Progressive massive fibrosis continues to impact coal miners in 2023
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Key takeaways:
- More than 1,000 coal miners had a progressive massive fibrosis diagnosis between 2017 and 2023.
- A Mine Safety and Health Administration proposal may better protect coal miners from occupational exposures.
Between 2017 and 2023, more than 1,000 cases of progressive massive fibrosis emerged in coal miners, according to a research letter published in JAMA.
“Most people think of coal mining and black lung as ancient history, but the current burden of progressive massive fibrosis (PMF) in the U.S. is important for people to recognize,” Drew A. Harris, MD, associate professor of medicine in the pulmonary division at University of Virginia and medical director of the black lung program at Stone Mountain Health Services, told Healio. “This devastating disease is still ruining patients’ lives and impacting thousands of families and countless communities.”
Using data collected between February 2017 and June 2023 from 15 federally funded Black Lung Clinics in the U.S., Harris and colleagues sought to find out the number of coal miners with PMF and characteristics of the observed cases.
Two out of the 15 clinics are a part of Stone Mountain Health Services (SMHS), and data collection in these clinics started in February 2017, whereas data collection in the remaining clinics started in July 2019.
During these time periods, researchers found more cases of PMF at SMHS (n = 651; mean age, 66 years; 99.9% men) than at the remaining 12 clinics (n = 526; mean age, 64 years; 99.8% men).
“PMF is incurable and leads to significant impairment in patient’s lives, preventing patients from doing the things they enjoy due to progressive shortness of breath,” Harris said. “As the disease progresses it often impairs patients’ ability to do things most people take for granted, like going to work, or even going to the grocery store or getting dressed.”
Currently, treatment options for patients with this condition are limited. Since no treatments have been approved, Harris said clinicians can only offer exercise programs and oxygen. Lung transplantation is often not an option.
“For a variety of factors, most patients with PMF are not eligible for a lung transplant, and those that do receive a transplant typically only extend their lives by a few years,” Harris said.
Patient characteristics
Of the total cohort, 79 individuals worked fewer than 15 years as a coal miner and 70 individuals were aged younger than 50 years, according to researchers.
Residence in the central Appalachian states (Kentucky, Virginia or West Virginia) was common (86%).
“In central Appalachia, the proportion of PMF among former U.S. coal miners applying for Federal Black Lung Program benefits between 1970 to 2016 has been shown to be around 10%, according to a study by Kirsten S. Almberg, PhD, MS, and colleagues,” Harris told Healio. “Our study shows that over 1,000 miners have received a new diagnosis of PMF since 2017.”
Another characteristic frequently reported by individuals in this population was spending all or a portion of their career working underground (91%).
Two hundred seventy-five individuals did not report whether they are active or former miners, but of the remaining individuals, 92% identified as former miners.
Since diseases, such as black lung, can continue to develop after exposure, Harris told Healio that clinicians must be aware of patients’ occupational exposure history.
“For any patient with a coal mining history and progressive pulmonary symptoms, further workup is needed (often including pulmonary function testing and chest imaging),” he said. Clinicians also should appreciate that black lung causes a wide spectrum of lung diseases such as emphysema, chronic bronchitis, pulmonary fibrosis, pneumoconiosis and PMF, Harris continued.
“If clinicians are uncertain about whether or not a lung disease is caused by a workplace exposure, such as coal mine dust, they should refer to a specialist,” he added. “For coal miners, there are specialized black lung clinics located all over the country.”
Looking ahead
In order to stop PMF in coal miners, protections need to be put in place.
“No one should have their lives ruined by a disease caused by a preventable exposure at work,” Harris told Healio. “PMF is 100% preventable with sufficient workplace protections from toxic dusts (such as improved ventilation in coal mines or using equipment with water sprays that direct dust away from miners).”
When asked if the prevalence of PMF will change in the future, Harris said a recent proposal from the Mine Safety and Health Administration who help achieve workplace protections for coal miners may reduce their exposure to silica.
“This rule has not yet been finalized, but we are hopeful that the federal regulators will take into consideration the magnitude of the PMF-problem that this paper describes and enact the strongest feasible protections to prevent PMF in current and future generations of miners,” Harris told Healio.