tag:theconversation.com,2011:/ca/topics/pneumoconiosis-23108/articlesPneumoconiosis – The Conversation2018-02-16T11:41:49Ztag:theconversation.com,2011:article/916372018-02-16T11:41:49Z2018-02-16T11:41:49ZBlack lung disease on the rise: 5 questions answered<figure><img src="https://images.theconversation.com/files/206620/original/file-20180215-131032-1ufco25.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Coal miner Scott Tiller works next to a drill in an underground coal mine roughly 40 inches high in Welch, West Virginia.</span> <span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/Divided-America-American-Moments/1a2120a4c93045849281476fcbf7a72c/88/0">AP Photo/David Goldman</a></span></figcaption></figure><p><em>Editor’s note: An <a href="http://dx.doi.org/0.1001/jama.2017.18444">article</a> published Feb. 6, 2018 in the Journal of the American Medical Association reported that researchers from the <a href="https://www.cdc.gov/niosh/">National Institute for Occupational Safety and Health</a> had identified 416 cases of advanced black lung disease among coal miners in central Appalachia. New cases of black lung had been rare until recently, but this study suggests that the incidence is rising. Anna Allen and Carl Werntz, professors of occupational medicine at West Virginia University who treat miners with black lung, explain what causes this disabling disease.</em></p>
<h2>1. What is black lung disease, and what causes it?</h2>
<p>Underground mining is <a href="https://www.bls.gov/iif/oshwc/osh/os/osar0012.htm">one of the most dangerous occupations</a> in the United States. Risks include inhaling toxic gases, such as methane, carbon monoxide and hydrogen sulfide; being crushed by roof falls or mining equipment; drowning when tunnels fill with water; and injury in fires and explosions. Even if miners survive the workplace, they may suffocate to death years later.</p>
<p>Surface and underground mining is associated with two pneumoconioses, or dust diseases of the lung. Black lung disease, also known as coal workers’ pneumoconiosis, comes from inhaling coal mine dust. The other disease, silicosis, is caused by inhaling silica dust from crushed rocks. Black lung and silicosis often appear together because coal seams are found between rock layers that contain silica.</p>
<p>When miners inhale dust, it deposits along their airways. Their bodies try to remove the dust by sending in special white blood cells called <a href="https://askabiologist.asu.edu/macrophage">macrophages</a> to engulf and chemically digest it. But the cells are unable to break down the dust, so they die and release enzymes that damage lung tissue. This causes problems that include chronic bronchitis, emphysema and fibrosis (scarring). In progressive massive fibrosis, the most severe version of black lung, scarring causes lung volume to shrink, further damaging adjacent lung tissue and making air exchange even worse.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/206607/original/file-20180215-131003-1tx9xsb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/206607/original/file-20180215-131003-1tx9xsb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/206607/original/file-20180215-131003-1tx9xsb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=515&fit=crop&dpr=1 600w, https://images.theconversation.com/files/206607/original/file-20180215-131003-1tx9xsb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=515&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/206607/original/file-20180215-131003-1tx9xsb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=515&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/206607/original/file-20180215-131003-1tx9xsb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=647&fit=crop&dpr=1 754w, https://images.theconversation.com/files/206607/original/file-20180215-131003-1tx9xsb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=647&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/206607/original/file-20180215-131003-1tx9xsb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=647&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Coal worker’s lungs, with black pigmentation and fibrosis due to inhalation of carbon pigment and silica.</span>
<span class="attribution"><a class="source" href="https://flic.kr/p/8Ur4Ao">Yale Rosen</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>Miners typically work 10 to 12 hours a day and up to seven days a week. This increases their exposure time and decreases the recovery time their bodies need to heal damage from silica and coal dust particles. Traditionally, black lung was associated with miners who had been working for at least 20 years, with symptoms often appearing after retirement. The recent trend is that black lung, including progressive massive fibrosis, is occurring after a <a href="https://www.cdc.gov/niosh/nioshtic-2/20044371.html">shorter time in mining</a> – as little as five years mining underground. </p>
<h2>2. Are you surprised by the large case cluster described in the JAMA article?</h2>
<p>The “hot spot” described in the JAMA study is in parts of western Virginia, southern West Virginia and eastern Kentucky. This area includes three of the federal <a href="https://www.msha.gov/about/program-areas/coal-mine-safety-and-health">Mine Safety and Health Administration</a> enforcement districts – areas where the agency inspects coal mines and investigates accidents and complaints from miners.</p>
<p>We see patients in Morgantown in north-central West Virginia and Cabin Creek in south-central West Virginia. We have noticed increased severity of disease in patients in the southern part of the state. During our first year, from June 2016 to May 2017, working in Cabin Creek providing federally authorized black lung exams, the incidence was 16 percent for black lung and about 6 percent for progressive massive fibrosis. In contrast, the same exams in our Morgantown clinic found black lung in less than 3 percent of cases, and only a few progressive massive fibrosis cases in four years.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/206611/original/file-20180215-131013-273uc5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/206611/original/file-20180215-131013-273uc5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/206611/original/file-20180215-131013-273uc5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=594&fit=crop&dpr=1 600w, https://images.theconversation.com/files/206611/original/file-20180215-131013-273uc5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=594&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/206611/original/file-20180215-131013-273uc5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=594&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/206611/original/file-20180215-131013-273uc5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=746&fit=crop&dpr=1 754w, https://images.theconversation.com/files/206611/original/file-20180215-131013-273uc5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=746&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/206611/original/file-20180215-131013-273uc5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=746&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">In 1974 progressive massive fibrosis affected nearly 3.5 oercent of coal miners with 25 or more years of underground mining tenure. Rates dropped precipitously under new protective rules but have since rebounded.</span>
<span class="attribution"><a class="source" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4710586/#r7">Environmental Health Perspectives</a></span>
</figcaption>
</figure>
<h2>3. What do you think could be causing more cases of black lung disease?</h2>
<p>The increase is likely the result of several factors. Much of the coal in the area of the JAMA study is so-called “low coal,” with seams that are only 20 to 36 inches high. This “low coal” is hard to mine but profitable because it is metallurgical coal, which has high value for steel production.</p>
<p>Manufacturers stopped producing shorter machines designed for mining “low coal” in about 1990 due to quality control problems. Now mines use taller machines designed for seams that are 32 to 36 inches high. As these machines cut coal from the seam, they must remove at least 12 to 16 inches of sandstone adjacent to the coal.</p>
<p>Cutting that much sandstone significantly increases miners’ exposure to silica dust from the crushed rock. Newer machines also cut through coal and rock much more quickly than older models, generating more dust. Generally, what we call black lung is primarily silicosis in a coal miner, so <a href="https://www.cdc.gov/mmwr/volumes/65/wr/mm6549a1.htm">silica exposure is significant</a> to the development and progression of disease.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/6AYZG5n2VUA?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">In this video a longwall mining machine can be seen spraying water to control dust.</span></figcaption>
