Coal workers' pneumoconiosis: causes, symptoms and support

The word pneumoconiosis covers a group of lung diseases caused by breathing in dust that then stays in the lungs. The HSE lists coal worker's pneumoconiosis, from coal dust, and silicosis, from respirable crystalline silica, as the most commonly occurring types apart from asbestosis.

Patient.info explains what happens inside the lung. Tiny particles of coal dust, only 2 to 5 microns across, are retained in the air sacs (alveoli). They are engulfed by immune cells called macrophages, but eventually the system is overwhelmed and an immune response follows, which produces scarring (fibrosis). The reference notes that dust high in silica increases the risk of fibrosis, and that morbidity and mortality relate to the type of coal dust and the duration of exposure.

Many coal miners are also exposed to silica, and Patient.info says silicosis and coal workers' pneumoconiosis are indistinguishable on a chest X-ray. If coal workers' pneumoconiosis occurs together with rheumatoid arthritis, it is called Caplan's syndrome.

Patient.info describes two patterns. They differ in how much lung is involved and in how much they affect everyday life.

Early disease may cause no symptoms at all. When symptoms develop, breathlessness is the main one, with a persistent cough. The NHS lists shortness of breath, particularly when active, a persistent chesty cough with phlegm, frequent chest infections and persistent wheezing as the main symptoms of COPD, which can occur alongside or as a result of coal dust exposure; the NHS names coal dust among the substances linked to COPD, and says the risk is higher if you also smoke.

The NHS says to see a GP if you have been coughing for more than 3 weeks or if your shortness of breath gets worse with normal activity or when you lie down. It says to call 999 or go to A&E if you have severe difficulty breathing, a tight or heavy chest, pain spreading to the arms, back, neck or jaw, blue, grey or very pale lips or skin, or sudden confusion, and to get urgent advice from NHS 111 if you are more short of breath than usual or cough up blood.

If you worked in coal mining at any point, say so to your GP, even if it was decades ago. The HSE notes that the delay between exposure and disease can be long, so an occupational history that goes back many years is part of any assessment.

Patient.info says a good occupational history is essential, going back over many years and including hobbies and pastimes, and that a chest X-ray and lung function tests are required. It adds that occupational lung disease cannot be diagnosed by radiology alone, and that high-resolution CT scans are increasingly used because they are more sensitive and specific than X-ray. Referral to a chest physician is advised for diagnostic and management advice.

The reference also explains that pneumoconiosis is a notifiable and prescribed industrial disease, meaning that with the patient's consent a doctor must notify the employer in writing, and that financial compensation may be available where someone worked in a job for which the disease is prescribed and the illness is likely due to the exposure.

There is no cure. Patient.info states that none of these diseases is curable, and advises strong encouragement to stop smoking, treatment or palliation of symptoms and support for the patient and family through the disease and its social, occupational and legal ramifications. The NHS describes the main treatments for COPD, which are often relevant when airflow is affected: stopping smoking, inhalers and medicines to make breathing easier, pulmonary rehabilitation, and in a very small number of people surgery or a lung transplant.

The outlook varies a great deal. Simple disease may cause few or no problems for years, while progressive massive fibrosis can lead to respiratory failure. The NHS says that damage to the lungs from COPD is permanent but treatment can slow its progression.

GOV.UK explains that Industrial Injuries Disablement Benefit (IIDB) covers diseases caused by a job, including pneumoconiosis, silicosis and asbestosis, and that you cannot claim if you were self-employed. Patient.info notes that chronic bronchitis and emphysema (COPD) became prescribed diseases in 1993 for coal miners with a specified level of lung function impairment and a minimum of 20 years of underground exposure to coal dust.

GOV.UK also describes the Coal Industry Pneumoconiosis Compensation Scheme. To claim you must be getting IIDB for pneumoconiosis (including black lung), asbestosis or silicosis, or certain other listed conditions, and you must have worked for 10 years or more in coal mining, partly in a mine licensed by the National Coal Board or British Coal Corporation. Accepting a payment means you cannot claim through the courts, so GOV.UK advises getting legal advice. Families of deceased miners may be able to claim in some circumstances.

Patient.info says it is probably impossible to prevent all industrial dust diseases but they can be reduced by following safety precautions: adequate ventilation, keeping down dust levels in the workplace and wearing face masks. It notes that exposure in the post-industrial UK is nowhere near the scale of the 1950s and 1960s. The HSE says that for silica, health surveillance must be provided to workers regularly exposed to respirable crystalline silica where silicosis may develop.