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) ⛏️🫁

Feature	Simple CWP	Progressive Massive Fibrosis (PMF)
Pathology	Accumulation of coal dust in macrophages → small fibrotic nodules	Coalescence of nodules into large fibrotic masses (>1 cm)
Symptoms	Often asymptomatic, may have mild cough/dyspnoea	Severe exertional dyspnoea, chronic cough, weight loss, fatigue
Chest X-ray / HRCT	Multiple small rounded opacities (≤1 cm), upper lobe predominance	Large confluent fibrotic masses, distortion of lung architecture, emphysema
Pulmonary function	May be normal or show mild obstructive/restrictive pattern	Marked restrictive defect, reduced DLCO, progressive hypoxaemia
Complications	Usually minimal; can progress slowly even after exposure stops	Pulmonary hypertension, cor pulmonale, increased TB risk
Prognosis	Often benign course if exposure ceases	Poor prognosis, progressive respiratory disability
Management	Dust avoidance, smoking cessation, surveillance	Supportive care: LTOT, vaccination, pulmonary rehab, palliative approach in advanced cases

📉 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

3 Clinical Cases — Coal Worker’s Pneumoconiosis (CWP) ⛏️🫁

Case 1 — Simple CWP (asymptomatic) 👷: A 52-year-old coal miner with 25 years of underground exposure attends for routine occupational health screening. He is asymptomatic. CXR: multiple small, rounded opacities (<1 cm) in the upper lung zones. Spirometry: normal. Teaching: Simple CWP may be asymptomatic and discovered on surveillance imaging. It is caused by chronic inhalation of coal dust. Prevention relies on dust control and surveillance.
Case 2 — Symptomatic simple CWP with mild obstruction 🌫️: A 60-year-old retired miner presents with chronic cough and exertional dyspnoea. CXR: diffuse nodular opacities, upper-zone predominance. Spirometry: mild obstructive defect. Teaching: Symptomatic CWP can mimic COPD, especially in smokers. Differentiation rests on occupational history and radiology. Disease can progress even after exposure stops.
Case 3 — Progressive Massive Fibrosis (PMF) 🖤: A 64-year-old ex-miner with worsening breathlessness, weight loss, and right heart strain. CXR and HRCT: large (>1 cm) fibrotic masses in upper lobes with surrounding emphysema. Echo: evidence of pulmonary hypertension. Teaching: PMF is the advanced stage of CWP. It causes severe lung restriction, hypoxaemia, and cor pulmonale. Management is supportive: oxygen, symptom control, vaccination, and early consideration of palliative care.

The content on this website is provided for educational and informational purposes only to support exam preparation (e.g., MLA, MRCP, USMLE) and learning. This is NOT medical advice, diagnosis, treatment, or professional guidance. It does not replace consultation with a qualified healthcare professional, official guidelines (e.g., NICE, GMC, BNF), or supervised clinical practice. Always verify information with current, authoritative sources. Makindo and its contributors accept no liability for any reliance on this content, including errors, omissions, or any resulting harm, loss, or consequences. By using this site, you agree to these terms.

Coal Worker's Pneumoconiosis

⚒️ About