</figure>
<p>Working in “low coal” also involves more physical effort than mining “high coal.” Crawling and stooping while carrying mining gear and operating equipment requires more physical effort. Miners breathe more heavily and frequently, which can increase dust exposure. And it is hard to keep air flowing smoothly through these smaller mines, so dust concentrations may be higher in some spots.</p>
<h2>4. What does the coal industry do to prevent black lung?</h2>
<p>Screening is available to current miners through the federal government’s <a href="https://www.cdc.gov/niosh/topics/cwhsp/cwhsp-xray.html">Coal Workers’ Health Surveillance Program</a>, which uses x-rays to detect early changes in the lungs. This information is shared with miners so they can decide whether to continue working in coal mining, but is kept private from their employers.</p>
<p>The main way to prevent black lung is to keep miners from inhaling dust. After <a href="https://www.npr.org/2012/07/10/155981916/black-lung-rule-loopholes-leave-miners-vulnerable">20 years of debate</a>, recent changes in federal law <a href="https://arlweb.msha.gov/endblacklung/docs/summaryEffectiveDates.pdf">decreased the allowed exposure</a> from 2.0 milligrams per cubic meter of air to 1.5 milligrams. Continuous personal dust sampling has also been implemented so that miners can have real-time data on their exposures. This information is then used to determine whether a mine requires more frequent inspections.</p>
<p>To decrease dust exposure, mine operators can spray water to knock dust out of the air, increase air flow in tunnels to move dust out more quickly, or require miners to wear respirators. </p>
<h2>5. What resources are available for miners who may have black lung?</h2>
<p>Black lung diagnosis can be complicated. Some of the most common symptoms include shortness of breath, decreased exercise tolerance, chronic cough, coughing up phlegm and inability to breathe lying flat. Other diseases can cause similar symptoms, so it is important for miners to talk to their primary care doctors. </p>
<p>Some states have workers compensation programs that offer benefits to workers diagnosed with black lung. The Federal <a href="https://www.dol.gov/owcp/dcmwc/">Black Lung Program</a> provides medical coverage for eligible miners with lung diseases related to pneumoconiosis, along with benefits for those who are totally disabled by it, and for families of miners who die of black lung disease.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/206601/original/file-20180215-131016-mrmlv6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/206601/original/file-20180215-131016-mrmlv6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/206601/original/file-20180215-131016-mrmlv6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=348&fit=crop&dpr=1 600w, https://images.theconversation.com/files/206601/original/file-20180215-131016-mrmlv6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=348&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/206601/original/file-20180215-131016-mrmlv6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=348&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/206601/original/file-20180215-131016-mrmlv6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=437&fit=crop&dpr=1 754w, https://images.theconversation.com/files/206601/original/file-20180215-131016-mrmlv6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=437&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/206601/original/file-20180215-131016-mrmlv6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=437&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Mobile unit for providing coal miner health screenings.</span>
<span class="attribution"><a class="source" href="https://upload.wikimedia.org/wikipedia/commons/1/10/NIOSH_Mobile_Health_Screenings_%2816027817612%29.jpg">NIOSH</a></span>
</figcaption>
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<p>There is no cure for black lung disease – we can only treat symptoms. Medications, such as inhaled steroids, can help patients breathe more easily. More severe cases can require oxygen and possibly lung transplants. One step patients can take is to stop smoking, which also destroys lung tissue. Smoking does not cause black lung, but it can make the symptoms more severe.</p><img src="https://counter.theconversation.com/content/91637/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Anna Allen, MD, MPH, is the Associate Residency Director of West Virginia University Occupational Medicine, which is funded by NIOSH. She is currently working on a NIOSH funded project assessing PAPR usage in the healthcare setting. She is also on the board of the Association of Occupational and Environmental Clinics, which has advocated for worker safety and health. All opinions expressed in this article are the author's and should not be attributed to WVU or other affiliated organizations.</span></em></p><p class="fine-print"><em><span>Carl Werntz is a part-time employee of the National Institutes for Occupational Safety and Health, although he has not been involved with any of the research mentioned in this article. The findings and conclusions in this report are those of the author(s) and do not represent the official position of the National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention.</span></em></p>A recent study found the largest cluster of advanced black lung disease ever recorded among coal miners in central Appalachia. Two doctors who treat black lung patients explain how miners contract it.Anna Allen, Associate professor of Occupational Medicine, West Virginia UniversityCarl Werntz, Associate Professor of Occupational Medicine, West Virginia UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/804652017-08-07T02:09:55Z2017-08-07T02:09:55ZExplainer: what is silicosis and why is this old lung disease making a comeback?<figure><img src="https://images.theconversation.com/files/179579/original/file-20170725-6656-edt7nc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">You can barely see this construction worker for dust. His lack of protective face mask puts him at risk of silicosis and other lung diseases.</span> <span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/Category:Silicosis#/media/File:DustWorker.jpg">Lamiot/Wikimedia</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>Silicosis is a group of occupational lung diseases caused by breathing in silica dust. It has been described since ancient times, when miners and stone cutters were exposed to dust containing this crystalline mineral.</p>
<p>Silicosis was more common in Australia in the 1940s to 60s, particularly in construction and demolition workers. Growing awareness of the disease and the importance of reducing exposure to dust – for instance, wearing masks at work, wetting the dust and other safe work practices – has reduced the number of cases.</p>
<p>However, there has been a worrying resurgence of cases recently, as a recent New South Wales parliamentary committee <a href="https://www.parliament.nsw.gov.au/committees/DBAssets/InquiryEventTranscript/Transcript/9950/Transcript%20-%2028%20June%202017%20-%20UNCORRECTED.pdf">has heard</a>. Now one of the fastest growing occupational groups we’re seeing with silicosis are people who <a href="https://www.mja.com.au/journal/2017/206/9/complicated-silicosis-resulting-occupational-exposure-engineered-stone-products">make and install engineered stone products</a>, the type of benchtops and tiles you might find in your kitchen or bathroom. </p>
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Read more:
<a href="https://theconversation.com/australias-occupational-health-and-safety-regime-needs-first-aid-12794">Australia's occupational health and safety regime needs first aid </a>
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</em>
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<p>This resurgence in cases is likely related to a poor understanding of the risks involved in working with engineered stone, and a <a href="https://www.parliament.nsw.gov.au/committees/DBAssets/InquiryEventTranscript/Transcript/9950/Transcript%20-%2028%20June%202017%20-%20UNCORRECTED.pdf">lack of adherence to safety regulations and surveillance requirements</a>.</p>
<h2>What is silica and how are people exposed?</h2>
<p>Silica is in quartz, sand, stone, soil, granite, brick, cement, grout, mortar, bitumen and engineered stone products.</p>
