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A Conversation about Mining and Black Lung Disease

Deborah Wills is the Program Coordinator of the Black Lung Program at Valley Health Systems, which has three clinic sites: Southern West Virginia-Upper Kanawha, Stepptown, and Harts. She holds a BS degree in Industrial Relations and Labor Studies, and is certified by NIOSH to perform Spirometry (lung function screening). Debbie has been working with black lung patients for sixteen years. The following is Jane Martin's interview with Ms. Wills, conducted in late 2005. Thanks to Ms. Wills for her time and expertise.

What is Black Lung disease?

Black lung is a disease that comes from the inhalation of minute coal dust particles.  These particles are present during the extraction, cleaning and transportation of coal.  They are also present when coal is used for industrial purposes.  For instance, coal is used in some power plants to make electricity.  It is also used to fuel furnaces in the production of steel, alloys and aluminum.  Although black lung is typically thought of as a miner's disease, many other workers are also at risk for the disease.

What is the NCBLRDC, and what do they do?  

The National Coalition of Black Lung and Respiratory Disease Clinics is an organization of health care providers who specialize in the diagnosis, treatment, and counseling of miners and other workers with black lung, silicosis and asbestosis.

What is a coal miner's clinic?

Each of our programs is different in some ways. Some are primary care clinics with family practice doctors.  Some are specialty clinics with pulmonologists.  Black lung is diagnosed and treated on site.  Other programs contract with hospitals to have testing and treatment of their patients.

What kinds of physical symptoms would lead somebody to visit a clinic such as this, or, what signs should they watch for?

Often the first clue to a person would be a chronic cough.  If a worker reports he/she has coughed every day over a three-month period, we would begin testing. Other signs include shortness of breath, chest pain, and chest congestion. We routinely go into the community and tell workers who have been exposed for two or more years to have a screening x-ray.  In some cases, the disease is present on x-ray prior to symptoms.

What might a person expect on the visit?

Generally, we do a screening chest x-ray, a pulmonary function study and a thorough medical/employment history on the first visit.  The chest x-ray is read by a B-reader.  The B-reader is a doctor, usually a radiologist or a pulmonologist, who has been specifically trained to read chest x-rays for black lung, silicosis or asbestosis.  On the second visit, we discuss the results with the worker.  If there was no disease found, we advise patients to have annual screening, chest x-rays, and breathing tests.  If there was disease found, we educate the patients on the disease process, prevention through use of respirators, smoking cessation, benefits programs, and other health issues specific to their medical history, like nutrition or exercise. Our programs also encourage pulmonary rehabilitation programs.  Some patients return for rehabilitation depending on the circumstances.

What are the basic health-related rights of a miner?  

To my knowledge, the miner may participate in a program called the Coal Workers' Health Surveillance Program.  Every underground coal miner is eligible to have a free chest x-ray. Those diagnosed with Coal Workers' Pneumoconiosis (CWP) are given a dust transfer letter by the National Institute of Occupational Safety and Health.  This gives them the right to transfer to a less dusty area of the mine.  Unfortunately, there are no dust free areas in any coal mine.

How are we doing ÷ I mean, is the incidence of Black Lung increasing, or is it going down with improved working conditions?  

If we strictly look at the number of miners diagnosed, there is a decline.  But the decline reflects the fact the mines are more and more automated using less human workers in the process. If we look carefully at the data, the percentage of workers diagnosed is about the same.  

Many of your clients live in out of the way places, requiring a long drive to medical care. Are there pulmonary rehabilitation centers available, or pulmonary support group meetings that people can get to?  

Every program and every state is different. There are pulmonary rehabilitation programs/centers on-site at some of the clinics.  Others refer to local hospitals' programs.  We are not able to provide this service in every rural area.  This is one goal we are working toward as we all recognize the importance of rehabilitation and support.

What safeguards are in place today to prevent miners from getting Black Lung Disease, or at least improve conditions for the health of their lungs?

The 1969 Mine Safety and Health Act provides the basis for regulations in effect today.  There are guidelines in place and dust sampling is required.  In 1991 numerous coal operations were cited and fined for tampering with dust samples.  The quality of the sampling is still questionable.

Is Black Lung considered to be an Obstructive Lung Disease (Emphysema, Chronic Bronchitis ¸some consider asthmatic bronchitis in here too), or a Restrictive Lung Disease, which includes the fibrosis and silicosis-type of disorders? From what I read it sometimes seems to fall into both. What's your take on this?

According to a NIOSH (National Institute for Occupational Safety and Health), it is either.  In some miners, it is restrictive.  In others, it is obstructive.  The information was published and could be obtained by contacting NIOSH directly.

What is the most important thing for a coal miner to do to keep his/or her lungs healthy?

In my opinion, to prevent the disease, a miner should use a respirator and not smoke cigarettes.


Link to PDF listing of clinics



Here are just a few of the many internet resources on Black Lung Disease. For more, go to and type in ŃBlack Lung Diseaseń in quotes.

Black Lung Overview

Information on Black Lung Compensation.

Mine Safety and Health Administration

Black Lung background

Basic information on Black Lung Disease from the BBC

Weatherization assistance in Pennsylvania for those with Black Lung NEW!!


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