These studies were undertaken to determine and differentiate the relationship of age, coal mining tenure, cigarette smoking, and coal workers' pneumoconiosis (CWP) to the type and severity of emphysema found in a group of autopsy cases from southern West Virginia. The study group consisted of 266 coal miners (41 non-smokers) and 75 non-miner controls (14 non-smokers). Whole lung sections prepared systematically were reviewed by two pathologists and emphysema and CWP were classified and graded for severity using a standardized grading schema. The results of these studies showed no correlation between age and emphysema index in non-miner, non-smoker controls (r=0.15), but the non-miner controls who smoked showed a strong correlation to years smoked (r=0.63) and increasing age. In the non-smoking coal miners, emphysema was significantly higher than in controls (p < 0.01). Emphysema index in the coal miners who smoked also showed a significant increase compared to non-miner smokers (p < 0.01). Coal mining tenure also showed a significant relationship with emphysema index for both smokers and non-smokers (p < 0.01). An additive effect of cigarette smoking and coal mining was evident. The most common type of emphysema in non-miner controls who smoked was centriacinar, and in coal miners with and without cigarette smoking exposure, it was focal emphysema associated with the macule, indicating that both cigarette smoking and coal mine dust exposure preferentially affect the centriacinar portion of the lobule. Panacinar emphysema was found only in the smokers. There was a slightly positive relationship between the retained coal dust in the lung and the emphysema index (p = 0.05). The results of these studies indicate that coal dust and cigarette smoking play important roles in the development and severity of emphysema in coal miners.
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