<p>Any occupation disturbing the earth’s crust increases the risk of silicosis. That includes sand blasting, cutting, excavating, building on sandstone, demolition work, tunnelling, quarry work and mining. Air-polishing concrete, foundry work, bricklaying, stone masonry, and making glass and ceramics also increase the risk.</p>
<p><a href="https://academic.oup.com/annweh/article-abstract/60/5/631/2196173">About 6.6% of Australian workers</a> are exposed to crystalline silica dust that can be breathed in, and 3.7% are heavily exposed.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/180981/original/file-20170804-27426-1gis17k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/180981/original/file-20170804-27426-1gis17k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/180981/original/file-20170804-27426-1gis17k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/180981/original/file-20170804-27426-1gis17k.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/180981/original/file-20170804-27426-1gis17k.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/180981/original/file-20170804-27426-1gis17k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/180981/original/file-20170804-27426-1gis17k.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/180981/original/file-20170804-27426-1gis17k.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Stone masons are also at risk from silicosis if they don’t take precautions against breathing in silica dust.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/341489507?src=kqnbp-yH_j46iZGl762w8g-1-48&size=medium_jpg">from www.shutterstock.com</a></span>
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<p>While not all of these will go on to develop silicosis a significant proportion will, with symptoms appearing between months and many years after exposure, depending on the type of silicosis. </p>
<p>The likelihood of developing severe silicosis increases depending on how much dust people are exposed to and for how long. Genetics may also play a role in susceptibility, with some groups, <a href="https://academic.oup.com/aje/article/144/9/890/95225/Silicosis-among-Foundry-Workers-Implication-for">like African Americans</a>, having a higher risk.</p>
<p>Symptoms of silicosis include a cough, breathlessness and tiredness. But in the early stages of the disease, there may be no symptoms.</p>
<p>As silicosis can progress long after exposure at work, people should report any troublesome symptoms to their GP, even after they have left the industry. If silicosis is suspected, they should be referred to a respiratory physician.</p>
<h2>Different types of silicosis</h2>
<p>There are three different types of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1637684/">silicosis </a>:</p>
<ul>
<li>acute silicosis can develop within weeks of very heavy exposure to silica. The lungs are filled with a fluid containing a lot of protein, which causes severe breathlessness</li>
<li>accelerated silicosis is also associated with high exposures (the type currently being seen in people working with engineered stone products), where there’s a rapid increase of scarring in the lung (fibrosis) within 10 years of first exposure, and</li>
<li>chronic silicosis, the most common form of silicosis, where fibrosis occurs more slowly over 10-30 years after first being exposed.</li>
</ul>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/179575/original/file-20170725-11666-135if6g.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/179575/original/file-20170725-11666-135if6g.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=584&fit=crop&dpr=1 600w, https://images.theconversation.com/files/179575/original/file-20170725-11666-135if6g.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=584&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/179575/original/file-20170725-11666-135if6g.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=584&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/179575/original/file-20170725-11666-135if6g.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=734&fit=crop&dpr=1 754w, https://images.theconversation.com/files/179575/original/file-20170725-11666-135if6g.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=734&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/179575/original/file-20170725-11666-135if6g.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=734&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Chest x-ray of complicated silicosis, showing large areas of scarring.</span>
<span class="attribution"><span class="license">Author provided</span></span>
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</figure>
<p>Then there’s simple and complicated silicosis. Simple silicosis results in many small white spots (nodules) that you can see on a chest x-ray or CT scan. With complicated silicosis there are large areas of scarring called progressive massive fibrosis.</p>
<p>In general, the more scarring and the more widespread it is, the more trouble people have breathing as their lungs lose their capacity to expand and contract with each breath. Silicosis also increases people’s susceptibility to <a href="https://theconversation.com/explainer-what-is-tb-and-am-i-at-risk-of-getting-it-in-australia-75290">tuberculosis</a>.</p>
<h2>How is silicosis treated and what are the outcomes?</h2>
<p>Diseases due to silica exposure are serious and potentially lethal, and there is no specific treatment other than supportive care. This can include stopping smoking, using inhalers, vaccination against infections, and antibiotics. In the late stages, oxygen treatment or a lung transplant may be needed.</p>
<p>Once diagnosed, the disease generally progresses over time. Patients with accelerated silicosis may progress to progressive massive fibrosis over a period of four to five years. Overall, people diagnosed with silicosis lose an average 11.6 years of life. So, prevention is vital.</p>
<h2>How can we prevent silicosis?</h2>
<p>Diseases due to silica exposure – for instance silicosis, <a href="https://monographs.iarc.fr/ENG/Monograph">lung cancer</a>, connective tissue disorders like <a href="http://www.sclerodermaaustralia.com.au/about/about-scleroderma">scleroderma</a>, kidney disease and <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/lung-conditions-chronic-obstructive-pulmonary-disease-copd">chronic obstructive lung disease</a> – are entirely preventable.</p>
<p>Wetting of silica dust, using appropriate exhaust ventilation and extraction hoods, and wearing the right dust masks and air filters all reduce the chances of someone breathing in silica dust at work.</p>
<p>There are also <a href="https://www.safeworkaustralia.gov.au/system/files/documents/1705/workplace-exposure-standards-airborne-contaminants-v2.pdf">workplace standards</a> on exposure to silica dust. And workplace screening for lung disease is <a href="https://www.safeworkaustralia.gov.au/system/files/documents/1702/guide-pcbu-health-monitoring-exposure-hazardous-chemicals.pdf">mandatory</a> for those at significant risk, which can include a physical examination as well as x-rays and lung function tests.</p>
<h2>How can we keep track of silicosis?</h2>
<p>Silicosis carries a high <a href="https://www.safeworkaustralia.gov.au/system/files/documents/1702/occupational_respiratory_disease_australia.pdf">social and economic cost</a>. And workers can receive compensation for silica-related disease in some states. In NSW, for instance, <a href="https://www.safeworkaustralia.gov.au/system/files/documents/1702/occupational_respiratory_disease_australia.pdf">186 workers</a> received compensation payments through the Dust Diseases Board in 2002-2003.</p>
<p>Yet, we don’t know the true number of new cases in Australia. While there are voluntary reporting systems in Victoria, Tasmania and NSW, these are likely to have underestimated the true incidence of disease.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-what-is-black-lung-and-why-do-miners-get-it-51649">Explainer: what is black lung and why do miners get it?</a>
</strong>
</em>
</p>
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<p>So specialist doctors concerned about the resurgence of silicosis <a href="https://www.parliament.nsw.gov.au/committees/DBAssets/InquiryEventTranscript/Transcript/9950/Transcript%20-%2028%20June%202017%20-%20UNCORRECTED.pdf">have called for</a> mandatory reporting of occupational lung disease to a centralised registry, as occurs in Europe and America.</p>
