Molecular Activation of NLRP3 Inflammasome by Particles and Crystals: A Continuing Challenge of Immunology and Toxicology

Particles and crystals constitute a unique class of toxic agents that humans are constantly exposed to both endogenously and from the environment. Deposition of particulates in the body is associated with a range of diseases and toxicity. The mechanism by which particulates cause disease remains poorly understood due to the lack of mechanistic insights into particle-biological interactions. Recent research has revealed that many particles and crystals activate the NLRP3 inflammasome, an intracellular pattern-recognition receptor. Activated NLRP3 forms a supramolecular complex with an adaptor protein to activate caspase 1, which in turn activates IL-1β and IL-18 to instigate inflammation. Genetic ablation and pharmacological inhibition of the NLRP3 inflammasome dampen inflammatory responses to particulates. Nonetheless, how particulates activate NLRP3 remains a challenging question. From this perspective, we discuss our current understanding of and progress on revealing the function and mode of action of the NLRP3 inflammasome in mediating adaptive and pathologic responses to particulates in health and disease.

Impact of Epidemic Intelligence Service Training in Occupational Respiratory Epidemiology

The Centers for Disease Control and Prevention's Epidemic Intelligence Service (EIS) is a fellowship in applied epidemiology for physicians, veterinarians, nurses, scientists, and other health professionals. Each EIS fellow is assigned to a position at a federal, state, or local site for 2 years of on-the-job training in outbreak investigation, epidemiologic research, surveillance system evaluation, and scientific communication. Although the original focus of the program on the control of infectious diseases remains salient, positions are available for training in other areas of public health, including occupational respiratory disease. In this Perspective, we describe the EIS program, highlight three positions (one federal and two state-based) that provide training in occupational respiratory epidemiology, and summarize trainees' experiences in these positions over a 30-year period. For early-career health professionals interested in understanding and preventing occupational respiratory hazards and diseases, EIS offers a unique career development opportunity.

Increased odds of mortality from non-malignant respiratory disease and lung cancer are highest among US coal miners born after 1939

OBJECTIVES

Coal miners suffer increased mortality from non-malignant respiratory diseases (NMRD), including pneumoconioses and chronic obstructive pulmonary disease, compared with the US population. We characterised mortality trends from NMRD, lung cancer and ischaemic heart disease (IHD) using data from the Federal Black Lung Program, National Coal Workers' Health Surveillance Program and the National Death Index.

METHODS

We compared mortality ORs (MORs) for NMRD, lung cancer and IHD in former US coal miners to US white males. MORs were computed for the study period 1979-2017 by birth cohort (<1920, 1920-1929, 1930-1939, ≥1940), with a subanalysis restricted to Central Appalachia.

RESULTS

The study population totalled 235 550 deceased miners, aged >45 years. Odds of death from NMRD and lung cancer across all miner birth cohorts averaged twice those of US males. In Central Appalachia, MORs significantly increased across birth cohorts. There was an eightfold increase in odds of death from NMRD among miners born after 1940 (MORBC≥1940 8.25; 95% CI 7.67 to 8.87). Miners with progressive massive fibrosis (PMF) were younger at death than those without PMF (74 vs 78 years; p<0.0001). We observed a pattern of reduced MORs from IHD in coal miners compared with national and regional counterparts.

CONCLUSION

US coal miners have excess mortality from NMRD and lung cancer compared with total US and Appalachian populations. Mortality is highest in the most recent birth cohorts, perhaps reflecting increased rates of severe pneumoconiosis.

Calibration of low-cost particulate matter sensors for coal dust monitoring

Mining-induced coal dust causes various respiratory diseases to mine workers mainly coal workers' pneumoconiosis (CWP). Currently available underground monitors are expensive and bulky. These disadvantages limit them for regulatory sample monitoring purposes. Moreover, personal exposure levels for most miners remain unknown, risking them to potential overexposures. Low-cost light scattering particulate matter (PM) sensors offer a potential solution to this problem with the capability to characterize PM concentration with high spatio-temporal resolution. However, these sensors require precise calibration before they can be deployed in mining environments. No previous study has promulgated a standard protocol to assess these sensors for coal dust monitoring. The goal of this study was to calibrate Plantower PMS5003 sensors for coal dust monitoring using linear regression models. Two other commercially available PM sensors, the Airtrek and Gaslab CM-505 multi-gas sensors, were also evaluated and calibrated. They were evaluated for factors including linearity, precision, limit of detection, upper concentration limits, and the influence of temperature and relative humidity in a laboratory wind tunnel. The PMS5003 sensors were observed to be accurate below 3.0 mg/m³ concentration levels with R-squared values of 0.70 to 0.90 which was the best among the sensors under with an acceptable precision below 1.5 mg/m³. Moreover, this study shows that temperature and relative humidity have minimal influence on the efficacy of low-cost PM sensors' ability to monitor coal dust. This investigation reveals the feasibility of low-cost sensors for real-time personal coal dust monitoring in underground coal mines if a robust calibration model is applied.

Postexposure progression of pneumoconiosis among former Appalachian coal miners

BACKGROUND

The prevalence of pneumoconiosis among working United States underground coal miners has been increasing for the past two decades, with the highest rates of disease observed among miners in the central Appalachian states of Kentucky, Virginia, and West Virginia. Surveillance for this disease in the United States focuses on working coal miners, who continue to be occupationally exposed to dust. This study examines the radiographic evidence for postexposure progression of pneumoconiosis in a population of former coal miners no longer occupationally exposed to coal mine dust who were seen at a community radiology clinic in eastern Kentucky.

METHODS

Data were obtained and analyzed from clinical records of former coal miners who had a clinic encounter during January 1, 2017-August 1, 2019, a recorded final year of employment, and ≥2 postemployment digital chest radiographs. Radiographs were classified according to the International Labour Office guidelines by at least two B Readers. A final summary pneumoconiosis severity score (range, 0-13), accounting for both small and large opacities, was assigned to each chest radiograph. Progression was defined as an increase in severity score between a miner's radiographs over time.

RESULTS

Data for 130 former coal miners were analyzed. All miners were male and most (n = 114, 88%) had worked primarily in Kentucky. Information on race/ethnicity was not available. The most common job types were roof bolters (n = 51, 39%) and continuous miner operators (n = 46, 35%). Forty-one (31.5%) miners had evidence of radiographic disease progression after leaving the workforce, with a median of 3.6 years between first and latest postretirement radiograph. A total of 80 (62%) miners had evidence of pneumoconiosis on their latest radiograph, and two-thirds (n = 53) of these were classified as progressive massive fibrosis (PMF), the most severe form of the disease.

CONCLUSIONS

Postexposure progression can occur in former coal miners, emphasizing the potential benefits of continued radiographic follow-up postemployment. In addition to participating in disease screening throughout their careers to detect pneumoconiosis early and facilitate intervention, radiographic follow-up of former coal miners can identify new or progressive radiographic findings even after workplace exposure to respirable coal mine dust ends. Identification of progressive pneumoconiosis in former miners has potential implications for clinical management and eligibility for disability compensation.

