Coal Workers’ Pneumoconiosis

COAL WORKERS’ PNEUMOCONIOSIS

Coal workers’ pneumoconiosis (“black lung disease”) includes a variety of respiratory diseases found in coal workers who have in-haled coal dust over the years. Coal miners are exposed to dusts that are mixtures of coal, kaolin, mica, and silica.

Pathophysiology

When coal dust is deposited in the alveoli and respiratory bron-chioles, macrophages engulf the particles (by phagocytosis) and transport them to the terminal bronchioles, where they are re-moved by mucociliary action. In time, the clearance mechanisms cannot handle the excessive dust load, and the macrophages ag-gregate in the respiratory bronchioles and alveoli. Fibroblasts ap-pear and a network of reticulin is laid down surrounding the dust-laden macrophages. The bronchioles and the alveoli become clogged with coal dust, dying macrophages, and fibroblasts. This leads to the formation of the coal macule, the primary lesion of the disorder. Macules appear as blackish dots on the lungs. Fi-brotic lesions develop and, as the macules enlarge, the weakening bronchioles dilate, with subsequent development of a localized emphysema. The disease begins in the upper lobes of the lungs but may progress to the lower lobes.

Clinical Manifestations

The first signs are a chronic cough and sputum production, sim-ilar to the signs encountered in chronic bronchitis. As the dis-ease progresses, the patient develops dyspnea and coughs up large amounts of sputum with varying amounts of black fluid (melanoptysis), particularly if the individual is a smoker. Even-tually, cor pulmonale and respiratory failure result. The diagno-sis may first be made based on chest x-ray findings and a history of exposure.

Medical Management

Preventing this disease is key because there is no effective treatment. Instead, treatment focuses on early diagnosis and management of complications.

Nursing Management

TEACHING ABOUT PREVENTION

The occupational health nurse serves as an employee advocate, making every effort to promote measures to reduce the exposure of workers to industrial products. Laws require that the work en-vironment be ventilated properly to remove any noxious agent. Dust control can prevent many of the pneumoconioses. Dust con-trol includes ventilation, spraying an area with water to control dust, and effective and frequent floor cleaning. Air samples need to be monitored. Toxic substances should be enclosed and placed in restricted areas. Workers must wear or use protective devices (facemasks, hoods, industrial respirators) to provide a safe air sup-ply when a toxic element is present. Employees who are at risk should be carefully screened and followed. There is a risk of de-veloping serious smoking-related illness (cancer) in industries in which there are unsafe levels of certain gases, dusts, fumes, fluids, and other toxic substances. Additionally, there is the potential for second-hand exposure. Asbestos and toxic dusts and substances may be transferred to others through the handling of clothing or shoes that have been exposed. Ongoing educational programs should be designed to teach workers to take responsibility for their own health and to stop smoking and receive an influenza vaccination.

The Right to Know law stipulates that employees must be in-formed about all hazardous and toxic substances in the work-place. Specifically, they must be educated about any hazardous or toxic substances they work with, what effects these substances can have on their health, and the measures they can take to protect themselves. The responsibility for implementing these controls inevitably falls on the federal or state government.