<p>Australia is seeing the re-emergence of diseases like silicosis and coal worker’s lung (also known as black lung) that were previously believed to have disappeared. So, workers, employers, doctors, public health officials, and legislators need to work together to prevent more cases of these deadly, but preventable, lung diseases.</p><img src="https://counter.theconversation.com/content/80465/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Susan Miles is a Staff Specialist at Calvary Mater Newcastle, and a Member of the Occupational and Environmental Lung Disease Special Interest Group of the Thoracic Society of Australia and New Zealand.</span></em></p>We’re seeing the resurgence of an old lung disease in people who make and install the type of engineered stone product you might find in your kitchen or bathroom.Susan Miles, Respiratory, sleep and general physician and conjoint lecturer in medicine, University of NewcastleLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/779402017-05-18T20:15:37Z2017-05-18T20:15:37ZClimate Council: climate, health and economics are against Carmichael mine<figure><img src="https://images.theconversation.com/files/169902/original/file-20170518-12226-108eqzi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Many banks are worried that coal investments could be left stranded on their asset books.</span> <span class="attribution"><span class="source">Rasta777/Shutterstock.com</span></span></figcaption></figure><p>Despite the overwhelming evidence that fossil fuels are <a href="https://theconversation.com/great-barrier-reef-bleaching-would-be-almost-impossible-without-climate-change-58408">killing the Great Barrier Reef</a> and making many <a href="https://theconversation.com/climate-changes-signature-was-writ-large-on-australias-crazy-summer-of-2017-73854">extreme weather events worse</a>; despite the <a href="https://theconversation.com/the-government-is-swimming-against-the-tide-on-westpacs-adani-decision-76950">emphatic thumbs-down</a> from the finance sector; and despite the growing awareness of the serious health impacts of coal, the proposed Carmichael coal mine staggers on, zombie-like, amid <a href="http://www.abc.net.au/news/2017-05-18/queensland-government-gives-adani-royalties-holiday/8536560">reports it has been offered a deferment of A$320 million in royalty payments</a>.</p>
<p>A new Climate Council report, <a href="http://www.climatecouncil.org.au/carmichael-coal-report?vid=4617">Risky Business: Health, Climate and Economic Risks of the Carmichael Coalmine</a>, makes an emphatic case against development of the proposed mine, or of any other coal deposits in Queensland’s Galilee Basin, or indeed elsewhere around the world.</p>
<p>Burning coal is a major contributor to climate change. Australia is already reeling from the escalating impacts of a warming climate. Heatwaves and other extreme weather events are worsening. The Great Barrier Reef has suffered consecutive mass bleaching events in 2016 and 2017. Climate change is likely making <a href="https://www.climatecouncil.org.au/foodsecurityreport2015">drought conditions worse in the agricultural belts of southwest and southeast Australia</a>. Our coastal regions are increasingly exposed to <a href="https://www.climatecouncil.org.au/coastalflooding">erosion and flooding as sea level rises</a>.</p>
<p>If we are to slow these disturbing trends and stabilise the climate at a level with which we might be able to cope, only a relatively small amount of the world’s remaining coal, oil and gas reserves can actually be used.</p>
<p>The majority must be left unburned in the ground, without developing vast new coal deposits such as those in the Galilee Basin.</p>
<h2>On budget</h2>
<p>The amount of fossil fuels we can burn for a given temperature target (such as the 1.5°C and 2°C targets of the <a href="https://theconversation.com/the-paris-climate-agreement-at-a-glance-50465">Paris climate agreement</a>) is known as the “<a href="https://www.climatecouncil.org.au/unburnable-carbon-why-we-need-to-leave-fossil-fuels-in-the-ground">carbon budget</a>”. </p>
<p>To give ourselves just a 50% chance of staying within the 2°C Paris target, we can burn only 38% of the world’s existing fossil fuel reserves. When this budget is apportioned among the various types of fossil fuels, coal is the big loser, because it is more emissions-intensive than other fuels. <a href="https://www.nature.com/nature/journal/v517/n7533/full/nature14016.html">Nearly 90%</a> of the world’s existing coal reserves must be left in the ground to stay within the 2°C budget.</p>
<p>When the carbon budget is apportioned by region to maximise the economic benefit of the remaining budget, <a href="https://www.nature.com/nature/journal/v517/n7533/full/nature14016.html">Australian coal in particular is a big loser</a>. More than 95% of Australia’s existing coal reserves cannot be burned, and the development of new deposits, such as the Galilee Basin, is ruled out.</p>
<h2>The health case</h2>
<p>Exploiting coal is very harmful to human health, with serious impacts all the way through the process from mining to combustion. Recently the life-threatening “black lung” (coal workers’ pneumoconiosis) has <a href="https://theconversation.com/black-lungs-back-how-we-became-complacent-with-coal-miners-pneumoconiosis-57718">re-emerged in Queensland</a>, with 21 reported cases. Across Australia, the estimated costs of health damages associated with the combustion of coal amount to <a href="http://www.atse.org.au/Documents/Publications/Reports/Energy/ATSE%20Hidden%20Costs%20Electricity%202009.pdf">A$2.6 billion per year</a>.</p>
<p>In India, the country to which coal from the proposed Carmichael mine would likely be exported, coal combustion already takes a heavy toll. An <a href="http://www.sciencedirect.com/science/article/pii/S135223101400329X">estimated 80,000-115,000 deaths</a>, as well as 20 million cases of asthma, were attributed to pollutants emitted from coal-fired power stations in 2010-11. Up to 10,000 children under the age of five died because of coal pollution in 2012 alone.</p>
<p>Compared with the domestic coal resources in India, Carmichael coal will not reduce these health risks much at all. Galilee Basin coal is of poorer quality than that from other regions of Australia. Its <a href="https://theconversation.com/black-lungs-back-how-we-became-complacent-with-coal-miners-pneumoconiosis-57718">estimated ash content of about 26%</a> is double the Australian benchmark.</p>
<p>This is bad news for children in India or in any other country that ends up burning it.</p>
<h2>The economics</h2>
<p>The economic case for the Carmichael mine doesn’t stack up either. Converging global trends all point to rapidly reducing demand for coal. </p>
<p>The cost of renewable energy is <a href="https://www.climatecouncil.org.au/uploads/6b17494f8d727a073e349badd5ac6a7f.pdf">plummeting</a>, and efficient and increasingly affordable storage technologies are emerging. Coal demand in China is <a href="https://www.climatecouncil.org.au/uploads/6b17494f8d727a073e349badd5ac6a7f.pdf">dropping</a> as it ramps up the rollout of renewables. India is <a href="https://theconversation.com/india-wants-to-become-a-solar-superpower-but-its-plans-dont-add-up-68011">moving towards energy independence</a>, and is eyeing its northern neighbour’s push towards renewables.</p>
<p>All of these trends greatly increase the risk that any new coal developments will become <a href="https://theconversation.com/the-danger-of-stranded-assets-lurks-for-unwary-coal-producers-48733">stranded assets</a>. It’s little wonder that the financial sector has turned a cold shoulder to the Carmichael mine, and Galilee Basin coal development in general. Some 17 banks worldwide, including the “big four” in Australia, have ruled out any investment in the Carmichael mine.</p>
<p>From any perspective – climate, health, economy – the proposed mine is hard to justify. And yet the project <a href="https://theconversation.com/why-does-the-carmichael-coal-mine-need-to-use-so-much-water-75923">keeps on keeping on</a>.</p><img src="https://counter.theconversation.com/content/77940/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Hilary Bambrick has previously received funding from the National Health and Medical Research Council, the Victorian and NSW Governments, the United Nations Development Programme, and the World Health Organization. She sits on the research committee of The Australia Institute. </span></em></p><p class="fine-print"><em><span>Will Steffen does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A new Climate Council report points out that the Paris Agreement’s carbon budget leaves no room for the development of massive new coal reserves such as the proposed Carmichael mine.Will Steffen, Emeritus professor, Fenner School of Environment and Society, Australian National UniversityHilary Bambrick, Head of School, School of Public Health and Social Work, Queensland University of TechnologyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/578172016-07-15T07:02:51Z2016-07-15T07:02:51ZWhy the health scheme for coal workers is inadequate to detect black lung<figure><img src="https://images.theconversation.com/files/130510/original/image-20160714-12386-1asgtze.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Radiologists will struggle to find black lung in x-rays if they haven't been told to look for it.</span> <span class="attribution"><span class="source">from www.shutterstock.com.au</span></span></figcaption></figure><p><a href="https://theconversation.com/black-lungs-back-how-we-became-complacent-with-coal-miners-pneumoconiosis-57718">Recent cases of black lung</a> in Queensland coal miners after many years of no known cases have raised important questions about control of dust exposure in coal mines, as well as the adequacy of medical screening to detect such cases at an early stage. </p>
