16th January 2024

Coal worker’s pneumoconiosis (CWP)

Coal worker’s pneumoconiosis arises from chronic coal dust inhalation. Like silicosis, CWP may present as simple pneumoconiosis or may progress to progressive massive fibrosis (PMF). Incidence of disease is linked to total dust exposure.

Pathophysiology

Following inhalation, coal particles are retained in the alveoli. Macrophages then engulf these particles, triggering an immune response that precipitates fibrotic lung changes. CWP is also a known cause of chronic obstructive pulmonary disease (COPD).

Presentation

Simple CWP features:

• Asymptomatic
• Incidental small, rounded opacities found in the upper zones
• Associated with focal emphysema

Progressive massive fibrosis features:

• Coalescence of small nodules to form larger, widespread masses of fibrotic tissue
• Lesions may cavitate
• Symptoms include progressive dyspnoea, cough, and black productive sputum.

Caplan syndrome features:

• This syndrome describes a combination of pneumoconiosis and features of/diagnosis of Rheumatoid Arthritis 

Diagnosis 

Imaging 

Chest x-ray findings are similar to those found in Silicosis- small, rounded opacities in upper zones.

Pulmonary function tests

Mixed obstructive (due to emphysematous changes) and restrictive changes (due to fibrotic changes)