20th February 2025

Coal worker’s pneumoconiosis

Overview and diagnosis of coal worker’s pneumoconiosis

This is an ILD caused by the inhalation and deposition of coal dust in the lung. Macrophages engulf coal dust particles and form coal macules. These accumulate throughout the lung and ultimately lead to focal emphysema.

This condition may be asymptomatic and respiratory examination is often normal.

Symptoms, if present, include gradual-onset shortness of breath (particularly on exertion), cough and wheeze. Patients may produce black-pigmented sputum.

History is an essential part of diagnosis to determine exposure.

Investigations include:

• CXR and HRCT: nodules, predominantly in the upper and middle zones, and there may be distortion of lung architecture and emphysema
• Lung function tests: a mixed obstructive and restrictive picture in severe disease

Management of coal worker’s pneumoconiosis

Management is mostly supportive. Avoidance of exposure or using personal protective equipment is of benefit. If there is evidence of COPD as a complication, bronchodilator therapy might be tried.

See note on nintedanib – this has now been approved as a treatment option for chronic progressive fibrosing interstitial lung diseases.

Caplan syndrome

Caplan syndrome describes lung fibrosis in the context of a history of exposure to coal dust on a background of rheumatoid arthritis. Symptoms include cough and shortness of breath as well as painful joints and morning stiffness. Signs include features of RA.

Treatment involves cessation of dust exposure and smoking. Steroids can be used after TB is excluded and DMARDs should be considered for the treatment of RA.