Coal Workers Pneumoconiosis

Question 1

What is coal workers’ pneumoconiosis?

Answer 1

Occupational lung disease caused by long term exposure to coal dust particles.
(Long lead time between exposure and disease)

Question 2

What is the epidemiology of coal workers’ pneumoconiosis?

Answer 2

Areas with large coal mining industries
High male proportion
CWP makes up 7% of all pneumconiosis
Diagnosis 15-20 years after initial exposure

Question 3

What is the pathophysiology of coal workers’ pneumoconiosis?

Answer 3

Coal dust enters the lungs
Reaches terminal bronchioles and is engulfed by alveolar and interstitial macrophages
Removed by the macrophages via the mucocilliary elevator and removed from the body as mucus

If prolongued exposure, system is overwhelmed and the macrophages begin to accumulate in the alveoli, starting an immune resonse which damages the lung tissue.

Question 4

What are the two types of presentation of coal workers’ pneumoconiosis?

Answer 4

Simple pneumoconiosis

Progressive massive fibrosis

Question 5

What is the presentation of simple pneumoconiosis?

Answer 5

Commonest type
May be asymptomatic
Increases risk COPD
May lead to progressive massive fibrosis (PMF), occuring in around 30% of those with stage 3 grading.

Question 6

How is the coal workers’ pneumoconiosis simple pneumoconiosis stages?

Answer 6

Category 1: some opacities but normal lung markings visible
Category 2: large number of opacities but normal lung markings visible
Category 3: large number of opacities with normal lung not visible

Question 7

What is progressive massive fibrosis (CMP)?

Answer 7

Dust exposure causes patients to develop round fibrotic masses which can be several centimeters in diameter, commonly in upper lobes.

Patients are symptomatic and have breathlessness of exertion and cough, some may have black sputum.

LFTs show mixed obstructive/restricive picture

Question 8

What are the investigations and findings of coal workers’ pneumoconiosis?

Answer 8

Chest x-ray: upper zone fibrosis

Spirometry: restrictive (slightly obstructive picture) - normal or slightly reduced FEV1 and a reduced FVC.

Question 9

What is the management of coal workers’ pneumoconiosis?

Answer 9

Avoid exposure to coal dust and respiratory irritants (e.g. smoking)
Manage symptoms of chronic bronchitis
Patients may be eligible for monetary compensation

Question 10

What is pneumoconiosis?

Answer 10

accumulation of dust in the lungs and the response of the bodily tissue to its presence, most commonly used in relation to coal worker’s pneumoconiosis