Black Lung Disease (Coal Workers’ Pneumoconiosis)

What is black lung disease?

Black lung disease — also known as coal workers’ pneumoconiosis or coal miners’ lung — is inflammation (swelling and irritation) and fibrosis (thickening or scarring) in lung tissue brought about by inhaling dust particles in and around coal mines.

Many workplaces have occupational hazards. But unlike falling off a ladder, you won’t feel it right away if you have black lung disease. It might be years after breathing in coal dust particles before you notice symptoms. But those tiny dust particles — and the irritation it causes — can scar your lungs and lead to breathing problems.

Types of black lung disease

There are two types of coal workers’ pneumoconiosis (pronounced “new-moe-koh-knee-o-sis”) depending on how much dust you inhaled and how long you worked in the coal mine. They both affect your breathing.

• Simple: You have a little scarring in your lungs that looks like small black spots on a chest X-ray or CT scan. You’ll need to follow your healthcare provider’s instructions about medications, avoid further exposure to coal dust, and get regular check-ups and lung imaging. The earlier that simple black lung disease is found, the better. That’s why screening is so important.
• Complicated: Your scarring is severe and covers more of your lung. While healthcare providers can’t fix the scarring, there are treatments that can help you feel better. Your healthcare provider may also refer to this as progressive massive fibrosis.

How common is this condition?

Black lung disease is a form of interstitial lung disease, which itself is rare. But only people who work in coal mines develop black lung disease. Among people who work in coal mines, black lung disease is somewhat common. Even after decades of knowing that coal mine dust can cause disease, black lung disease still affects about 16% of coal workers. And these rates are increasing.

What are the symptoms of black lung disease?

It might be years after exposure before you start noticing symptoms of black lung disease. At first, you might not have any symptoms. But with coal workers’ pneumoconiosis, your symptoms may get worse over time. Symptoms include:

• Tightness in your chest.
• Difficulty exercising.
• Feeling short of breath. You may notice this even in routine tasks that didn’t make you tired before.
• A cough that’s sometimes productive (you may cough up black mucus).

On physical exam, your healthcare provider might hear wheezing or crackling when you breathe. Although you won’t be able to see that your lungs are black, imaging will reveal specific markers that tell your healthcare provider that it’s black lung and not another form of lung (pulmonary) disease.

What causes black spots on your lung?

You can’t always see the particles you’re inhaling. But the tiny specs of dust (particles) in coal mines have carbon. And depending on where your mine is and what types of rock you’re drilling through, the dust may also contain something called silica.

When you take a breath in a coal mine, these small particles of dust can get all the way to your lungs. Your immune system will recognize them as invaders (foreign bodies) and try to get rid of them. This immune reaction can lead to inflammation and scarring and, eventually, the symptoms of black lung disease.

Does weed make your lungs black?

Smoking any substance is bad for your lungs. It doesn’t matter if you’re smoking marijuana (also called weed or cannabis), cigarettes or cigars. When you smoke, you inhale particles that contain toxins, irritants and carcinogens into your airways.

Smoking can cause your lungs to scar and puts you at greater risk of developing breathing problems like chronic cough, bronchitis, COPD and lung cancer. But it doesn’t cause black lung disease (coal workers’ pneumoconiosis). Only coal causes this particular form of lung disease.

Does vaping make your lungs black?

Just like smoking, vaping causes lung damage but doesn’t make your lungs black. That said, vaping (and smoking) can make the symptoms of black lung disease worse.

But vaping carries unique risks. In vaping, you use a vape pen (or e-cigarette) to heat a liquid into a vapor that you breathe in to get the substance (whether it’s tobacco or cannabis or something else). The particles you inhale in vaping cause a similar immune reaction in your lungs. But it’s not called black lung disease. It can cause lung scarring, organ damage and a serious condition called e-cigarette or vaping use-associated lung injury (EVALI).

Is black lung disease contagious?

Black lung disease isn’t contagious. You can’t catch it or give it to someone else. It’s also not inherited or genetic. The only way to get black lung disease is to mine coal.

Is it viral or bacterial?

Although you’ll eventually feel sick from black lung disease, it’s not a viral or bacterial infection. Just as your body responds to foreign invaders like viruses and bacteria, your immune system is activated by the particles you’ve inhaled in the coal mine. At first, this immune response might feel like you have a common cold or flu.

What are the complications of black lung disease?

Complications of black lung disease include:

• Tuberculosis (TB).
• Heart failure.
• Lung cancer.

How is coal workers’ pneumoconiosis diagnosed?

If you’re having problems breathing, your healthcare provider will ask about your medical history and your work (occupational) history. They’ll conduct a physical exam. If needed, they’ll perform medical tests.

What tests will be done to diagnose this condition?

After a chest X-ray or computed tomography scan shows possible black lung disease, your provider may do some tests to see how well your lungs work (pulmonary function tests). These tests are important to find out how black lung disease affects your lung. Your healthcare team can look back on these measurements later as they assess whether treatment is working and if your condition is getting worse.

Your healthcare team may also get a special blood test called an “arterial blood gas” to see whether your oxygen levels are low. If you’re getting evaluated for black lung benefits, they may do this twice: Once sitting still and resting and once after exercising as hard as you can.

How is black lung disease treated?

