I have been the physician for the Department of Labor’s Coal Workers program for many years. Recently, I have seen an increase in the number of patients that are referred for examinations. These exams include a chest x-ray, pulmonary function studies, blood gas analysis and EKG. The purpose of the exam is to determine if the patient has socalled “Black Lung Disease” and if there is impairment. The Department of Labor then determines if the patient is worthy of a monetary recovery.

What I find interesting is that until a ground breaking report in 1942 there was a wide spread belief that coal dust was relatively non-toxic, and when pneumoconiosis (lung disease due to dust exposure) was reported, it was due to the inhalation of silica dust. Silica dust occurs when workers perform jobs where they drill into rock. It was finally discovered that coal dust itself can cause disease. However, recently more cases of rapidly progressive scarring have been seen in some of the coal workers. These workers are being exposed to mixed dusts. Often the major component of these dusts, along with coal, is silica. It appears that this combination of coal and silica may be responsible for the accelerated disease found. Much of the coal dust exposure today occurs in China, but there has been an uptick in the amount of pneumoconiosis seen in the United States and that of more rapidly progressive disease. Protective standards for coal dust are well established and should be applied worldwide.