Progressive massive fibrosis: An overview of the recent literature

This review provides an overview of literature addressing progressive massive fibrosis (PMF) from September 2009 to the present. Advances are described in understanding its pathophysiology, epidemiology of the occurrence of PMF and related conditions, the impact of PMF on pulmonary function, advances in imaging of PMF, and factors affecting progression of pneumoconiosis in dust-exposed workers to PMF. Basic advances in understanding the etiology of PMF are impeded by the lack of a well-accepted animal model for human PMF. Recent studies evaluating lung tissue samples and epidemiologic investigations support an important role for the silica component of coal mine dust in causing coal workers' pneumoconiosis and PMF in contemporary coal miners in the United States and for silica in causing silicosis and PMF in artificial stone workers throughout the world. Development of PMF is associated with substantial decline in pulmonary function relative to no disease or small opacity pneumoconiosis. In recent reports, computed tomography has had greater sensitivity for detecting PMF than chest x-ray. Magnetic resonance imaging shows promise in differentiating between PMF and lung cancer. Although PMF develops in dust-exposed workers without previously identified small opacity pneumoconiosis, the presence of small opacity pneumoconiosis increases the risk for progression to PMF, as does heavier dust exposure. Recent literature does not document any effective new treatments for PMF and new therapies to prevent and treat PMF are an important need.

Thermogravimetric analysis of respirable coal mine dust for simple source apportionment

Resurgence of coal mine dust lung diseases in the central Appalachian region of the United States and elsewhere has spurred a range of efforts to better understand respirable coal mine dust (RCMD) exposures and sources. Thermogravimetric analysis (TGA) of RCMD samples can enable the dust mass to be fractionated into three main components: coal, non-carbonate minerals, and carbonates. These are expected to approximate, respectively, the three primary dust sources in many underground mines: the coal seam being mined, the surrounding rock strata (i.e., typically dominated by non-carbonate minerals) being drilled or mined along with the coal, and the rock dust products (i.e., typically made from carbonate-rich limestone or dolostone) being applied in the mine to mitigate explosibility hazards. As proof of concept, TGA was applied to respirable dust samples that were laboratory-generated from real source materials representing 15 mines. Except in the case of two mines, compositional results were generally consistent with expectations. TGA was also applied to RCMD samples collected in standard locations of 23 mines (including the 15 mines represented by the dust source materials). Results showed significantly different compositions with respect to sampling location and geographic region (i.e., within and outside of central Appalachia). To further interpret the RCMD results, a simple source apportionment model was built using the dust compositions yielded from the source materials analysis. Model results indicated that, on average, about twice as much dust was sourced from mining into rock strata than from mining the target coal seam. This finding is particularly important for mines extracting relatively large amounts of rock along with the coal or for mines that frequently encounter high-silica rock strata.

Characterization of Respirable Dust Generated from Full Scale Cutting Tests in Limestone with Conical Picks at Three Stages of Wear

Respirable rock dust poses serious long-term health complications to workers in environments where mechanical rock excavation is utilized. The purpose of this study is to characterize respirable dust generated by cutting limestone with new, partially worn, and fully worn conical pick wears. Characterizing limestone respirable dust can aid in decision making for respirable dust suppression levels and exposures throughout the lifetime of a pick in underground mining and engineering activities. The methods include full scale cutting of a limestone sample in the laboratory with three conical picks at different stages of wear. Dust samples were collected during cutting with various instruments connected to pumps and subsequently analyzed to determine the concentrations, mineralogy, particle shapes, and particle size distributions. The results show that the worn pick generated the highest concentration of dust, all picks generated dust containing quartz, all three picks generated dust particles of similar shapes, and all three picks generated various particle size distributions. In conclusion, a preliminary suite of respirable dust characteristics is available and with further future additional studies, results could be used for the evaluation of possible strategies and methods of dust suppression and exposures during mining, tunneling, or drilling activities.

Characterization Analysis of Airborne Particulates from Australian Underground Coal Mines Using the Mineral Liberation Analyser

Exposure monitoring and health surveillance of coal mine workers has been improved in Australia since coal workers’ pneumoconiosis was reidentified in 2015 in Queensland. Regional variations in the prevalence of mine dust lung disease have been observed, prompting a more detailed look into the size, shape, and mineralogical classes of the dust that workers are being exposed to. This study collected respirable samples of ambient air from three operating coal mines in Queensland and New South Wales for characterization analysis using the Mineral Liberation Analyser (MLA), a type of scanning electron microscope (SEM) that uses a combination of the backscattered electron (BSE) image and characteristic X-rays for mineral identification. This research identified 25 different minerals present in the coal samples with varying particle size distributions for the overall samples and the individual mineralogies. While Mine 8 was very consistent in mineralogy with a high carbon content, Mine 6 and 7 were found to differ more significantly by location within the mine.

Estimating mortality from coal workers' pneumoconiosis among Medicare beneficiaries with pneumoconiosis using binary regressions for spatially sparse data

Background

Coal workers' pneumoconiosis (CWP) is an occupational lung disease due to inhalation of coal dust. We estimated mortality from CWP and other pneumoconioses among Medicare beneficiaries.

Methods

We used the 5% Medicare Limited Claims Data Set, 2011–2014, to identify patients diagnosed with ICD‐9‐CM 500 (CWP) through 505 (Asbestosis, Pneumoconiosis due to other silica or silicates, Pneumoconiosis due to other inorganic dust, Pneumonopathy due to inhalation of other dust, and Pneumoconiosis, unspecified) codes. We applied binary regression models with spatial random effects to determine the association between CWP and mortality. Our inferences are based on Bayesian spatial hierarchical models, and model fitting was performed using Integrated Nested Laplace Approximation (INLA) algorithm in R/RStudio software.

Results

The median age of the sample was 76 years. In a sample of 8531 Medicare beneficiaries, 2568 died. Medicare beneficiaries with CWP had 25% higher odds of death (adjusted OR: 1.25, 95% CI: 1.07, 1.46) than those with other types of pneumoconiosis. The number of comorbid conditions elevated the odds of death by 10% (adjusted OR: 1.10, 95% CI: 1.09, 1.10).

Conclusion

CWP increases the likelihood of death among Medicare beneficiaries. Healthcare professionals should make concerted efforts to monitor patients with CWP to prevent premature mortality.

Pathology and Mineralogy Demonstrate Respirable Crystalline Silica is a Major Cause of Severe Pneumoconiosis in US Coal Miners

Rationale

The reasons for resurgent coal workers’ pneumoconiosis and its most severe forms, rapidly progressive pneumoconiosis and progressive massive fibrosis (PMF), in the United States are not yet fully understood.

Objectives

To compare the pathologic and mineralogic features of contemporary coal miners with severe pneumoconiosis with those of their historical counterparts.

Methods

Lung pathology specimens from 85 coal miners with PMF were included for evaluation and analysis. We compared the proportion of cases with pathologic and mineralogic findings in miners born between 1910 and 1930 (historical) with those in miners born in or after 1930 (contemporary).

Results

We found a significantly higher proportion of silica-type PMF (57% vs. 18%; P < 0.001) among contemporary miners compared with their historical counterparts. Mineral dust alveolar proteinosis was also more common in contemporary miners compared with their historical counterparts (70% vs. 37%; P < 0.01). In situ mineralogic analysis showed that the percentage (26.1% vs. 17.8%; P < 0.01) and concentration (47.3 × 10⁸ vs. 25.8 × 10⁸ particles/cm³; P = 0.036) of silica particles were significantly greater in specimens from contemporary miners compared with their historical counterparts. The concentration of silica particles was significantly greater when silica-type PMF, mineral dust alveolar proteinosis, silicotic nodules, or immature silicotic nodules were present (P < 0.05).