<p>A <a href="https://www.dnrm.qld.gov.au/__data/assets/pdf_file/0009/383940/monash-qcwp-final-report-2016.pdf">review for the Queensland government</a> on the health assessment of miners has identified serious deficiencies at virtually all levels of the scheme.</p>
<p>Black lung is the commonly used name for <a href="http://www.ncbi.nlm.nih.gov/pubmed/23590267">coal workers’ pneumoconiosis</a>, which is a lung condition where inhaled coal dust <a href="https://theconversation.com/explainer-what-is-black-lung-and-why-do-miners-get-it-51649">causes scarring of lung tissue</a>. Black lung can cause severe symptoms including shortness of breath, heart problems and death, and so it is important to detect it early and reduce further exposure to coal dust. </p>
<h2>So what’s wrong with the Queensland coal miners’ health scheme?</h2>
<p>Our review found several major deficiencies. These include:</p>
<ul>
<li><p>a lack of appropriate training for doctors working within the scheme and a standardised process of deciding who should have chest x-rays</p></li>
<li><p>poor-quality tests to measure the functioning of the lungs</p></li>
<li><p>radiologists not being informed what they’re looking for in chest x-rays</p></li>
<li><p>inadequate data collection</p></li>
<li><p>a lack of clinical guidelines for when follow-up tests and specialist referral are necessary. </p></li>
</ul>
<p>The scheme also has limited ability for doctors to access previous medical findings. This makes it difficult to assess longitudinal changes.</p>
<p>Some criticism has been made of chest x-rays performed under the scheme, but this requires some further context. No-one doubts that radiological expertise is of a high standard in Australia, but the problem with chest x-rays being performed under the scheme is that the radiologists have not been notified that it is for screening of lung disease in coal mine workers. </p>
<p>The radiologists have not been specifically trained for the purposes of the scheme, nor have they used the specific ILO reporting form designed to identify early changes consistent with black lung.</p>
<h2>Why did this happen?</h2>
<p>A key original purpose of the health assessments was to identify early stages of black lung in any affected coal miners so that measures could be put in place to reduce coal dust exposure. In more recent years, this purpose has been lost. The prime focus of the health assessments has instead become a pre-employment medical assessment.</p>
<p>This loss of purpose has then influenced the operation of the scheme, as the doctors who do these medicals haven’t focused on identifying early signs of black lung, but on whether the mine worker can do the job. This is a completely different perspective. This shift of focus away from lung screening has had a negative influence on the operation of the various components of the scheme.</p>
<p>The mining boom in Queensland compounded the problems with the health assessment scheme. The rapid expansion of the coal industry meant a huge influx of mine workers in a short time. As a result, the demand for health assessments for coal mine workers increased greatly, and the capacity of the health assessment scheme and the doctors performing these medicals became very stretched.</p>
<p>Complacency also played a factor. There was a widespread belief that lung disease in coal miners was a thing of the past, based on the apparent lack of any black lung cases being identified by the scheme. But nothing could be further from the truth, as this disease is still a <a href="http://www.ncbi.nlm.nih.gov/pubmed/25052085">major problem in the US</a> and many other countries. Therefore it requires constant vigilance.</p>
<p>Another important consideration is that workplace exposure limits for coal dust in Queensland are <a href="https://theconversation.com/black-lungs-back-how-we-became-complacent-with-coal-miners-pneumoconiosis-57718">set higher than the more stringent levels</a> in many other countries, and even in other states of Australia. </p>
<p>A <a href="http://oem.bmj.com/content/67/12/801.extract">major problem in the effective control</a> of workplace diseases is exposure limits not in keeping with the latest evidence. This has been exemplified by the situation in Queensland coal mines.</p>
<p>Primary prevention of coal dust diseases, through the effective monitoring and control of coal dust, should be the main focus of prevention efforts in this industry. </p>
<p>Medical screening is a secondary prevention measure, which should be thought of as an adjunct to dust control, not a replacement for it. This is particularly important to remember for diseases with long latency periods from first exposure to disease onset, <a href="https://theconversation.com/explainer-what-is-black-lung-and-why-do-miners-get-it-51649">such as black lung</a>. The importance of focusing on dust control in coal mines was also an important conclusion of a recent <a href="http://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Health/Health/Fifth_Interim_Report">Senate inquiry into coal dust</a>.</p>
<h2>Wider implications</h2>
<p>The findings of our review have important implications over and above the coal industry in Queensland and the coal mine workers’ health scheme. It is well known there is a <a href="http://www.ncbi.nlm.nih.gov/pubmed/?term=Purdue%20MP%5BAuthor%5D&cauthor=true&cauthor_uid=25487971">serious underestimate</a> of <a href="http://www.ncbi.nlm.nih.gov/pubmed/?term=Hutchings%20SJ%5BAuthor%5D&cauthor=true&cauthor_uid=25487971">cancer and other chronic diseases</a> resulting from workplace exposures. </p>
<p>For an advanced country, we know remarkably little about the extent and risk factors for occupational diseases. The deficiencies of the Queensland coal mine workers’ health scheme, and the lack of reliability of the findings coming from it, have again highlighted this problem.</p>
<p>Australia <a href="http://search.informit.com.au/documentSummary;dn=200801991;res=IELAPA">needs more robust surveillance</a> and other information systems to better document occupational disease, to assist in guiding prevention programs and to monitor the effectiveness of such programs. The workers of Australia deserve nothing less.</p><img src="https://counter.theconversation.com/content/57817/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Malcolm Sim led the review funded by the Queensland Department of Natural Resources and Mines. </span></em></p>Recent cases of black lung in Queensland coal miners after many years of no known cases have raised important questions about control of dust exposure in coal mines.Malcolm Sim, Professor, Epidemiology & Preventative Medicine, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/577182016-04-20T20:10:19Z2016-04-20T20:10:19ZBlack lung’s back? How we became complacent with coal miners’ pneumoconiosis<figure><img src="https://images.theconversation.com/files/119385/original/image-20160420-25631-x3niy5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Black lung used to be commonplace among coal miners, and is now on the rise again. </span> <span class="attribution"><span class="source">from www.shutterstock.com.au</span></span></figcaption></figure><p>The name black lung says it all. When miners inhale excessive amounts of coal dust, the fine air filtration system of the lungs sieves out the dust, which then remains permanently in the lung. These deposits can even be seen with the naked eye if the lungs are removed from the body, hence the name. </p>
<p>The sinister part is the slow progressing breathing disorder that develops over many years due to excessive lung inflammation and scarring that is triggered by coal mine dust. This disease, coal workers’ pneumoconiosis or black lung, is preventable and was widely considered a thing of the past in Australian miners.</p>
<p>But just before Christmas 2015, people were shocked to hear about newly confirmed cases of black lung in Queensland miners. Governments responded swiftly to investigate the problem, with inquiries established by the Queensland government and the federal senate. </p>
