Coal Workers Pneumoconiosis (Anthracosilicosis)

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1- Definition & Types

2- Causes (Aetiology)

3- Pathophysiology

4- Clinical Features & Examination

5- Investigations

6- Management

7- Complications

8- Core Concepts

Definition & Types

Coal Workers’ Pneumoconiosis is a chronic interstitial lung disease caused by long-term inhalation of coal dust, leading to fibrosis and structural lung damage.

Types:

  •  Simple CWP (SCWP):

    • Characterized by small nodules in the upper lung zones.

    • Usually asymptomatic or mildly symptomatic.

    • Lung function often preserved.

  • Complicated CWP / Progressive Massive Fibrosis (PMF):

    • Coalescence of nodules into large fibrotic masses.

    • Leads to progressive dyspnoea, cough, and hypoxaemia.

    • Often continues progressing even after dust exposure ends.

  • Caplan’s Syndrome:

    • CWP + rheumatoid arthritis

    • Multiple rounded nodules (0.5–5 cm) with necrotic centers and inflammatory cells

    • Immune-mediated process

© image from Wikimedia Commons

Causes (Aetiology)

  • Chronic exposure to inhaled coal dust in:

    • Underground mining

    • Coal processing

  • Dust contains carbon, silica, and other minerals

  • Disease severity correlates with:

    • Duration and intensity of exposure

    • Presence of coexisting conditions (e.g. RA)

Pathophysiology

  • Coal dust is inhaled and deposited in alveoli.

  • Alveolar macrophages engulf dust particles.

  • Accumulated dust and immune response → macule formation and fibrosis.

  • Ongoing inflammation leads to:

    • Nodules (in SCWP)

    • Large fibrotic masses (in PMF)

    • Autoimmune nodules in Caplan’s syndrome

© image from Wikimedia Commons

Clinical Features & Examination

Symptoms:

  • SCWP: often asymptomatic or mild cough

  • PMF:

    • Persistent cough

    • Black sputum (melanoptysis)

    • Breathlessness

    • Weight loss and fatigue

 Signs:

  • May include reduced breath sounds, fine crepitations, and cyanosis

  • No clubbing, unless complicated or with RA

Investigations

  • Chest X-ray:

    • SCWP: small nodular opacities in upper lobes

    • PMF: large masses (may cavitate), mimicking TB or cancer

  • High-resolution CT (HRCT):

    • Defines mass size, location, and cavitation

  • Pulmonary Function Tests:

    • Normal in SCWP

    • Restrictive ± obstructive in PMF

  • Autoimmune screen if Caplan’s suspected

  • TB testing to exclude differential

Management

No specific cure—management is supportive and preventative

  • Remove exposure: STOP coal dust inhalation

  • Vaccinations: influenza and pneumococcal

  • Treat infections promptly

  • Inhaled bronchodilators if airway obstruction

  • Oxygen therapy if hypoxaemic

  • Pulmonary rehabilitation

  • Monitor for TB, cancer, and RA symptoms

Complications

  • Progressive massive fibrosis (PMF)

  • Respiratory failure

  • Cor pulmonale (right heart failure)

  • Chronic bronchitis/emphysema overlap

  • Caplan’s syndrome (if RA is present)

  • Tuberculosis mimicry (must exclude)

Core Concepts

  • Fibrosis can progress even after exposure ends

  • Caplan’s = RA + CWP + nodules → think autoimmune

  • Always exclude TB in cavitating upper lobe lesions

  • Chest X-ray and CT are essential for staging

  •  Prevention via dust control is key to public health

  •  Lung function may remain intact in SCWP—don’t overdiagnose!

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