Conclusions

Exposure to respirable crystalline silica appears causal in the unexpected surge of severe disease in contemporary miners. Our findings underscore the importance of controlling workplace silica exposure to prevent the disabling and untreatable adverse health effects afflicting U.S. coal miners.

Cost-effectiveness of comprehensive preventive measures for coal workers' pneumoconiosis in China

Background

Coal workers’ pneumoconiosis (CWP) remains one of the most severe occupational diseases in China. Despite the implementation of CWP comprehensive preventive measures, the unreasonable allocation of investment by coal enterprises limits the effect of preventing CWP, especially when the health resources are inadequate. This study aims to evaluate the cost-effectiveness of comprehensive measures for CWP from the perspective of coal enterprises.

Methods

Comprehensive measures and two primary interventions (engineering controls and individual protective equipment) were selected. A time-dependent Markov model was developed to evaluate cost and quality-adjusted life-years (QALYs). The input data were collected from the survey and literature. A hypothetical null situation, in which the currently implemented interventions were eliminated, was used as a comparator based on the generalised cost-effectiveness analysis (GCEA) recommended by the World Health Organization (WHO). The primary outcomes of the model were reported in terms of incremental cost-effectiveness ratios (ICERs). Uncertainty was verified using one-way and probabilistic sensitivity analyses.

Results

The QALYs of the comprehensive measures, engineering controls, and individual protective equipment were 17.60, 17.50, and 16.85 years, respectively. Compared with null, the ICERs of the interventions were 65,044.73, 30,865.15, and 86,952.41 RMB/QALY, respectively. Individual protective equipment was dominated by an ICER of -11,416.02 RMB/QALY compared to engineering controls. Sensitivity analysis suggested the robustness of the results.

Conclusions

The comprehensive preventive measures for CWP that are currently implemented in Chinese state-owned mines are cost-effective. In comprehensive measures, engineering controls are more cost-effective than individual protective equipment. Investment in engineering controls should be increased to improve the cost-effectiveness of preventing CWP.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-07654-7.

High-fat western diet-consumption alters crystalline silica-induced serum adipokines, inflammatory cytokines and arterial blood flow in the F344 rat

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Silica reduced serum leptin and adiponectin, no effects on body or fat pad weight.

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HFWD-consumption altered pro-inflammatory cytokines in silica-exposed animals.

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Silica altered pulse frequency; HFWD increased mean blood flow; effects additive.

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HFWD affected silica-induced metabolic effects.

Adipose tissue (AT) plays a central role in the maintenance of whole-body energy homeostasis through release of adipokines. High-fat Western diet (HFWD)-consumption contributes to obesity, disruption of adipocyte metabolism, chronic systemic inflammation, and metabolic dysfunction (MetDys). MetDys is associated with impaired lung function, pulmonary hypertension, and asthma. Thirty-five percent of adults in the U.S. have MetDys, yet the impact of MetDys on susceptibility to occupational hazards is unknown. The aim of this study was to determine the potential of HFWD-consumption to alter inhaled crystalline silica dust-induced metabolic responses. Six-wk old male F344 rats were fed a HFWD (45 kcal % fat, sucrose 22.2 % by weight) or standard rat chow (STD, controls), and exposed to silica-inhalation (6 h/d, 5 d/wk, 39 d; Min-U-Sil 5®, 15 mg/m³) or filtered air. Indices of MetDys and systemic inflammation were measured at 0, 4, and 8 wk following cessation of silica exposure. At 8 wk post-exposure, silica reduced serum leptin and adiponectin levels, and increased arterial pulse frequency. HFWD-consumption induced weight gain, altered adipokines, liver, kidney, and pancreatic function, and increased tail artery blood flow. At 8 wk in HFWD + SIL-treated animals, the levels of serum pro-inflammatory cytokines (IFN-γ, CXCL-1, TNF-α, IL-1β, IL-4, IL-5, IL-6, IL-10 and IL-13) were increased compared to STD + SIL but were less than HFWD + AIR-induced levels. In conclusion, consumption of a HFWD altered silica-induced metabolic responses and silica exposure disrupted AT endocrine function. These findings demonstrate previously unknown interactions between HFWD-consumption and occupational silica exposure.

High-fat Western diet consumption exacerbates silica-induced pulmonary inflammation and fibrosis

Consumption of a high-fat Western diet (HFWD) contributes to obesity, disrupted adipose endocrine function, and development of metabolic dysfunction (MetDys). Impaired lung function, pulmonary hypertension, and asthma are all associated with MetDys. Over 35% of adults in the U.S. have MetDys, yet interactions between MetDys and hazardous occupational inhalation exposures are largely unknown. Occupational silica-inhalation leads to chronic lung inflammation, progressive fibrosis, and significant respiratory morbidity and mortality. In this study, we aim to determine the potential of HFWD-consumption to alter silica-induced inflammatory responses in the lung. Six-wk old male F344 rats fed a high fat Western diet (HFWD; 45 kcal % fat, sucrose 22.2% by weight) to induce MetDys, or standard rat chow (STD, controls) for 16 wk were subsequently exposed to silica (6 h/d, 5 d/wk, 39 d; Min-U-Sil 5®, 15 mg/m³) or filtered air; animals remained on their assigned diet for the study duration. Indices of lung inflammation and histopathologic assessment of lung tissue were quantified at 0, 4, and 8 wk after cessation of exposure. Combined HFWD+silica exposure increased bronchoalveolar lavage (BAL) total cells, leukocytes, and BAL lactate dehydrogenase compared to STD+silica exposure controls at all timepoints. HFWD+silica exposure increased BAL proinflammatory cytokines at 4 and 8 wk compared to STD+silica exposure. At 8 wk, histopathological analysis confirmed that alveolitis, epithelial cell hypertrophy and hyperplasia, lipoproteinosis, fibrosis, bronchoalveolar lymphoid hyperplasia and granulomas were exacerbated in the HFWD+silica-exposed group compared to STD+silica-exposed controls. Our results suggest an increased susceptibility to silica-induced lung disease caused by HFWD consumption.

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HFWD exacerbates silica (SIL)-induced lung injury at 8 wk post-exposure.

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HFWD+SIL increases BAL cells and LDH compared to STD+SIL.

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HFWD+SIL increases BAL proinflammatory cytokines compared to STD+SIL.

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Histopathology confirms exacerbated lung injury HFWD+silica treatment.

Characterization of Particulates from Australian Underground Coal Mines

The re-identification of coal workers’ pneumoconiosis in Queensland in 2015 has prompted improvements in exposure monitoring and health surveillance in Australia. The potential consequences of excessive exposure to respirable dust may depend upon the size, shape and mineralogical classes of the dust. Technology has now advanced to the point that the dust characteristics can be explored in detail. This research collected respirable dust samples from four operating underground coal mines in Australia for characterization analysis using scanning electron microscopy (SEM) with energy dispersive X-ray (EDX). The research found multiple mineralogical classes present with their own particle size distributions. The variation between mines appears to have had a larger effect on particle size distribution than the differences in mining processes within individual mines. This may be due to variations in the geologic conditions, seam variation or mining conditions.

