Pathology and Mineralogy Demonstrate Respirable Crystalline Silica Is a Major Cause of Severe Pneumoconiosis in U.S. Coal Miners

Robert A. Cohen*, Cecile S. Rose, Leonard H.T. Go, Lauren M. Zell-Baran, Kirsten S. Almberg, Emily A. Sarver, Heather A. Lowers, Cayla Iwaniuk, Sidney M. Clingerman, Diana L. Richardson, Jerrold L. Abraham, Carlyne D. Cool, Angela D. Franko, Ann F. Hubbs, Jill Murray, Marlene S. Orandle, Soma Sanyal, Naseema I. Vorajee, Edward L. Petsonk, Rafia ZulfikarFrancis H.Y. Green

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

20 Scopus citations

Abstract

Rationale: The reasons for resurgent coal workers’ pneumoconiosis and its most severe forms, rapidly progressive pneumoconiosis and progressive massive fibrosis (PMF), in the United States are not yet fully understood. Objectives: To compare the pathologic and mineralogic features of contemporary coal miners with severe pneumoconiosis with those of their historical counterparts. Methods: Lung pathology specimens from 85 coal miners with PMF were included for evaluation and analysis. We compared the proportion of cases with pathologic and mineralogic findings in miners born between 1910 and 1930 (historical) with those in miners born in or after 1930 (contemporary). Results: We found a significantly higher proportion of silica-type PMF (57% vs. 18%; P, 0.001) among contemporary miners compared with their historical counterparts. Mineral dust alveolar proteinosis was also more common in contemporary miners compared with their historical counterparts (70% vs. 37%; P, 0.01). In situ mineralogic analysis showed that the percentage (26.1% vs. 17.8%; P, 0.01) and concentration (47.3 3 108 vs. 25.8 3 108 particles/cm3; P = 0.036) of silica particles were significantly greater in specimens from contemporary miners compared with their historical counterparts. The concentration of silica particles was significantly greater when silica-type PMF, mineral dust alveolar proteinosis, silicotic nodules, or immature silicotic nodules were present (P, 0.05). Conclusions: Exposure to respirable crystalline silica appears causal in the unexpected surge of severe disease in contemporary miners. Our findings underscore the importance of controlling workplace silica exposure to prevent the disabling and untreatable adverse health effects afflicting U.S. coal miners.

Original languageEnglish (US)
Pages (from-to)1469-1478
Number of pages10
JournalAnnals of the American Thoracic Society
Volume19
Issue number9
DOIs
StatePublished - Sep 2022

Keywords

  • coal workers
  • dust
  • silicosis

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

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