Environmental and occupational medicine, 4th edition. Rom WN, Markowitz SB, eds. Philadelphia, PA: Lippincott Williams & Wilkins, 2006 Dec; :345-364
Coal miners develop a variety of lung diseases as a result of their workplace exposures. Of these, coal workers' pneumoconiosis (CWP) has received the most attention because of its clear occupational association. Bronchitis and emphysema resulting from coal mine dust exposure, clinically indistinguishable from their nonoccupational analogues, are also prevalent and are associated with significant morbidity among coal miners. The group of lung diseases for which miners are at increased risk have been called "black lung" in coal mining communities and in U.S. federal compensation legislation. To date, most scientific investigations and preventive efforts have been directed toward the control of CWP. Although a disease attributed to coal dust inhalation was reported following the autopsy of a Scottish miner in 1831 (1), the nature of coal miners' lung diseases was debated for the next 150 years. CWP was not recognized as an entity distinct from silicosis in Great Britain until approximately 1940 (2,3). Coal mining has been an important industry in the United States since the early 19th century, but official recognition that coal mine dust causes chronic lung disease, premature disability, and death did not occur until the final third of the 20th century. The disastrous Farmington, West Virginia, mine explosion and fire, in which 78 miners died, combined with findings of U.S. Public Health Service studies and a significant level of political activism among coal miners ( 4) led to the passage of the Federal Coal Mine Health and Safety Act of 1969. This Act (5), amended in 1977 (6), directs the Secretary of Labor to set standards for exposure to toxic materials so that "no miner will suffer material impairment of health or functional capacity even if such miner has regular exposure to the hazards dealt with by such standard for the period of his working life." Specifically, health standards for exposure to coal mine dust were established with the intent "to permit each miner the opportunity to work underground during the period of his entire adult working life without incurring any disability from pneumoconiosis or any other occupation-related disease. A respirable coal mine dust standard (3 mg per m3 air, later reduced to 2 mg per m3) was established. The Act also provided for rigorous inspection procedures, medical examinations for working miners and autopsies for deceased miners, a federally administered compensation program for miners with disabling lung diseases, and federal agency right of entry for research to advance understanding of the health effects of mining. The United States has extensive coal deposits (Fig. 22.1). Owing to the increasing scarcity and cost of petroleum as a fuel, coal will continue to be an essential energy source. It is impossible to extract coal without some dust exposure, so it is critical to understand the relationships between coal mine dust exposure and the development of respiratory diseases in order to diagnose, treat, and prevent them.