Review of Respirable Coal Mine Dust Characterization for Mass Concentration, Size Distribution and Chemical Composition

Respirable coal mine dust (RCMD) exposure is associated with black lung and silicosis diseases in underground miners. Although only RCMD mass and silica concentrations are regulated, it is possible that particle size, surface area, and other chemical constituents also contribute to its adverse health effects. This review summarizes measurement technologies for RCMD mass concentrations, morphology, size distributions, and chemical compositions, with examples from published efforts where these methods have been applied. Some state-of-the-art technologies presented in this paper have not been certified as intrinsically safe, and caution should be exerted for their use in explosive environments. RCMD mass concentrations are most often obtained by filter sampling followed by gravimetric analysis, but recent requirements for real-time monitoring by continuous personal dust monitors (CPDM) enable quicker exposure risk assessments. Emerging low-cost photometers provide an opportunity for a wider deployment of real-time exposure assessment. Particle size distributions can be determined by microscopy, cascade impactors, aerodynamic spectrometers, optical particle counters, and electrical mobility analyzers, each with unique advantages and limitations. Different filter media are required to collect integrated samples over working shifts for comprehensive chemical analysis. Teflon membrane filters are used for mass by gravimetry, elements by energy dispersive X-ray fluorescence, rare-earth elements by inductively coupled plasma-mass spectrometry and mineralogy by X-ray diffraction. Quartz fiber filters are analyzed for organic, elemental, and brown carbon by thermal/optical methods and non-polar organics by thermal desorption-gas chromatography-mass spectrometry. Polycarbonate-membrane filters are analyzed for morphology and elements by scanning electron microscopy (SEM) with energy dispersive X-ray, and quartz content by Fourier-transform infrared spectroscopy and Raman spectroscopy.

Evaluation of Sub-micrometer-Sized Particles Generated from a Diesel Locomotive and Jackleg Drilling in an Underground Metal Mine

Concerns have been raised regarding small respirable particles, i.e. sub-micrometer-sized particles, associated with mining activities. This evaluation was designed to investigate the emissions from jackleg drilling and diesel engines and to characterize the nature of emitted particles using gravimetric analysis and number metrics. The mass concentration to which workers are potentially exposed was determined from a 4-h sampling in the vicinity of drilling activities in an underground metal mine; this concentration was found to be lower than 0.6 mg m-3 of total respirable dust. This mass concentration is low; however, the number concentrations of emitted particles from drilling exceeded 1 × 106 particles cm-3 in areas 7-9 m downwind from the drilling operation. Sub-micrometer-sized particles were also observed in aerosol samples collected using a specialized sampler, and various elements associated with drilling were found among these emitted particles. Finally, the particles in the diesel exhaust were collected, and the exhaust was found to contain nanometer-sized particles.

Assessment of pneumoconiosis in surface coal miners after implementation of a national radiographic surveillance program, United States, 2014-2019

BACKGROUND

Pneumoconiosis can occur in surface coal miners. The Coal Workers' Health Surveillance Program (CWHSP) has only included surface coal miners as part of its regular disease surveillance since 2014. This analysis identifies the prevalence of pneumoconiosis among working surface coal miners participating in the CWHSP since their initial inclusion, through 2019.

METHODS

Working surface coal miners who had chest radiographs through the CWHSP from January 1, 2014 through December 31, 2019 were included in this analysis. Demographic information, mining tenure and occupation, and radiographic classifications according to the International Labour Office system were included from each miner's most recent encounter with the CWHSP. Prevalence ratios were calculated comparing the prevalence of the disease by region and occupation by log-binomial regression.

RESULTS

Pneumoconiosis was present in 109 (1.6%) surface coal miners, including 12 miners with progressive massive fibrosis, the most severe form of the disease. After taking surface mining tenure into account, surface miners in Central Appalachia (prevalence ratio [PR], 3.2; 95% confidence interval [CI], 2.2-4.7) and surface miners who worked as a driller or blaster (PR, 2.1; 95% CI, 1.3-3.5) were at increased risk of pneumoconiosis.

CONCLUSION

The occurrence of pneumoconiosis in surface coal miners supports including them within a systematic respiratory health surveillance program. The current surveillance findings are consistent with past findings of pneumoconiosis, particularly silicosis, in surface mining occupations such as drilling and blasting.

Associations of VDR gene polymorphisms with risk of coal workers' pneumoconiosis in Chinese Han population

Some studies showed that the polymorphisms of vitamin D receptor (VDR) gene were associated with pulmonary diseases. However, the relationship between the VDR variations and susceptibility to coal worker's pneumoconiosis (CWP) remains unclear. The study aimed to determine the associations between VDR polymorphisms and susceptibility to CWP in Chinese Han population. The study involved 340 CWP patients and 312 healthy controls. The VDR polymorphisms were determined by DNA sequencing, and serum 25(OH)2D levels were detected by Ultra High-Performance Liquid Chromatography-Tandem Mass Spectrometry. The results showed that the VDR gene ApaI T allele increased the risk of CWP (OR = 1.486, 95% CI = 1.125-1.963, P = 0.006) and ApaI GT genotype as well as TT genotype increased the risk of CWP (GT vs. GG, OR = 1.461, 95% CI = 1.048-2.038, P = 0.025; TT vs. GG, OR = 2.673, 95% CI = 1.017-7.025, P = 0.039). Five haplotypes were identified and we found that the TGGT haplotype was associated with a lower risk of CWP (OR = 0.755, 95% CI = 0.603-0.946, P = 0.014). Meanwhile, multifactor dimensionality reduction analysis showed that the interaction between ApaI and exposure was the strongest, followed by TaqI and then BsmI. The study also found that the serum 25(OH)2D mean levels of the case group were significantly lower than that of the control group, and the serum 25(OH)2D mean levels of ApaI homozygous mutant and heterozygous mutant subjects were lower than that of the wild homozygosity, respectively (P < 0.001). The results suggested that ApaI T allele and GT or TT genotype and lower 25(OH)2D levels were increased the risk of CWP in Chinese Han population.

Transplantation for work-related lung disease in the USA

OBJECTIVES

Work-related lung diseases (WRLDs) are entirely preventable. To assess the impact of WRLDs on the US transplant system, we identified adult lung transplant recipients with a WRLD diagnosis specified at the time of transplant to describe demographic, payer and clinical characteristics of these patients and to assess post-transplant survival.

METHODS

Using US registry data from 1991 to 2018, we identified lung transplant recipients with WRLDs including coal workers' pneumoconiosis, silicosis, asbestosis, metal pneumoconiosis and berylliosis.

RESULTS

The frequency of WRLD-associated transplants has increased over time. Among 230 lung transplants for WRLD, a majority were performed since 2009; 79 were for coal workers' pneumoconiosis and 78 were for silicosis. Patients with coal workers' pneumoconiosis were predominantly from West Virginia (n=31), Kentucky (n=23) or Virginia (n=10). States with the highest number of patients with silicosis transplant were Pennsylvania (n=12) and West Virginia (n=8). Patients with metal pneumoconiosis and asbestosis had the lowest and highest mean age at transplant (48.8 and 62.1 years). Median post-transplant survival was 8.2 years for patients with asbestosis, 6.6 years for coal workers' pneumoconiosis and 7.8 years for silicosis. Risk of death among patients with silicosis, coal workers' pneumoconiosis and asbestosis did not differ when compared with patients with idiopathic pulmonary fibrosis.

CONCLUSIONS

Lung transplants for WRLDs are increasingly common, indicating a need for primary prevention and surveillance in high-risk occupations. Collection of patient occupational history by the registry could enhance case identification and inform prevention strategies.

