NPR

LEXINGTON, KY – Black lung is inseparable from coal mining, both in the minds of the public and in real life.

It is also known by the medical term “coalminers’ pneumoconiosis,” pneumoconiosis being a lung disease that leads to fibrosis, which is an accumulation of scar tissue and a decrease in lung capacity. It is related to other occupational lung diseases such as asbestosis and silicosis.

Black Lung is a relatively simple ailment. When something suspicious enters one's lungs, the immune systems kicks into action. Macrophage cells, acting to remove pathogens, attempt to consume the foreign particles. Macrophages are capable of ridding the body of bacteria, virus' and fungi, but not carbon or silicon micro particles. 

Macrophages are not capable of processing non-biological matter. When they encounter carbon or silicon dust, they instead sequester the matter out of main breathing pathways. Should one

 inhale small amounts of smoke or coal dust, one would likely develop anthracosis—a mild, asymptomatic version of pneumoconiosis. However, during jobs where one is routinely exposed to silica or coal dust, this anthracosis can develop into pneumoconiosis, forming “nodules” or “fibroids” of scar tissue in the lungs up to one centimeter wide.

When the nodules of scar tissue become larger than one centimeter on an x-ray or larger than two centimeters in a histologic (tissue) section from the lung itself, then the organ is declared to have progressive massive fibrosis, or PMF. A biopsied PMF lung contains a shriveled black lump where there once was a soft, pink organ.

Because Black Lung has no cure, prevention is crucial. Masks are generally insufficient—the particles that can reach deep into the alveolar sacs of the lungs are too small to be blocked by a remotely breathable mask anyway.

Studies have shown that workers in union mines, with their generally higher safety standards, have somewhat lower chances of developing black lung. There are no union mines in Eastern Kentucky—which has one of the highest cancer death rates (and sometimes the singular highest, depending on the source) in the nation. In the past few decades, it’s become increasingly common to develop a full-blown case of black lung even if you never set foot in a coal mine. These instances are most widely noted among those involved in surface mining.

There is a definite correlation between coal mining, both underground and at the surface level, and instances of Black Lung and cancer. These ailments are especially damaging in states like Kentucky which are highly dependent on coal mining revenue. Raising awareness and increasing research funding looking into Black Lung will surely save lives, both in Kentucky and elsewhere. 

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