<p>The Department of Natural Resources and Mines has <a href="https://www.dnrm.qld.gov.au/__data/assets/pdf_file/0008/352286/qcwp-interim-findings.pdf">released some interim findings</a> outlining poor documentation of confirmed cases, a lack of preventive measures taken where confirmed cases were found and too few screening tests being performed.</p>
<p>There is no cure for black lung. The review has recommended a greater focus on prevention and early detection, and ongoing surveillance.</p>
<h2>Preventing black lung</h2>
<p>Prevention involves managing exposure by monitoring dust levels and actively taking steps to reduce coal dust exposure in miners. Mining practices have progressively improved over the years, but overseas experience tells us not applying standards can result in cases of black lung. </p>
<p>There are no uniform standards for acceptable levels of dust exposure throughout Australia. Authorities permit Queensland miners to be exposed to coal dust levels higher than those in the United States, where the exposure limit is set at two micrograms per cubic metre.</p>
<p>Prevention also involves regular screening of exposed workers and having the results looked at by experts. The screening procedure requires imaging the lung with X-rays and assessing for possible lung impairment with breathing tests and focused clinical assessment. Each of these steps has to be quality controlled in order to successfully detect the subtle changes of black lung as early as possible.</p>
<p>The very early changes of black lung are an increase in dots and lines on the X-ray. The problem is the blood vessels and airways in the normal lung also show up as dots and lines, and so it takes expert training to tell when things become abnormal.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/119388/original/image-20160420-25595-zv5y1i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/119388/original/image-20160420-25595-zv5y1i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/119388/original/image-20160420-25595-zv5y1i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/119388/original/image-20160420-25595-zv5y1i.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/119388/original/image-20160420-25595-zv5y1i.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/119388/original/image-20160420-25595-zv5y1i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/119388/original/image-20160420-25595-zv5y1i.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/119388/original/image-20160420-25595-zv5y1i.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Black lung is difficult for doctors without specialist training to detect.</span>
<span class="attribution"><span class="source">from www.shutterstock.com</span></span>
</figcaption>
</figure>
<p>Fortunately, there are ongoing improvements in imaging technology, and there are now suggestions that a low-dose CT scan may make early detection easier and more reliable. Measuring impairment of lung capacity is very accurate when done in a quality controlled lung function laboratory, and this is the standard needed when trying to detect the changes of black lung as early as possible.</p>
<p>Of course, these assessments are useless if they’re not acted on. This means it is not only important to assess the results of individual workers, but to take a helicopter view of larger numbers of workers. </p>
<p>Given the significance of the issue and the potential implications, the peak professional body, the <a href="http://www.abc.net.au/am/content/2016/s4434387.htm">Thoracic Society of Australia and New Zealand</a> believes this is best done at a national level, and independent of mining companies. There is also value in making the results of monitoring and screening accessible, so that the process is transparent.</p>
<h2>Why has black lung returned?</h2>
<p>Efforts in the 20th century to eradicate the disease including setting occupational exposure limits, introducing personal protective equipment, and improvements in dust management and health monitoring dramatically reduced the numbers of miners with black lung. </p>
<p>But in 2013, there were <a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)61682-2/abstract">25,000 deaths globally</a> recorded from black lung. State-run mines in China now <a href="http://www.atsjournals.org/doi/abs/10.1164/rccm.201511-2154ED?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed#.VxBBRkbIY4I">report</a> black lung in between 4% and 17% of workers, and in Colombia, an growing coal producer, 36% of miners were <a href="http://www.atsjournals.org/doi/abs/10.1164/rccm.201511-2154ED?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed#.VxBBRkbIY4I">recently found</a> to have black lung.</p>
<p>Black lung has been classified by <a href="http://www.safeworkaustralia.gov.au/sites/SWA/about/Publications/Documents/931/deemed-diseases.pdf">Safe Work Australia</a> as a deemed disease. This means the disease is caused by specific work-related activities, in this case prolonged exposure to coal dust. We don’t know exactly what has happened to cause black lung to reappear, but statements in the <a href="https://www.dnrm.qld.gov.au/__data/assets/pdf_file/0008/311498/qld-mines-inspectorate-annual-performance-report-2014-15.pdf">Queensland mines inspectorate report</a> of 2014-15 indicating significant dust exposure above recommended limits are highly concerning.</p>
<p>There are now even recorded increases of black lung in the <a href="http://www.atsjournals.org/doi/abs/10.1164/rccm.201511-2154ED?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed#.VxBBRkbIY4I">United States</a>. It appears that just as the coal economy is a multinational activity, so are its risks. Black lung is just one of many diseases that can develop in miners. Conditions such as silicosis, occupational COPD (colloquially called emphysema), bronchitis and occupational lung cancer all require evaluation.</p><img src="https://counter.theconversation.com/content/57718/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Peter Gibson is affiliated with the Thoracic Society of Australia and new Zealand. </span></em></p>A review into black lung has found proper preventive measures haven’t taken place where confirmed cases have been found.Peter Gibson, Conjoint Professor, School of Medicine and Public Health, University of NewcastleLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/516492015-12-02T23:10:04Z2015-12-02T23:10:04ZExplainer: what is black lung and why do miners get it?<figure><img src="https://images.theconversation.com/files/104008/original/image-20151202-14458-q60qna.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Black lung is preventable – and hasn't been seen in Australia in more than 20 years.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/un_photo/7119599641/">United Nations Photo/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>Coal miners in Queensland have been <a href="http://www.abc.net.au/news/2015-12-01/'black-lung'-makes-comeback-in-queensland-coal-mines/6990842">diagnosed</a> with “black lung”, a disease that was thought to have been eradicated in Australia <a href="http://www.coalservices.com.au/MessageForceWebsite/Sites/320/Files/20120822_Press_Release_Black_Lung.pdf">more than 20 years ago</a>. Mining companies are <a href="http://www.smh.com.au/business/workplace-relations/black-lung-disease-returns-to-queensland-mines-20151201-glcqzo.html">copping heat</a> for allowing health standards to deteriorate enough to see the disease return. So what is black lung? And why is it back?</p>
<p>Black lung is a chronic, irreversible occupational lung disease caused by the inhalation and deposition of coal dust in the lungs. It is part of a spectrum of respiratory diseases caused by coal dust and is known more formally as coal workers’ pneumoconiosis.</p>
<p>With prolonged exposure, the inhaled fine dust particles overwhelm the lung’s defence mechanisms. The particles accumulate in the parts of the lung where oxygen from the air is taken up by the blood and carbon dioxide waste is released from the blood into the air (known as the “gas exchange region”). </p>
<p>This causes inflammation and scarring of the lung tissue. In the early stages of the disease these accumulations of coal dust and the affected lung tissue will show up as small (less than 1cm) rounded opacities (opaque masses) on x-rays. </p>
<p>Patients with coal workers’ pneumoconiosis may experience symptoms of shortness of breath and a chronic cough. With further exposure and time the disease may progress to a more severe form known as progressive massive fibrosis. </p>