Occupational lung diseases in the 21st century: the changing landscape and future challenges

PURPOSE OF REVIEW

Occupational exposures remain an underrecognized and preventable cause of lung disease in high-income countries. The present review highlights the emergence of cleaning-related respiratory disease and the re-emergence of silicosis as examples of trends in occupational lung diseases in the 21st century.

RECENT FINDINGS

Employment trends, such as the shift from large-scale manufacturing to a service economy, the growth of the healthcare sector, and changing consumer products have changed the spectrum of work-related lung diseases. Following decades of progress in reducing traditional hazards such as silica in U.S. workplaces, cases of advanced silicosis have recently re-emerged with the production of engineered stone countertops. With growth in the healthcare and service sectors in the United States, cleaning products have become an important cause of work-related asthma and have recently been associated with an increased risk of chronic obstructive pulmonary disease (COPD) in women. However, these occupational lung diseases largely go unrecognized by practicing clinicians.

SUMMARY

The present article highlights how changes in the economy and work structure can lead to new patterns of inhalational workplace hazards and respiratory disease, including cleaning-related respiratory disease and silicosis. Pulmonary clinicians need to be able to recognize and diagnose these occupational lung diseases, which requires a high index of suspicion and a careful occupational history.

Coal mining and lung disease in the 21st century

PURPOSE OF REVIEW

To review the impact of coal mining and resurgence of coal workers' pneumoconiosis (CWP) in 21st century and effect of ambient air pollution on lung function.

RECENT FINDINGS

At the beginning of 21st century, statistics by National Institute for Occupational Safety and Health showed a steep rise in pneumoconiosis. This was followed by numerous epidemiologic and pathologic studies that confirmed increasing CWP prevalence as well as disease in younger miners and those with a shorter mining tenure. Recent studies have demonstrated that poor dust control in mines, a relative shift in composition of the coal mine dust, small sized mines and increase in surface mining are all possible contributors to this resurgence. There is also growing literature evaluating the effects of worsening air pollution on health, including decreasing lung function and development of emphysema, worsening quality of life measures and lung cancer.

SUMMARY

This irreversible but preventable disease currently haunts approximately 60 000 miners across United States and millions across the world. Its resurgence despite the strict dust regulations is a setback from the public health standpoint. The continued reliance on coal for energy will continue to place coal miners at danger of developing disease as well as the world.

Progression of coal workers' pneumoconiosis absent further exposure

OBJECTIVES

The natural history of coal workers' pneumoconiosis (CWP) after cessation of exposure remains poorly understood.

METHODS

We characterised the development of and progression to radiographic progressive massive fibrosis (PMF) among former US coal miners who applied for US federal benefits at least two times between 1 January 2000 and 31 December 2013. International Labour Office classifications of chest radiographs (CXRs) were used to determine initial and subsequent disease severity. Multivariable logistic regression models were used to identify major predictors of disease progression.

RESULTS

A total of 3351 former miners applying for benefits without evidence of PMF at the time of their initial evaluation had subsequent CXRs. On average, these miners were 59.7 years of age and had 22 years of coal mine employment. At the time of their first CXR, 46.7% of miners had evidence of simple CWP. At the time of their last CXR, 111 miners (3.3%) had radiographic evidence of PMF. Nearly half of all miners who progressed to PMF did so in 5 years or less. Main predictors of progression included younger age and severity of simple CWP at the time of initial CXR.

CONCLUSIONS

This study provides further evidence that radiographic CWP may develop and/or progress absent further exposure, even among miners with no evidence of radiographic pneumoconiosis after leaving the industry. Former miners should undergo regular medical surveillance because of the risk for disease progression.

Polarization of Immune Cells in the Pathologic Response to Inhaled Particulates

Polarization of immune cells is commonly observed in host responses associated with microbial immunity, inflammation, tumorigenesis, and tissue repair and fibrosis. In this process, immune cells adopt distinct programs and perform specialized functions in response to specific signals. Accumulating evidence indicates that inhalation of micro- and nano-sized particulates activates barrier immune programs in the lung in a time- and context-dependent manner, including type 1 and type 2 inflammation, and T helper (Th) 17 cell, regulatory T cell (Treg), innate lymphoid cell (ILC), and myeloid-derived suppressor cell (MDSC) responses, which highlight the polarization of several major immune cell types. These responses facilitate the pulmonary clearance and repair under physiological conditions. When exposure persists and overwhelms the clearance capacity, they foster the chronic progression of inflammation and development of progressive disease conditions, such as fibrosis and cancer. The pulmonary response to insoluble particulates thus represents a distinctive disease process wherein non-infectious, persistent exposures stimulate the polarization of immune cells to orchestrate dynamic inflammatory and immune reactions, leading to pulmonary and pleural chronic inflammation, fibrosis, and malignancy. Despite large variations in particles and their associated disease outcomes, the early response to inhaled particles often follows a common path. The initial reactions entail a barrier immune response dominated by type 1 inflammation that features active phagocytosis by M1 macrophages and recruitment of neutrophils, both of which are fueled by Th1 and proinflammatory cytokines. Acute inflammation is immediately followed by resolution and tissue repair mediated through specialized pro-resolving mediators (SPMs) and type 2 cytokines and cells including M2 macrophages and Th2 lymphocytes. As many particles and fibers cannot be digested by phagocytes, resolution is often extended and incomplete, and type 2 inflammation becomes heightened, which promotes interstitial fibrosis, granuloma formation, and tumorigenesis. Recent studies also reveal the involvement of Th17-, Treg-, ILC-, and MDSC-mediated responses in the pathogenesis caused by inhaled particulates. This review synopsizes the progress in understanding the interplay between inhaled particles and the pulmonary immune functions in disease pathogenesis, with focus on particle-induced polarization of immune cells and its role in the development of chronic inflammation, fibrosis, and cancer in the lung.

Estimating the prevalence and spatial clusters of coal workers' pneumoconiosis cases using medicare claims data, 2011-2014

BACKGROUND

Workers employed in the coal mining sector are at increased risk of respiratory diseases, including coal workers' pneumoconiosis (CWP). We investigated the prevalence of CWP and its association with sociodemographic factors among Medicare beneficiaries.

METHODS

We used 5% Medicare Limited Data Set claims data from 2011 to 2014 to select Medicare beneficiaries with a diagnosis of ICD-9-CM 500 (CWP). We aggregated the data by county and limited our analysis to seven contiguous states: Illinois, Indiana, Kentucky, Ohio, Pennsylvania, Virginia, and West Virginia. We estimated county-level prevalence rates using total Medicare beneficiaries and miners as denominators and performed spatial hotspot analysis. We used negative binomial regression analysis to determine the association of county-wise sociodemographic factors with CWP.

RESULTS

There was significant spatial clustering of CWP cases in Kentucky, Virginia, and West Virginia. Spatial clusters of 210 and 605 CWP cases representing an estimated 4200 to 12 100 cases of Medicare beneficiaries with CWP were identified in the three states. Counties with higher poverty levels had a significantly elevated rate of CWP (adjusted rate ratios [RR]: 1.15; 95% CI, 1.12-1.18). There was a small but significant association of CWP with the county-wise catchment area. Rurality was associated with a more than three-fold elevated rate of CWP in the unadjusted analysis (RR: 3.28, 95% CI, 2.22-4.84). However, the rate declined to 1.45 (95% CI, 1.04-2.01) after adjusting for other factors in the analysis.

CONCLUSIONS

We found evidence of significant spatial clustering of CWP among Medicare beneficiaries living in the seven states of the USA.

