,” Petsonk said. “It’s more dangerous for miners now than it was 10-15 years ago. They’re getting sick. They’re getting lung transplants and dying from black lung.”

This is all in spite of safety mandates at coal mines that were established in 1969, along with requirements that coal operators offer underground employees periodic chest x-rays and maintain ventilation, dust control systems, and dust regulations in coal mines.

Petsonk said, “We have identified clusters or pockets of disease in southern West Virginia, eastern Kentucky, western Virginia and some areas of Pennsylvania. Black lung disease does occur in Illinois, Indiana, Utah, Colorado and other coal mining states, but fewer miners have the disease. In the cluster areas, black lung disease is both more prevalent and more severe.”

If coal miners wore masks and respirators frequently, would cases of black lung disease decrease? Petsonk said it’s unlikely. Masks and respirators can be cumbersome and inhibiting for miners to wear in cramped, dangerous, and noisy underground work areas.

“Mine operators must control the dust with types of dust traps, fans, or filters first, and then they can offer masks or respirators if the miners choose to wear them, but masks are not a practical and effective solution to controlling dust – that’s why current rules require mining companies to have controls in place and demonstrate that they are meeting the dust requirements. Certainly, mask issues don’t account for why people are getting black lung,” he said.

Larry Mongold, 57, a retired underground coal miner for 19 years, said he received thorough safety and health training at the mine he worked at in Keyser, West Virginia.

“We had training on wearing respirators and self-oxygen masks. We were well trained, and it was required by law each year to get refreshed on everything. We wore masks and respirators from time to time. Sometimes, they got in your way or interfered with your work or breathing, and I didn’t wear them,” Mongold said.

It was years after Mongold left the mine and was working elsewhere that he began to notice something was wrong. “I was having trouble doing day-to-day things like walking up and down hills on account of not getting enough oxygen. I did a lot of coughing. I still do a lot of coughing,” he said.

He began to see WVU pulmonary specialists and had lung function tests to determine what was going on. The tests confirmed that Mongold had black lung disease – an irreversible, debilitating and potentially fatal condition caused by inhaling coal dust. “It wasn’t really a surprise on account of knowing I was a coal miner. I dearly loved my coal mining job. It was the type of job that you could have and be proud of. If I had it to do over again, I would have worn my respirator more than I had,” he said.

Multiple possible explanations abound for the spike in black lung disease, including flaws in existing dust regulations, dust control practices, and dust exposure enforcement of coal mining companies, Petsonk said. Other theories include miners working longer shifts underground because fewer miners are employed today and they’re exposed to more dust, silica, and other toxins.

“With these cases of advanced black lung we are seeing, 100 percent of the people who get the disease have too much exposure in a very dusty environment. No one has ever gotten this type of massive lung scarring from smoking, and black lung disease has never been reported outside of very dusty jobs,” Petsonk said.

In an effort to end black lung disease among the nation’s coal miners, the U.S. Mine Safety and Health Administration submitted a draft of tougher rules this fall to the White House Office of Management and Budget for review. “The system still needs to be aware of black lung…It’s the coal dust that you can’t see that gets you,” Mongold said.

Petsonk continues to research black lung disease by studying autopsy reports, x-rays, and consulting with the world’s best pathologists for a future clinical review publication. “My job is to get the facts out and give a scientific basis for what’s causing an increase in this disease. I want the world to know about this and help us figure this out.”