<p>This occurs when the accumulations of coal dust and abnormal lung tissue lump together in larger lesions that show up as large (more than 1cm) opacities on x-ray. As these lesions lump together there is generally significant destruction of lung tissue, with debilitating severe symptoms including:</p>
<p>• shortness of breath</p>
<p>• chronic cough</p>
<p>• coughing up black mucus</p>
<p>• high blood pressure</p>
<p>• heart problems</p>
<p>• increased susceptibility to autoimmune conditions such as rheumatoid arthritis and scleroderma (excessive hardening of the skin).</p>
<p>Progressive massive fibrosis leads to premature death, with the outlook worsening with increasing severity of the disease.</p>
<h2>What causes black lung?</h2>
<p>The only cause of black lung is excessive inhalation of “respirable” coal dust – that is, particles that are small enough to reach the spaces in the lung where gas exchange takes place – and deposition of dust in the lungs, which causes scarring of lung tissue. </p>
<p>The occurrence and severity of the disease depends on the intensity and duration of exposure, and also to some extent on the type of coal being mined. Smoking does not increase the risk of developing this disease, but it may have an additional harmful effect on the lungs. </p>
<p>Unfortunately, once the disease process has begun it may not resolve with removal from exposure to coal dust and can progress from simple coal workers’ pneumoconiosis to progressive massive fibrosis with time.</p>
<h2>How is it treated?</h2>
<p>There is no specific treatment for either simple coal worker’s pneumoconiosis or progressive massive fibrosis that can slow or reverse the progressive scarring of the lung tissue. </p>
<p>Medical care of patients is palliative and is directed at limiting complications, such as airflow obstruction and associated lung disorders, and protecting against infectious complications. </p>
<h2>How do you prevent it?</h2>
<p>As black lung cannot be cured, the only way to control it is through preventing exposure to coal dust. The strict application of engineering controls such as dust suppression combined with ventilation systems in all mining operations is necessary to limit exposure to respirable coal dust to levels below recognised occupational exposure standards. </p>
<p>The American Conference of Governmental Industrial Hygienists has recommended <a href="https://www2.worksafebc.com/PDFs/regulation/ExposureLimits.pdf">threshold limit values</a> of 0.4 mg/m³ for anthracite (a type of coal with the highest carbon content) and 0.9 mg/m³ for bituminous coal (soft coal containing bitumen) or lignite (brown coal).</p>
<p>Due to the extremely small size of the coal dust particles that cause this disease, overexposure will not be immediately obvious to mine workers. So it is also important to regularly monitor the actual level of worker exposures, using personal respirable dust monitoring equipment, so interventions can be made if excessive dust levels are detected. </p>
<p>Medical surveillance programs are also vital, aimed primarily at early detection so interventions can be made to prevent disease progression by limiting further exposure.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/104017/original/image-20151202-14444-760y49.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/104017/original/image-20151202-14444-760y49.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/104017/original/image-20151202-14444-760y49.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/104017/original/image-20151202-14444-760y49.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/104017/original/image-20151202-14444-760y49.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/104017/original/image-20151202-14444-760y49.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/104017/original/image-20151202-14444-760y49.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/104017/original/image-20151202-14444-760y49.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Dust suppression and proper ventilation of coal mines can prevent the disease.</span>
<span class="attribution"><span class="source">from www.shutterstock.com</span></span>
</figcaption>
</figure>
<h2>Why has it come back?</h2>
<p>With the introduction of stringent dust control measures in mining in the developed world in the 1970s, this disease was virtually eradicated. The National Institute for Occupational Safety and Health has <a href="http://big.assets.huffingtonpost.com/NIOSHletter.pdf">monitored trends in black lung</a> for over 40 years in the United States. Only 0.08% of all mine workers and 0.33% of underground coal miners with at least 25 years of mining were diagnosed with progressive massive fibrosis in 2000.</p>
<p>However, prevalence has dramatically <a href="http://big.assets.huffingtonpost.com/NIOSHletter.pdf">increased over the past ten years</a> to 3.23% (five-year moving average) of working miners in the central Appalachian states of Kentucky, Virginia and West Virginia. Such an increase can only be the result of overexposure to coal dust. This is probably due to a relaxation of dust control regimes in many countries in recent years.</p>
<p>The Queensland Resource Council <a href="http://www.abc.net.au/news/2015-12-01/'black-lung'-makes-comeback-in-queensland-coal-mines/6990842">has admitted</a> it had become complacent with regulations because no new cases had been reported in Australia for decades. A <a href="http://www.abc.net.au/news/2015-12-01/'black-lung'-makes-comeback-in-queensland-coal-mines/6990842">review</a> will now be undertaken to assess practices that allowed this to occur.</p><img src="https://counter.theconversation.com/content/51649/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>David McLean receives funding from the New Zealand Health Research Council</span></em></p>Coal miners in Queensland have been diagnosed with “black lung”, a disease that was thought to have been eradicated in Australia over 20 years ago. So what is black lung, and why is it back?David McLean, Senior Research Officer, Centre for Public Health Research, Massey UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/148452013-06-03T04:29:41Z2013-06-03T04:29:41ZHealth harms of asbestos won’t be known for decades<figure><img src="https://images.theconversation.com/files/24844/original/d47w7zv9-1370222683.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Exposure to even a single fibre of asbestos dust can cause significant health problems.</span> <span class="attribution"><span class="source">Image from shutterstock.com</span></span></figcaption></figure><p>The digital age crashed into the bronze age when the roll out of Australia’s high-speed broadband network was disrupted by the discovery of <a href="http://www.abc.net.au/news/2013-06-03/government-fund-nbn-rollout-asbestos/4728316">asbestos in Telstra pits</a> in recent weeks. </p>
<p>Workplace relations minister Bill Shorten is <a href="http://www.abc.net.au/news/2013-06-03/government-fund-nbn-rollout-asbestos/4728316">expected to introduce</a> a bill to parliament later today to set up national registry for residents and contractors exposed to asbestos as a result of this work. In light of the strong link between asbestos exposure and lung cancer, the register is a sensible first step in managing the health risks associated with exposure to asbestos. </p>
<h2>What is asbestos?</h2>
<p>Asbestos is a naturally occurring mineral which humans have been mining for more than <a href="http://cat.inist.fr/?aModele=afficheN&cpsidt=15374478">4,000 years</a>, principally for its fire-retardant properties. </p>
<p>Mining and production of asbestos increased substantially from the end of the industrial revolution in the middle of the 19th century, eventually peaking in the middle to late 20th century. By then asbestos was being used as a component in hundreds of everyday products such as building materials, brake linings, fuse-boxes, and pipe insulation.</p>
<h2>Health harms</h2>
<p>Exposure to even a single fibre of asbestos dust can cause <a href="http://www.nhmrc.gov.au/your-health/asbestos-related-diseases">significant health problems</a>. Every one of the six variations of the fibrous silicate minerals known collectively as asbestos have the potential to cause malignant lung cancers, <a href="http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Mesothelioma">mesothelioma</a>, <a href="http://www.asbestos.com/mesothelioma/pleural-plaques.php">pleural plaques</a> (calcification of the lungs), or asbestosis (pneumoconiosis, a type of lung disease). </p>