Associations of HMGB1 gene polymorphisms with risk of coal workers' pneumoconiosis susceptibility in Chinese Han population

Background: High-mobility group box 1 (HMGB1) protein plays an important pathogenic role in various diseases such as pulmonary fibrosis. However, the relationship between variation of HMGB1 gene and susceptibility to coal worker's pneumoconiosis (CWP) remains unclear. The objective of the study was to determine the association between HMGB1 polymorphisms and CWP in Chinese Han population.Methods: The genotypes of HMGB1 gene rs1045411, rs2249825, rs1412125 and rs1360485 in 340 CWP patients and 312 healthy controls were determined and serum HMGB1 levels were detected.Results: Our finding showed that the HMGB1 rs1360485 G allele increased the risk of CWP in comparison with A allele (P = 0.005). HMGB1 rs1360485 GG genotype as well as AG+GG genotype increased the risk of CWP in comparison with AA genotype (P = 0.010, P = 0.025, respectively). Four haplotypes were identified and we found that the GCTA haplotype was associated with resistance to CWP (P = 0.005), while GCTG haplotype was associated with risk to CWP (P<0.001). Meanwhile, multifactor dimensionality reduction (MDR) analysis showed that the interaction between rs1360485 and exposure had the strongest, followed by rs2249825 and rs1412125. This study also found that the serum HMGB1 levels of the case group were significantly higher than that of the control group, and the serum HMGB1 levels of homozygous subjects with rs1360485 mutant were higher than that of the heterozygous wild type, respectively (P<0.001). Meanwhile, the levels of HMGB1 with GCTA haplotype was lower than with GCTG haplotype (P<0.001)Conclusion: Our findings indicated that HMGB1 gene rs1360485 polymorphism was associated with the susceptibility to CWP in Chinese Han population.

Pneumoconiosis progression patterns in US coal miner participants of a job transfer programme designed to prevent progression of disease

OBJECTIVES

Pneumoconiosis prevalence and severity among US coal miners has been increasing for the past 20 years. An examination of the current approaches to primary and secondary prevention efforts is warranted. One method of secondary prevention is the Mine Safety and Health Administration-administered part 90 option programme where US coal miners with radiographic evidence of pneumoconiosis can exercise their right to be placed in a less dusty area of the mine. This study focuses on characterising the progression of disease among US coal miners who participated in the National Institute for Occupational Safety and Health-administered Coal Workers' Health Surveillance Programme (CWHSP) and exercised their part 90 job transfer option.

METHODS

Chest radiograph classifications of working underground coal miners who exercised their part 90 job transfer option during 1 January 1986 to 21 November 2016 and participated in the CWHSP during 1 January 1981 to 19 March 2019 were analysed.

RESULTS

513 miners exercised their part 90 option and participated in the CWHSP at least once during this time period. Of the 149 miners with ≥2 radiographs available, 48 (32%) showed progression after exercising part 90 and had more severe disease prior to exercising, compared with miners who did not progress (severity score of 2.8 vs 1.7, p=0.0002).

CONCLUSION

The part 90 job transfer option programme is not routinely used as intended to prevent progression of pneumoconiosis among US coal miners. The one-third of miners who participated in part 90 and continued to progress, exercised their part 90 option at a later stage of disease compared with non-progressors.

Respirable coal mine dust at surface mines, United States, 1982-2017

BACKGROUND

Exposure to respirable coal mine dust can cause pneumoconiosis, an irreversible lung disease that can be debilitating. The mass concentration and quartz mass percent of respirable coal mine dust samples (annually, by occupation, by geographic region) from surface coal mines and surface facilities at U.S. underground mines during 1982-2017 were summarized.

METHODS

Mine Safety and Health Administration (MSHA) collected and analyzed data for respirable dust and a subset of the samples were analyzed for quartz content. We calculated the respirable dust and quartz concentration geometric mean, arithmetic mean, and percent of samples exceeding the respirable dust permissible exposure limit (PEL) of 2.0 mg/m3, and the average percent of quartz content in samples.

RESULTS

The geometric mean for 288 705 respirable dust samples was 0.17 mg/m³ with 1.6% of the samples exceeding the 2.0 mg/m³ PEL. Occupation-specific geometric means for respirable dust in active mining areas were highest among drillers. The geometric mean for respirable dust was higher in central Appalachia compared to the rest of the U.S. The geometric mean for respirable quartz including 54 040 samples was 0.02 mg/m³ with 15.3% of these samples exceeding the applicable standard (PEL or reduced PEL). Occupation-specific geometric means for respirable quartz were highest among drillers.

CONCLUSION

Higher concentrations of respirable dust or quartz in specific coal mining occupations, notably drilling occupations, and in certain U.S. regions, underscores the need for continued surveillance to identify workers at higher risk for pneumoconiosis.

A thermogravimetric analysis application to determine coal, carbonate, and non-carbonate minerals mass fractions in respirable mine dust

Occupational lung diseases such as coal worker's pneumoconiosis, often called black lung, are caused by exposures to respirable coal mine dust. Dust composition is increasingly understood as an important disease factor, and it can vary significantly depending on dust source materials and generation processes. For regulatory compliance purposes, the mass concentration and quartz percentage of respirable dust are monitored in U.S. coal mines, but the whole composition is not typically determined. Previous work has indicated that thermogravimetric analysis (TGA) can be used to apportion the respirable dust mass to three important component fractions (i.e., coal, non-carbonate minerals, and carbonate), which should generally correlate with three different dust sources (i.e., coal strata, rock strata, and limestone rock dusting products being applied in the mine). However, a primary shortcoming of that previous work was use of fibrous sampling filters, which limited dust recovery and thus analytical accuracy. Here, an improved TGA application is presented using smooth polycarbonate filters. Based on experiments with laboratory-generated dust samples (masses ranging between 95-1,319 µg), the TGA-derived mass fractions (reported as percentage values) for all three components were found to generally be within ±10% of expected values.

Use of the Field-Based Silica Monitoring Technique in a Coal Mine: A Case Study

Exposure to respirable crystalline silica (RCS) can cause serious and irreparable negative health effects, including silicosis and lung cancer. Workers in coal mines have the potential of being exposed to RCS found in dust generated by various mining processes. The silica content of respirable dust in one single mine can vary substantially over both time and location. The current monitoring approach for RCS relies on the use of traditional air sampling followed by laboratory analysis. Results generated using this approach are generally not available for several days to several weeks after sampling, and this delay prevents timely and effective intervention if needed. An alternate analytical method is needed to reduce the time required to quantify the RCS exposure of mine workers. The National Institute for Occupational Safety and Health (NIOSH) has developed a new method using commercially available portable infrared spectrometers for measuring RCS at the end of the sampling shift. This paper will describe the application of the new field-based RCS analytical process for coal mines, including the use of the new method with the existing Coal Mine Dust Personal Sampler Unit. In a case study conducted by NIOSH with a coal mine operator in West Virginia, field-based RCS analysis was completed at a mine site to evaluate the new technique. The RCS analysis results obtained by the field-based method in this case study showed sufficiently strong correlation with results obtained by the MSHA standard laboratory analysis method to allow the mine operator to use the field-based method for evaluating process improvements.

