Makindo Medical Notes

⚒️ About

• Coal Worker’s Pneumoconiosis (CWP), also called Black Lung Disease, results from long-term inhalation of coal dust → chronic lung inflammation, fibrosis, and progressive respiratory impairment.
• Part of the spectrum of pneumoconioses (with silicosis, asbestosis).
• UK context: recognised industrial disease → miners may be eligible for compensation.

🔎 Aetiology

• Caused by prolonged inhalation of respirable coal dust particles (especially underground miners).
• Risk increases with dust concentration, exposure duration, and smoking.
• ~10% of miners develop CWP after 20 years of exposure; risk higher with intense exposure.
• Can progress even after exposure stops due to ongoing inflammatory cascade.

🩺 Clinical Features

• Simple CWP:
  • Often asymptomatic or mild cough/sputum.
  • Radiology: small nodules (<0.15 cm) in upper zones.
  • Usually little impact on lung function if exposure ceases.
• Progressive Massive Fibrosis (PMF):
  • Large fibrotic masses (1–10 cm), cavitation possible.
  • Chronic cough, dark sputum (melanoptysis), breathlessness, respiratory failure.
  • Complicated by infections (esp. TB).
• Caplan’s Syndrome:
  • Rheumatoid arthritis + pneumoconiosis → rounded necrotic nodules in lungs.

🧪 Investigations

• Chest X-ray:
  • Simple CWP → tiny nodules, upper zone predominance.
  • PMF → large fibrotic opacities mimicking TB or lung cancer.
• HRCT: Defines nodules, fibrosis, distinguishes CWP vs PMF.
• Pulmonary Function Tests (PFTs):
  • Normal in simple CWP.
  • PMF → restrictive pattern, ↓ DLCO; advanced disease → mixed obstructive/restrictive (esp. smokers with COPD).
• Sputum culture: Rule out TB or secondary infection.

💊 Management

• Prevention & Occupational Health:
  • Respirators, dust suppression, health surveillance.
  • UK: compensation via Industrial Injuries Disablement Benefit.
• Medical:
  • Symptomatic relief: bronchodilators, pulmonary rehab, O₂ therapy if hypoxic.
  • Treat complications → TB, chest infections, COPD.
  • Smoking cessation critical 🚭.
• Surgical:
  • Rare: resection of suspicious masses.
  • Lung transplantation for end-stage disease (uncommon).
• Legal/Forensic:
  • Death from CWP must be reported to the coroner; post-mortem often required.

Comparison Table — Coal Worker’s Pneumoconiosis (CWP) ⛏️🫁

📉 Prognosis

• Simple CWP → good prognosis if exposure ceases.
• PMF → progressive respiratory impairment, ↑ risk of TB, respiratory failure.
• Caplan’s → associated with systemic rheumatoid arthritis morbidity.

📚 References

• NCBI Bookshelf – Coal Worker’s Pneumoconiosis
• ERS Journal – Clinical spectrum of pneumoconiosis
• UK Gov – Industrial Injuries Benefit