Black lung disease

Black lung disease is a layman term used for coal workers' Pneumoconiosis or CWP. It is an occupational lung disease normally developed by mine workers who are continuously exposed to coal dust. Over a period of few years, the coal dust starts to accumulate in the lungs and turns them black instead of healthy pink. That is why the condition is known as black lung disease.

Our lungs are not capable of expelling the dust and that leads to scar tissues in the organ. When the disease progresses, simple coal workers' pneumoconiosis may develop into Progressive Massive Fibrosis or PMF. PMF is fatal as it hardens the lung and eventually leads to respiratory failure. Unfortunately there is no cure for black lung disease in its advanced form. However if the condition is caught early, one can lead asymptomatic and normal life by adopting few preventive measures. Black lung disease is said to affect workers over age 50 and those who have at least a 10 years of continuous exposure to coal dust.

Symptoms of Black Lung Disease

Simple form of black lung disease may not produce any symptoms. However, as the disease progresses one may develop the following symptoms:

• Shortness of breath
  
• Obstruction of airway
  
• Severe cough with mucus
  

Diagnosis of black lung disease

As a first step towards diagnosis, doctor takes note of the history of the patient, nature of the working environment and other risk factors during the clinical trials. Chest x-rays and pulmonary function test are the standard diagnostic tools used to diagnose black lungs. If the X-rays show up black spots, chest CT may be ordered to confirm the condition.

Treatment of black lung disease

There is no specific treatment available for black lung disease. Symptomatic treatment is offered to the patient to relieve him of the discomfort. Further progress of the disease can be curtailed by avoiding exposure to the dust. As the black lung disease progresses, it forms into progressive massive fibrosis and becomes untreatable.

Prevention of black lung disease

The only way to handle the black lung disease is to prevent it. Most countries have implemented coal dust regulation acts and have laid down safety standards to prevent this debilitating disease. Some of the preventive measures are mentioned below:

1. Masks may be provided to the workers to control the dust inhalation.
2. Adequate ventilation should be provided in the mines.
3. Regular health check up of workers should be conducted periodically to test for respiratory function.
4. Effective Engineering controls must be placed to check the coal dust. Currently technically advanced dust suppression systems are available to control fine airborne coal particles.

Progressive Massive Fibrosis

Progressive massive fibrosis is a lung disease that is predominantly reported in people who work in mines. Hence it is also called Coal worker's Pneumoconiosis. Fibrosis is a nodular formation in different regions of the body. Often lungs are the most vulnerable. This is because of aerosol initiation, which has a faster chance of nodule formation causing tissue damage.

Clinical Manifestations

Most conditions associated with massive fibrosis are coherent to silicosis and pneumoconiosis. Lesions are caused due to tissue necrosis, which leads to hardening of the tissue forming nodular structures. In case of progressive fibrosis, massive scars are noticed because of dense agglomeration of the thickened nodules. These nodules predominantly appear in the upper lobes causing respiratory difficulties.

The onset of this disease is triggered by macrophage proliferation in the respective regions. The macrophages engulf the inhaled silicon particles causing the production of interleukin -I which facilitates the chemical mediation for tissue necrosis. Silica is commonly found in these necrotic nodules. The adverse effects of these silica particles are the onset of Pulmonary Alveolar Proteinosis (PAP) causing the accumulation of large particles, which can be noticed as spaces on radiological examination. Along with the affected upper lobe, the interstitial zones of the lower lobe are also obstructed and bronchial regions are damaged with the infiltration of the nodules. Honeycomb lung or asbestos bodies are common references for progressive massive fibrosis as both these conditions have giant cells upon pathological examination. Bronchogenic carcinoma and mesothelioma are the associated adverse conditions of progressive massive fibrosis.

The evaluation of patients suffering progressive massive fibrosis includes the understanding of the type of chemical or particle inhaled as it enables the physicians to rule out diagnostic errors. In cases such as pleural plaques, calcified regions of the lungs are noticed which is another cause of asbestosis. The lower region of the lungs are predominantly affected. In case of interstitial fibrosis, the bronchus and alveoli are affected with characteristic nodules of the upper and mid region. The evaluation is based on the type of chemical and the respective interleukins it releases. Most patients associated with these conditions are miners, shipyard workers, automobile mechanics and petrochemical employees.

Diagnosis and Treatment

Most diagnostic evaluations are radiological in origin as the MRI provides detailed description about the zones of the fibrosis and the size of each nodule. Histopathological analysis studies the intensity of the necrosis, giant cell presence and the macrophagic proliferation patterns. The treatment pattern is based on symptomatic analysis. Since the condition includes both lower and upper lobes, any associated mycobacterial infection has to be treated. Oxygen is given as a critical care measure in patients with hypoxemia. Surgical interventions are applicable in case of intense and irreversible tissue necrosis. Patients with progressive massive fibrosis are advised to quit smoking if as it causes intense damage.

Bronchopulmonary Dysplasia

Babies who are born prematurely experience various disorders. These disorders occur because of the underdevelopment of a particular organ. Bronchopulmonary Dysplasia is a very serious condition which occurs predominantly in premature babies. Bronchopulmonary Dysplasia was first noticed in 1976, among pre term babies suffering respiratory distress. The babies were categorized as ventilator dependent as they needed increased oxygen.

Symptoms of Bronchopulmonary Dysplasia

Chronic lung disease or Bronchopulmonary dysplasia occurs because of developmental disorders. The cellular arrangement in the lung tissue is also impaired to a large extent. Babies who are born at a gestation period of 34 weeks are prone to chronic lung disease. Studies imply that babies whose weight is less than 4 pounds during this period also experience symptoms of this condition. This happens because of the reduced development of the alveoli in the lung tissue.

These babies are often treated with positive pressure ventilation (PPV), but since they do not have enough antioxidants, there is a possibility of developing oxygen toxicity. The relation between Bronchopulmonary dysplasia and oxygen toxicity is very significant in understanding the exact cause. In many cases, ventilator associated positive pressure treatment has aggravated the condition. The classical symptoms associated are shortness of breath, cyanosis, increased breathing rate and cough.

Diagnosis of Bronchopulmonary Dysplasia

The treatment options become easier for Bronchopulmonary dysplasia, if the root cause is effectively diagnosed. The major diagnostic parameters that have to be taken in to consideration are:

• Gestation period of the baby.
  
• Underlying intrauterine infections.
  
• Duration of ventilator exposure after birth.
  
• Estimation of oxygen toxicity during positive pressure ventilation.
  

Careful analysis has to be done in differentiating respiratory distress condition and bronchopulmonary dysplasia through X-rays as both have significant appearance radiologically. One of the diagnostic identifications includes the oxygen dependency of the patient after initial treatment, as this enables evaluation of the lung functionality in the long term. Other tests that add relevance to the diagnosis include arterial blood gas estimation in case of cyanosis, pulse oxymetry and CT scan.

Treatment of Bronchopulmonary Dysplasia

One of the early ways to treat bronchopulmonary dysplasia was to administer systemic steroids. This method was practiced to minimize ventilator utilization. The only disadvantage was the onset of adrenal suppression; hence the dosage pertaining to these steroids was reduced and was given in combination with hydrocortisone to balance the cortisol levels.

Diuretics are also advised. Inflammation associated with bronchopulmonary dysplasia is treated with inhaled nitric oxide therapy as it facilitates the process of vasodilation. Other treatment options include the administration of vitamin A and E to facilitate free radical removal and enhance immunity. Nutrition is an important factor as it meets the demands of the increased energy levels in these babies and also provides the antioxidants to remove the free radicals formed during metabolic pathways.