The Impact of Black Lung and a Methodology for Controlling Respirable Dust

Coal workers' pneumoconiosis (CWP), commonly known as black lung, is caused by the inhalation of respirable coal mine dust and is a disabling and potentially fatal lung disease with no cure. Historically, CWP has taken a tremendous human and financial toll in the US coal mining industry. Recent health surveillance data indicates that CWP continues to occur at elevated levels. Respirable coal dust exposure must be controlled to prevent the development of CWP. The Pittsburgh Mining Research Division of the National Institute for Occupational Safety and Health (NIOSH) conducts laboratory and mine-site research to identify control technologies that can be used to successfully reduce respirable dust levels. Various technologies, using multiple methods of control, can be applied in order to reduce dust levels. An overview of CWP's impact and a general methodology for controlling respirable dust in underground coal mines are discussed in this paper.

Work Practices and Respiratory Health Status of Appalachian Coal Miners With Progressive Massive Fibrosis

OBJECTIVE

The aim of this study was to characterize workplace practices and respiratory health among coal miners with large opacities consistent with progressive massive fibrosis (PMF) who received care at a federally funded black lung clinic network in Virginia.

METHODS

Participants were interviewed about their workplace practices and respiratory health. Medical records were reviewed.

RESULTS

Nineteen former coal miners were included. Miners reported cutting rock, working downwind of dust-generating equipment, nonadherence to mine ventilation plans (including dust controls), improper sampling of respirable coal mine dust exposures, working after developing respiratory illness, and suffering from debilitating respiratory symptoms.

CONCLUSION

Consistent themes of suboptimal workplace practices contributing to development of PMF emerged during the interviews. Some of the practices reported were unsafe and unacceptable. Further research is needed to determine the prevalence of these factors and how best to address them.

Progressive Massive Fibrosis Resurgence Identified in U.S. Coal Miners Filing for Black Lung Benefits, 1970-2016

RATIONALE

There has been a resurgence of progressive massive fibrosis (PMF) in the United States, particularly among central Appalachian miners.

OBJECTIVES

We characterized the proportion of PMF among former U.S. coal miners applying for Federal Black Lung Program benefits, 1970-2016.

METHODS

Data from the U.S. Department of Labor were used to characterize trends in proportion of PMF cases, defined as an approved black lung claim with a determination of PMF, among all miners who filed for federal benefits between January 1, 1970, and December 31, 2016. Joinpoint, logistic, and linear regression models were used to identify changes in the proportion of claimants with PMF over time.

RESULTS

There were 4,679 unique PMF cases among claimants for federal black lung benefits between 1970 and 2016, with 2,474 miners determined to have PMF since 1996. The number of PMF cases among Federal Black Lung Program claimants fell from 404 (0.5% of claimants) in 1978 to a low of 18 cases (0.6%) in 1988, and then increased to 353 cases (8.3%) in 2014. The proportion of federal black lung benefits claimants with PMF has been increasing since 1978 (0.06% annual percent change [APC]; 95% confidence interval [CI], 0.05-0.07%; P < 0.0001), and began increasing at a significantly increased rate after 1996 (0.26% APC; 95% CI, 0.25-0.28%; P < 0.0001). Most miners with PMF (84%) last mined in West Virginia, Kentucky, Pennsylvania, or Virginia. Since 1970, the proportion of claimants with PMF has increased significantly among miners who last worked in Kentucky (16.6% APC; 95% CI, 16.5-16.7%), Pennsylvania (4.7% APC; 95% CI, 4.6-4.8%), Tennessee (16.1% APC; 95% CI, 15.7-16.4%), West Virginia (16.8% APC; 95% CI, 16.6-16.9%), and most sharply among miners last working in Virginia (31.5% APC; 95% CI, 31.2-31.7%), where in 2009, more than 17% of claimants received a PMF determination. The proportion of PMF determinations for the rest of the United States has not exceeded 4%.

CONCLUSIONS

There has been a resurgence of PMF, particularly in central Appalachian miners. The resurgence of this preventable disease points to the need for improved primary and secondary prevention of dust-related lung disease in U.S. coal miners.

"Youth Are More Aware and Intelligent than Imagined": The Mountain Air Youth Photovoice Project

Appalachian Kentucky reports some of the highest rates of respiratory illness in the United States, including chronic obstructive pulmonary disease and asthma. While smoking rates are high in the region, unexplained variation remains, and community-engaged research approaches are warranted to identify contributing factors. The Mountain Air Project's community advisory board recommended that investigators invite youth to provide their perspectives on possible contributing factors to respiratory illness, and we undertook an exploratory study to determine the utility of photovoice to elicit such perspectives with this population. While photovoice has been employed for other youth-focused health studies in Appalachia, to our knowledge, this work represents the region's first environmental study using photovoice among youth. Over eight weeks, ten participants (age 12-18) represented their perspectives through photographs and accompanying narratives. A brief thematic content analysis of the youth narratives that accompanied the photos revealed three primary themes of environmental determinants of respiratory illness. These themes included compromises community members make regarding respiratory health in order to secure a livelihood; tension between cultural legacies and respiratory health; and consequences of geographic forces. This study demonstrates the value of incorporating youth perspectives in environmental health research, and that photovoice was a valuable approach to elicit such perspectives.

Current Review of Pneumoconiosis Among US Coal Miners

PURPOSE OF REVIEW

This review summarizes recent research on pneumoconiosis in coal workers following the identification of the resurgence of this disease among US coal miners in the early 2000s. We describe the impact of this research and how this has led to increased public attention, benefitting affected miners.

RECENT FINDINGS

The latest research shows that the prevalence of pneumoconiosis, including progressive massive fibrosis, continues to increase, especially in central Appalachia. Contributing factors may include mining of thin coal seams or cutting rock to access coal, which may expose miners to coal mine dust with a higher content of silica and silicates than in the past. The impact of recently implemented changes, such as the reduced occupational exposure limit for respirable coal mine dust and the introduction of continuous personal dust monitors, will likely take years to appropriately evaluate.

Respirable coal mine dust in underground mines, United States, 1982-2017

BACKGROUND

This study summarized the mass concentration and quartz mass percent of respirable coal mine dust samples (annually, by district, and by occupation) from underground coal mines during 1982-2017.

METHODS

Respirable dust and quartz data collected and analyzed by Mine Safety and Health Administration (MSHA) were summarized by year, coal mining occupation, and geographical area. The older (before August 2016) 2.0 mg/m ³ respirable dust MSHA permissible exposure limit (PEL) was used across all years for comparative purposes. For respirable dust and quartz, geometric mean and percent of samples exceeding the respirable dust PEL (2.0 mg/m ³ or a reduced standard for samples with >5% quartz content) were calculated. For quartz samples, the average percent quartz content was also calculated.

RESULTS

The overall geometric mean concentration for 681 497 respirable dust samples was 0.55 mg/m ³ and 5.5% of the samples exceeded the 2.0 mg/m ³ PEL. The overall respirable quartz geometric mean concentration for 210 944 samples was 0.038 mg/m ³ and 18.7% of these samples exceeded the applicable standard. There was a decline over time in the percent of respirable dust samples exceeding 2.0 mg/m ³ . The respirable dust geometric mean concentration was lower in central Appalachia compared to the rest of the United States. However, the respirable quartz geometric mean concentration and the mean percent quartz content were higher in central Appalachia.

CONCLUSION

This study summarizes respirable dust and quartz concentrations from coal mine inspector samples and may provide an insight into differences in the prevalence of pneumoconiosis by region and occupation.