Treatments for black lung disease aim to make you feel better, but they won’t cure the condition. Aside from a lung transplant (which may cure black lung disease), your healthcare provider will manage your black lung symptoms with:

• Restricting exposure to coal.
• Efforts to avoid further irritating your lungs (quitting smoking and vaping, staying up to date on your vaccines).
• Medications (bronchodilators) that keep your airways open and soothe inflammation.
• Pulmonary rehabilitation.
• Oxygen.

Can black lung disease be prevented?

Yes, black lung disease is preventable. The U.S. Occupational Safety and Health Administration (OSHA) has standards to help prevent black lung disease. If you’re working in or around coal mines, the organization you work for should put into place methods to decrease the amount of coal mine dust in the area and improve the airflow where you’re working. If you can, wearing a mask that’s been “fit-tested” — it’s been checked to make sure it protects you from dust — can help.

After work, you should keep that mask on while you remove your work clothes. You can remove your mask to take a shower, washing any of the coal particles from your hair and skin. You may also want to wear a face mask when you do your work laundry.

What are the risk factors for black lung disease?

The biggest risk factor for black lung disease is working in coal mines. But you’re at increased risk if you work (or worked in) coal mines and:

• Smoke.
• Were exposed to a lot of dust on the job.
• Worked in the coal mines for many years.
• Worked jobs in the mine where you were exposed to lots of rock dust or high levels of silica.

What can I expect if I have this condition?

It can take a while to wrap your head around a diagnosis like black lung disease, especially if you don’t have any symptoms. You’ll have the condition for the rest of your life.

If you have complicated black lung disease, you’ll likely have more symptoms and require more frequent visits to the doctor. You may need supplemental oxygen. Overall, research shows that black lung disease decreases life expectancy by about 12.6 years.

When can I go back to work?

If you have black lung disease, you shouldn’t keep working in a job with high coal mine dust. Your healthcare provider can help you apply for the Part 90 program, which can help you change to a “low dust exposure” job. Depending on how bad your symptoms are, you may be able to do other work. You may need to take time off when you’re not feeling well, too.

How do I take care of myself?

If you have black lung disease, you’ll want to limit any exposure to things that can further irritate your lungs. These include:

• Quit smoking. It’s critical for your current and future health. But it’s not easy. If you have black lung disease and smoke, talk to your healthcare provider about how they might support you as you quit. You should also try to avoid environments where you might be exposed to secondhand smoke.
• Stay away from the coal mine. Breathing in more coal and silica particles will worsen your condition.
• Watch the weather. Specifically, the air quality index (AQI) that’s usually reported with the weather forecast. If the air quality index is “unhealthy for sensitive groups” or worse, you should try to stay inside — or wear a face mask if you go out — until it improves.
• Prevent infections. Your condition may be aggravated by a respiratory infection. Stay up to date on vaccines like influenza, pneumococcal pneumonia and COVID-19. And consider wearing a face mask in public during cold and flu season.
• Exercise, but do so carefully. Talk with your healthcare provider about what exercises you can do, how hard you should push yourself and how to know when you’re overdoing it.
• Plan for flare-ups. Nobody wants to think about feeling bad when they’re feeling fine. But developing a plan for how you’ll manage flare-ups means that everything is in place so you’re not scrambling to find medical care when you’re not feeling your best.

When should I see my healthcare provider?

Your healthcare provider will want to see you for regular check-ups. They’re also the best person to ask about when and where you should seek care.

What questions should I ask my doctor?

• How severe is my condition?
• What medications do I need? Do they have any side effects?
• Is there a way for me to exercise safely?
• How often do I need check-ups for black lung disease?
• What should I do if I have a flare-up?
• Do I need a lung transplant?

When should I go to the ER?

Seek emergency medical care if you have new or more trouble breathing, or your lips, hands or feet turn blue (cyanosis).

Is black lung tuberculosis?

No, black lung disease isn’t the same as tuberculosis (TB). TB is an infection caused by the bacterium Mycobacterium tuberculosis. It’s a contagious disease, but it doesn’t spread very easily in most people.

Having black lung disease puts you at higher risk of developing TB because your immune system is weakened. Some of the symptoms of TB and black lung disease are the same: cough, chest pain and coughing up sputum. But black lung disease isn’t an infection. If you have black lung disease without TB, you won’t likely have a fever or night sweats.

Is black lung a disability?

It depends. In the United States, disability is a legal issue. The key question here is: Can you perform the tasks you used to do when you worked as a coal miner? Your healthcare provider will need to report on how much black lung disease you have, what your symptoms are and how well they can be managed with medications. To qualify for black lung benefits, miners need to undergo a special test called the 413b examination. This is an examination and testing done by doctors specially trained in testing coal miners.

A note from Cleveland Clinic

Sometimes, it might feel like there are a lot of people telling you how to do your job. But no one should get sick because they work in unsafe conditions. That’s why rules and regulations exist — to help keep you working, safely. Even with all the workplace safety efforts, about 16% (or 1 in 6) of coal workers develop black lung disease.

Although you should feel better with medication and lifestyle changes, black lung disease can be a hard diagnosis to come to terms with, especially if you’ve seen your friends and colleagues go through it. If you’re newly diagnosed, or your symptoms are getting worse and you’re finding it difficult to cope, reach out to your healthcare provider. They can assess your health and recommend support groups and interventions that can help.