A Conversation About Black Lung

Mar 20, 2018

The Center for Disease Control’s National Institute for Occupational Safety and Health released a study on the largest cluster of complicated black lung cases ever reported. Kara Lofton spoke with WVU School of Public Health physicians Carl Werntz and Anna Allen about the study and what it means for West Virginia.

ALLEN: We actually have been noticing this trend over the last, about 18 years, that it has been going back up. And I think this might have just been the study that captured it in a, in the big picture.

LOFTON:  So yeah, and that kind of goes with my next question, I mean, do you think the numbers represented are accurate or are they low? Are you seeing a spike in this in your own practices?

WERNTZ: It's a geographic thing. We see patients for black lung evaluations both here in Morgantown and also down in Cabin Creek down a little bit south of Charleston. And we don't see a lot of the advanced form of black lung up here. And we see quite a bit more down in the Cabin Creek Clinic. Which again, is getting close to that geographic area where they identified in the study. In the area of Morgantown, the coal seams are anywhere from five to eight feet high. In the southern coalfields, it's not uncommon for them to be as little as 20 inches high. And so, to get the mining equipment in there that can be is - that requires 32 to 36 inches, they have to take all the time a foot to a foot and a half of sandstone, which, which,, there is a lot of silica dust. The more silica dust that is present, the more black lung there is, and the more of the aggressive black lung or complicated pneumoconiosis that you'll see.

LOFTON: So one of the things - Dr. Allen I think it was you mentioned in the press release that was sent out - is that the variability of the disease symptoms and the resemblance to other common lung diseases can make it difficult to truly know the numbers of people with black lung disease. Talk to me a little bit about that and about diagnosing black lung in West Virginia.

ALLEN: When we're talking about black lung disease, it covers a range of conditions. So black lung especially, as defined by the federal government, can include any lung disease that arises from exposure to coal dust or coal extraction. So even though people may start with the simple symptoms of – ‘a little bit fatigued,’ ‘I'm short of breath,’ ‘you know I have difficulty laying flat at night,’ ‘I can't catch my breath,’ it could be from the fact that they worked in coal dust or with coal dust exposure, but it could also be, you know, other medical conditions. There's a lot of other common medical conditions that start that way and you need to have a good evaluation to determine - is it something else like the heart, or is it coming from the lung or the workplace exposure?

WERNTZ: The final thing that makes it hard for - just on the medical side to figure out black lung -is that there are some physicians in the coal mining areas who don't ever want to call anything black lung because it generates papers that they need to fill out. And so there's sometimes that doctors will, in their own minds, think it's black lung but not really want to call it.

LOFTON: What does this report mean for West Virginia. Is there hope in terms of preventing and treating black lung here?

WERNTZ: Well there's certainly lots of room for improvement in the development of disease. I hope that this report serves as a wakeup call both to miners, to mine operators, and to regulatory agencies that this disease is real. It's important and it is preventable to a great extent.

ALLEN: We know what causes it and, you know, but treating it - we actually have no treatment for black lung other than perhaps a lung transplant for the most severe cases. So if someone has, you know, disease, it's going to be symptom control. And the big issue is the fact that things may be stable. Their breathing may be stable for a while, but then it could get worse and we can't tell people for sure if, you know, if you've got black lung and changes on your x-rays are going to stay that way or in five or ten years is it going to progress and become worse. So, so yes, so that's why this disease is just so difficult to manage because once you have it you have it.

Appalachia Health News is a project of West Virginia Public Broadcasting, with support from the Marshall Health, Charleston Area Medical Center and WVU Medicine.