Dust induces lung fibrosis through dysregulated DNA methylation

Pneumoconiosis is a serious occupational disease that often occurs to coal workers with no early diagnosis and effective treatment at present. Diffuse pulmonary fibrosis is the major pathological change of pneumoconiosis, and its mechanism is still unclear. Epigenetics is involved in the development of many diseases, and it is closely associated with fibrosis. In this study, we investigated whether DNA methylation contributes to the pathogenesis of pulmonary fibrosis in pneumoconiosis. By exposure to coal dust or silica dust, we established the models of coal worker's pneumoconiosis (CWP), which showed an increased expression of COL-I, COL-III. We further found that DNMT1, DNMT3a, DNMT3b, MBD2, MeCP2 protein expression changed. Pretreatment with DNMT inhibitor 5-aza-dC reduced expression of COL-I, COL-III, and reduced pulmonary fibrosis. In summary, our results showed that DNA methylation contributes to dust-induced pulmonary fibrosis and that it may serve as a theoretical basis for testing DNA methyltransferase inhibitors in the treatment of CWP.

Patterns of progressive massive fibrosis on modern coal miner chest radiographs

Clinical teaching generally asserts that large opacities of progressive massive fibrosis (PMF) on chest radiographs present primarily bilaterally in the upper lung zones, and with an elevated background profusion of small opacities. However, the contemporary basis for these descriptions is limited.Radiographs taken for the Coal Workers' Health Surveillance Program during 2000-2015 and previously determined to have large opacities ("PMF radiographs", n = 204), and a random sample previously deemed free of large opacities (n =22), were independently reevaluated by three National Institute for Occupational Safety and Health (NIOSH) B Readers. Large opacities were noted primarily in the upper right (41%) or upper left (28%) lung zone, but 31% were in middle or lower zones. Unilateral involvement was observed in 34% of readings, with right lung predominance (82%). The median small opacity profusion category for the radiographs with PMF was 2/1. The number of large opacities was not correlated with small opacity profusion category. The "classic" descriptions of PMF as bilateral, associated with elevated background profusions of small pneumoconiotic opacities, were each absent in a third of miners.

NIOSH's Respiratory Health Division: 50 years of science and service

The year 2017 marked the 50th anniversary of NIOSH's Respiratory Health Division (RHD). RHD began in 1967 as the Appalachian Laboratory for Occupational Respiratory Diseases (ALFORD), with a focus on coal workers' pneumoconiosis. ALFORD became part of NIOSH in 1971 and added activities to address work-related respiratory disease more generally. Health hazard evaluations played an important role in understanding novel respiratory hazards such as nylon flock, diacetyl, and indium-tin oxide. Epidemiologic and laboratory studies addressed many respiratory hazards, including coal mine dust, silica, asbestos, cotton dust, beryllium, diesel exhaust, and dampness and mold. Surveillance activities tracked the burden of diseases and enhanced the quality of spirometry and chest radiography used to screen workers. RHD's efforts to improve scientific understanding, inform strategies for prevention, and disseminate knowledge remain important now and for the future.

Outcomes after lung transplantation for patients with occupational lung diseases

Occupational lung diseases (OLD) including silicosis, asbestosis, and pneumoconiosis progress to end stage lung disease requiring lung transplantation (LT). Prognosis and treatment of OLDs are poorly understood and a paucity of data exists regarding LT outcomes. Additionally, transplant operative complexity for patients with OLD is high. A single center retrospective review of all single and bilateral LT recipients between May 2005 and Oct 2016 was performed. Patients were grouped by OLD, and nearest neighbor matching was performed at a ratio of 1:3 cases to controls. Thirty cases were matched to 88 controls. Seventeen patients (57%) with OLD required intraoperative support with either extra-corporeal membrane oxygenation (ECMO) or cardiopulmonary bypass (P = 0.02), and 5 (17%) required delayed chest closure (P = 0.05) which was more frequent than matched controls. In addition, operative time was significantly longer in patients with OLD (P = 0.03). Despite these factors, there were no significant differences in immediate post-operative outcomes including mechanical ventilator support, post-operative ECMO, and tracheostomy. Chronic lung allograft dysfunction and long-term survival were also similar between cases and controls. OLDs should not preclude LT. The operation should be performed at experienced centers.

Focusing on Coal Workers' Lung Diseases: A Comparative Analysis of China, Australia, and the United States

China has high and increasing annual rates of occupational lung diseases such as pneumoconiosis and silicosis. In contrast, Australia and the United States of America (USA) have greatly lowered their annual rates of lung diseases since the 1970s. This paper systematically compared and analysed the multi-elements of coal dust management and health management in these three countries to provide a reference for China. Regarding coal dust management, this paper found that coal workers in China are more susceptible to lung diseases compared to workers in the USA and Australia, considering fundamental aspects such as mine type, coal rank, and geological conditions. In addition, the controllable aspects such as advanced mitigation, monitoring methods, and the personal protective equipment of coal dust were relatively inadequate in China compared to the USA and Australia. Health management in China was found to have multiple deficiencies in health examination, co-governance, and compensations for coal workers suffering from lung diseases and healthcare for retired coal workers. These deficiencies may be attributed to insufficient medical resources, the Chinese government-dominated governance, ineffective procedures for obtaining compensation, and the lack of effective and preventive healthcare programs for the retired coal workers. Based on the USA and Australia experience, some suggestions for improvement were proposed.

Interstitial Lung Diseases in the U.S. Mining Industry: Using MSHA Data to Examine Trends and the Prevention Effects of Compliance with Health Regulations, 1996-2015

Given the recent increase in dust-induced lung disease among U.S. coal miners and the respiratory hazards encountered across the U.S. mining industry, it is important to enhance an understanding of lung disease trends and the organizational contexts that precede these events. In addition to exploring overall trends reported to the Mine Safety and Health Administration (MSHA), the current study uses MSHA's enforcement database to examine whether or not compliance with health regulations resulted in fewer mine-level counts of these diseases over time. The findings suggest that interstitial lung diseases were more prevalent in coal mines compared to other mining commodities, in Appalachian coal mines compared to the rest of the United States, and in underground compared to surface coal mines. Mines that followed a relevant subset of MSHA's health regulations were less likely to report a lung disease over time. The findings are discussed from a lung disease prevention strategy perspective.

Continued Increase in Prevalence of Coal Workers' Pneumoconiosis in the United States, 1970-2017

OBJECTIVES

To update prevalence estimates for coal workers' pneumoconiosis (CWP) among working underground coal miners in the United States.

METHODS

We conducted a prevalence study using radiographs collected from 1970 to 2017. We classified each radiograph using international standards. We defined CWP as the presence of small opacities, with profusion greater than or equal to subcategory 1/0, or the presence of a large opacity larger than 1 centimeter.

RESULTS

Following a low point in the late 1990s, the national prevalence of CWP in miners with 25 years or more of tenure now exceeds 10%. In central Appalachia (Kentucky, Virginia, West Virginia), 20.6% of long-tenured miners have CWP. When we excluded miners from central Appalachia, the prevalence for the remainder of the United States was lower, but an increase since 2000 remains evident.

CONCLUSIONS

The national prevalence of CWP among working coal miners is increasing. This increase is most pronounced in central Appalachia. Current CWP prevalence estimates will likely be reflected in future trends for severe and disabling disease, including progressive massive fibrosis. Public Health Implications. Recently enacted protections to prevent coal mine dust exposure and identify CWP at its early stage remain essential to protect US coal miners.