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The evolution of black lung disease: Why is it resurfacing in the 21st century?
Black lung disease (BLD), also known as coal workers' pneumoconiosis, is an occupational lung disease caused by long-term inhalation of coal dust. It is similar to silicosis and asbestosis. Similar to lung disease (asbestosis). The disease commonly affects coal miners and others who are exposed to coal dust. Its pathological mechanism involves the lung's long-term response to coal dust, leading to inflammation, fibrosis, and even necrosis. As environmental pollution increases, all urban residents are exposed to coal dust to some extent, and long-term high-dose exposure can lead to more serious symptoms.
"The resurgence of black lung disease in the 21st century has come as a shock to many, especially after decades of efforts to prevent it."
According to data, as of 2021, black lung disease is once again on the rise among coal miners in the United States. In 2013, the number of deaths from black lung disease worldwide was about 25,000, compared with about 29,000 in 1990. If we look at the situation in the United States, a 2018 research report shows that the incidence of black lung disease among coal miners has reached its highest level in the past 20 years, especially among senior coal miners, with the incidence rate as high as 9%.
The pathological basis of black lung disease is the persistent damage of coal dust to the lungs. Inhaled coal dust cannot be eliminated or excreted by the human body. It will be engulfed by alveolar macrophages and accumulate in the lungs, stimulating the macrophages to release a variety of inflammatory factors, leading to inflammation and fibrosis of lung tissue. Over time, visible black nodules may develop in the lungs, and more severe cases may cause widespread fibrosis and functional decline.
"Coal dust provides sufficient stimulation for macrophages to release various products that lead to the development of black lung disease."
Currently, there is no cure for black lung disease, and often only complementary therapies can be used to relieve symptoms. Common treatments include giving patients supplemental oxygen and advising them to stop smoking to prevent further deterioration of lung function. In some extreme cases, a lung transplant may be necessary to prolong a patient's life.
As for measures to prevent black lung disease, avoiding breathing coal dust is the most effective way. Common preventive measures include wearing a properly fitted ventilation mask and getting regular lung exams. It is also important to understand the risks of lung disease in the work environment.
"The first priority in preventing black lung disease is to avoid breathing coal dust completely."
As people's awareness of black lung disease continues to deepen, strict policies in the 1970s have historically reduced the incidence of black lung disease in the United States by 90%. However, data from recent years show that the disease has returned to the public health spotlight. In 2018, surveys showed that among experienced coal miners, especially those in surface coal mines, the risk of black lung disease has become non-negligible. Analysis of the data shows that the health risks for these workers are continuing to rise.
Experts have suggested a range of possibilities as to why this is happening, including longer working shifts and changes to how coal is mined. Previous high-yield mining and low-pollution standards seem to have unknowingly affected workers' health. This is a reminder of the importance of relevant health policies and industry standards to protect current and future miners.
On the research side, many institutions are conducting in-depth investigations to understand the prevalence of black lung disease among different ethnic groups. Especially in some areas of the United States, due to the large number of miners, the incidence of black lung disease in the area has increased significantly. The higher incidence rate lies in the delicate balance between industrialization and health policies, which are issues that must be addressed in the future.
In the process of prevention and treatment, relevant institutions are also conducting technological innovations and screening, which represents hope in the fight against black lung disease. As data collection continues, more specific recommendations will be available in the future to improve workers’ health.
With the improvement of global health awareness, it is believed that there will be more effective strategies to protect coal miners and prevent and treat black lung disease to reduce the incidence and mortality rates. However, how to find a balance between policy and implementation so that workers’ health can be fundamentally improved will be a challenge in the future.
