Coal workers' pneumoconiosis: an Australian perspective

Abstract

Coal workers' pneumoconiosis (CWP) is an untreatable but preventable lung disease arising from chronic inhalation of coal dust. Recent reports of CWP in Queensland, along with international data, suggest that there is a resurgence in pneumoconiosis. The prevalence of CWP varies considerably between countries. In Australia, there is no mandatory reporting system and no national data on the prevalence of CWP. The symptoms and manifestations of CWP vary depending on the composition of the inhaled dust, duration of exposure, stage of disease and host-related factors. CWP may develop into progressive massive fibrosis (PMF), which can be fatal. Radiological assessment should be performed according to evidence-based standards using the ILO (International Labour Office) International Classification of Radiographs of Pneumoconioses. As preventing exposure to coal dust prevents CWP, it is important to implement and enforce appropriate standards limiting exposure. In Australia, these standards currently vary between states and are not in keeping with international understanding of the levels of coal dust that cause disease. Longitudinal screening programs are crucial for monitoring the health of coal workers to identify individuals with early-stage disease and prevent progression from mild disease to PMF. We recommend: standardisation of coal dust exposure limits, with harmonisation to international regulations; implementation of a national screening program for at-risk workers, with use of standardised questionnaires, imaging and lung function testing; development of appropriate training materials to assist general practitioners in identifying pneumoconiosis; and a system of mandatory reporting of CWP to a centralised occupational lung disease register.

Radiological appearance of coal mine dust lung diseases in Australian workers

“…This means the current prevalence of disease in Australia is unknown. Recommendations for a national approach to dust exposure limits, screening of workers, and reporting of cases have been made and endorsed by key leaders and bodies in the field …”

Coal mine dust lung disease in the modern era

“…Black‐pigmented sputum production (melanoptysis) can occur when large nodules necrotized and liquefied into the airways. Lung function patterns include chronic airflow obstruction, true lung restriction, mixed ventilatory defects and reductions in carbon monoxide diffusing capacity, and these can vary according to the inhaled silica content, stage of disease and extent of tobacco smoke exposure. Even in the presence of radiologically confirmed pneumoconiosis, airflow obstruction seems to play a predominant role in coal workers’ breathlessness .…”

“…Even in high‐income countries, the increasing CWP prevalence is still of great concern. In Australia, there has been a call to standardize recommended exposure parameters and monitoring procedures, to implement a comprehensive screening programme and establish a centralized occupational lung disease register . There is also a need to employ methods such as cost‐effectiveness which have been used to evaluate other occupational health interventions such as silicosis .…”

Occupational lung diseases in Australia

“…Although these conditions were more common before modern occupational health standards, they should not be considered as merely of historical interest. The re‐identification of many cases of coal workers' pneumoconiosis (black lung) in Queensland has recently been highlighted in this Journal 31 …”