<p>Already in Australia asbestos diseases <a href="http://www.nhmrc.gov.au/your-health/asbestos-related-diseases">account for</a> at least 3,500 deaths every year. That rate is predicted to rise until about 2020, with <a href="http://www.nhmrc.gov.au/your-health/asbestos-related-diseases">current estimates</a> suggesting 40,000 Australians eventually will die. And it’s likely these statistics will be an under estimate.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/24847/original/kfkq4cf5-1370222782.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/24847/original/kfkq4cf5-1370222782.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=897&fit=crop&dpr=1 600w, https://images.theconversation.com/files/24847/original/kfkq4cf5-1370222782.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=897&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/24847/original/kfkq4cf5-1370222782.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=897&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/24847/original/kfkq4cf5-1370222782.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1127&fit=crop&dpr=1 754w, https://images.theconversation.com/files/24847/original/kfkq4cf5-1370222782.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1127&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/24847/original/kfkq4cf5-1370222782.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1127&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Australia has no systematic procedure for recording who has or may have been exposed to asbestos.</span>
<span class="attribution"><span class="source">Image from shutterstock.com</span></span>
</figcaption>
</figure>
<p>Asbestos diseases often take decades to manifest following exposure and many individuals may not even know they have been exposed. Once manufactured, asbestos can be difficult to recognise. It can be shaped and painted and so it often looks like other types of building materials. </p>
<p>Most problematic is that unlike, say, nuclear waste, asbestos does not have a half-life. It can be left alone for a few decades or for 30 generations and when it is disturbed it represents exactly the same health threat as it did when it was originally mined.</p>
<h2>Changing demographics</h2>
<p>Those characteristics are now having impact. Asbestos diseases were once a blue-collar affliction, affecting mainly men, often decades after exposure. Increasingly, younger DIY builders and women are presenting after, often unknowingly, they’ve encountered asbestos during home renovations, or after it’s been dumped on the footpath or in a skip. </p>
<p>While <a href="http://www.adfa.org.au/news2012.html#reno">television renovators</a> lustily knock down walls to rebuild a whole house in a day or a week might have had their own work sites checked for risk, drilling a hole to hang a picture at home, or having the kids build a cubby out of waste from the vacant block next door can be a risky proposition.</p>
<p>Not a home renovator? Even <a href="http://www.abc.net.au/news/2011-11-15/disaster-clean-up-sparks-asbestos-fears/3666512">disaster zones pose potential threats</a> after bush fires, floods and storms.</p>
<p>The best way to handle asbestos is <em>not</em> to handle it. There are experts who can inspect buildings and homes for asbestos and manage its removal. Various government agencies both state and <a href="http://www.health.gov.au/internet/main/publishing.nsf/Content/ohp-enhealth-asbestos-may2012.htm">federal</a> have been equipped to manage the issues associated with the discovery of asbestos. </p>
<p>A good place to start is the <a href="http://www.goldcoast.qld.gov.au/community/environmental-health-officers-3591.html">environmental health officer</a> at your local municipal council. Safe Work Australia also has <a href="http://www.safeworkaustralia.gov.au/sites/SWA/about/Publications/Documents/641/How_to_Safely_Remove_Asbestos.pdf">published guidelines</a> about who can remove asbestos and how that must be done. It might seem excessive but if asbestos could be in your home or neighbourhood, call an expert.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/24845/original/3yc38mb8-1370222684.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/24845/original/3yc38mb8-1370222684.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/24845/original/3yc38mb8-1370222684.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/24845/original/3yc38mb8-1370222684.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/24845/original/3yc38mb8-1370222684.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/24845/original/3yc38mb8-1370222684.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/24845/original/3yc38mb8-1370222684.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Experts can inspect your home for asbestos and manage its removal.</span>
<span class="attribution"><span class="source">Image from shutterstock.com</span></span>
</figcaption>
</figure>
<h2>Time for a national registry</h2>
<p>Anyone exposed to asbestos in their workplace, home, or within the community is at risk of developing an asbestos-related disease. By the time the illness manifests, up to 50 years later, the world will have changed: buildings will have been demolished and businesses closed; the names of former colleagues, neighbours and witnesses long forgotten. </p>
<p>Australia has no systematic procedure for recording who has or may have been exposed, how exposure took place, or for monitoring their health.</p>
<p>Compensation depends on where and how exposure occurred. For those exposed in the workplace, compensation in the form of weekly payments is governed by the state workers’ compensation scheme. Injured workers can also <a href="http://www.asbestos.com/mesothelioma/australia/legislation.php">use the common law to seek damages</a> from former employers thanks to the legal actions of former James Hardie employees. </p>
<p>For the increasing numbers of people exposed to asbestos in the home or within the community there is no home- or community-based equivalent of workers’ compensation. Common law damages are also problematic with issues of causation and knowledge of risk providing significant obstacles.</p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/24848/original/b4g7vdc6-1370222993.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/24848/original/b4g7vdc6-1370222993.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=398&fit=crop&dpr=1 600w, https://images.theconversation.com/files/24848/original/b4g7vdc6-1370222993.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=398&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/24848/original/b4g7vdc6-1370222993.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=398&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/24848/original/b4g7vdc6-1370222993.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/24848/original/b4g7vdc6-1370222993.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/24848/original/b4g7vdc6-1370222993.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The national registry would record the details of residents and contractors exposed to asbestos during the NBN roll out.</span>
<span class="attribution"><span class="source">Image from shutterstock.com</span></span>
</figcaption>
</figure>
<p>We are starting to build the big picture. Buildings posing potential asbestos-related health risks can now be tracked via the <a href="http://www.nar.asn.au/">National Asbestos Register</a>. <a href="http://www.mesothelioma-australia.com/">The Australian Mesothelioma Registry</a> collects data on all new cases of mesothelioma and information on past exposure. <a href="http://www.awu.net.au/campaigns/national-asbestos-register">The Australian Workers Union’s National Asbestos Register</a> contains details of more than 6,000 people previously exposed to asbestos in the workplace. </p>
<p>All three initiatives are important but are not enough. A national register of everyone exposed to asbestos, whether at home, in the community, or at work is needed to inform the state and federal policies required to deal with the legacy of asbestos in Australia.</p><img src="https://counter.theconversation.com/content/14845/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ricky van der Zwan receives funding from the Asbestos Innovation Fund for a project investigating the psychological impacts of a diagnosis of an asbestos disease for sufferers, their carers, and their families.</span></em></p><p class="fine-print"><em><span>SCU has received funding from Comcare to undertake research into the psychological, social and economic impact of asbestos-related disease on persons with a diagnosis and their carers.</span></em></p>The digital age crashed into the bronze age when the roll out of Australia’s high-speed broadband network was disrupted by the discovery of asbestos in Telstra pits in recent weeks. Workplace relations…Ricky van der Zwan, Associate Professor in Neuroscience and Psychology, Southern Cross UniversityJulie Tucker, Partnership Facilitator, Southern Cross UniversityLicensed as Creative Commons – attribution, no derivatives.