Coal workers' pneumoconiosis: recognition and management.
Intern Med Spec 1989 Apr; 10(4):91-97
Legislation was passed in the United States in 1969 which recognized the contribution of coal mine dust to chronic lung disease, premature disability, and death. This legislation mandated federal research in coal workers' pneumoconiosis (CWP). CWP results from the inhalation and deposition in the lung of respirable coal mine dust. Coal is mined in the United States both as underground seams and surface outcrops. Epidemiological studies have demonstrated that the risk of CWP increases as the worker's exposure increases over longer periods of time, as the worker is exposed to more intensely dusty conditions, and as the hardness of the coal being mined increases. CWP can be diagnosed through an adequate history of coal mine dust exposure and a characteristic chest radiograph. In simple CWP the radiographs shows small opacities with rounded nodules predominating. Complicated CWP is characterized by one or more large opacities greater than 1 centimeter. Upper lobe predominance is also typical in the advanced stages. The primary lesion of simple CWP is the coal macule, which is a focal collection of coal dust, pigment laden macrophages at the division of respiratory bronchioles, which may exist within the alveoli and extend into the peribronchiolar interstitium with associated reticulin deposits and focal emphysema. Simple CWP has no clinical symptoms nor abnormal physical signs and is often associated with only minimal ventilatory impairment. Complicated CWP may have findings of collapse or consolidation. No specific therapy is available for CWP. Improved mining methods and lower dust levels appear to be reducing the exposures and cases of both simple and complicated CWP. Cessation of smoking is important for all miners.
Coal-miners; Occupational-exposure; Underground-mining; Dust-control; Dust-inhalation; Coal-dust; Pulmonary-system-disorders; Pulmonary-function; Epidemiology
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