Journal Article

Impact of coal mine dust exposure and cigarette smoking on lung disease in Appalachian coalminers

Patel, Zalak, Anwar, Javeria, Abdullah, Amirahwaty, Ghio, Andrew J, Sangani, Rahul G., Vaidya, Vinita, Deepak, Vishal

2025

Overview

Introduction Interactions have been demonstrated between cigarette smoking (CS) and occupational exposures to several particles. This study tested the postulate that CS interacts with coal mine dust exposure to impact and change radiological and histological endpoints of coal mine dust lung disease. Methods A retrospective evaluation of coalminers with a high-resolution computed tomography (HRCT) of the chest was conducted at West Virginia University Hospital (2015- 2022). There was a consensus review of both radiology and histology findings and their comparative analysis with a non-miner surgical resection cohort collected from thoracic oncology clinic. Results The study cohort (n=556) was divided into groups: coal-/smoking- (8.3%), coal-/smoking+ (26.6%), coal+/smoking- (22.3%), and coal+/smoking+ (42.8%). Miners were older males with a median duration of coal mine work (CMW) of 30-years. Ever-smokers (66% of miner cohort and 76% of non-miner cohort) smoked 35 and 28 composite pack years (CPY) respectively, where miners had greater intensity of smoking (22 vs 18 cigarettes/day) compared to non-miners. On HRCT, 1/3 rd and 1/5 th of miners had simple and complicated coal workers’ pneumoconiosis (sCWP and cCWP), respectively. 35% of ever-smoking miners had radiologic patterns for probable usual interstitial pneumonitis, nonspecific interstitial pneumonitis, desquamative interstitial pneumonitis, and combined pulmonary fibrosis and emphysema. Radiologically, both coal-/smoking+ and coal+/smoking+ showed excessive emphysema (70-80%). Histologically, miners had more fibrosis (47% and 50% in coal+/smoking- and coal+/smoking+ vs. 11% and 28% in coal-/smoking- and coal-/smoking+). Never-smoking miners demonstrated more histological evidence of CWP than ever-smokers (60% and 27%); in addition, they had radiologic and histologic emphysema (30%), radiologic interstitial lung disease (ILD) (14.5%) and histologic evidence of fibrosis (47%). Ever-smokers demonstrated histologic emphysema more frequently (33% and 67% in coal+/smoking- and coal+/smoking+ vs. 24% and 72% in coal-/smoking- and coal-/smoking+). Logistic regression modeling showed the following associations: radiologic and histologic emphysema with CPY; histologic fibrosis, any ILD (not including RB-ILD), CPFE and anthracosis with both CPY and CMW; radiologic RB-ILD inclusive of small-opacities, cCWP with both CMW and silica; and sCWP and pulmonary artery dilation with CMW. Interestingly, CPY≥30 negatively correlated with radiologic cCWP and histologic CWP. Mortality was increased in smokers (14% and 29% in coal+/smoking- and coal+/smoking+ vs. 4% and 20% in coal-/smoking- and coal-/smoking+) with predictors being radiologic ILD, histologic CWP, and related co-morbid diseases including COPD, chronic kidney disease, and gastroesophageal reflux. Conclusion CS demonstrated a major impact on miners’ health including changing radiologic and histologic endpoints of interstitial lung diseases and emphysema.

• Publisher: BioMed Central,BioMed Central Ltd,Nature Publishing Group,BMC
• Subject: Adult / Aged / Appalachian Region - epidemiology / Asbestos / Autopsies / Biopsy / Body mass index / Bronchitis / Chronic obstructive pulmonary disease / Cigarette smoking / Cigarette Smoking - adverse effects / Cigarette Smoking - epidemiology / Cigarettes / Coal - adverse effects / Coal industry / Coal mines / Coal Mining / Coal workers’ pneumoconiosis / Cohort Studies / Comparative analysis / Computed tomography / CT imaging / Diagnostic imaging / Dust / Electronic health records / Emphysema / Exposure / Female / Fibrosis / Gastroesophageal reflux / Health aspects / High resolution CT chest / Histology / Histopathology / Humans / Interstitial lung diseases / Kidney diseases / Lung diseases / Lung Diseases - diagnostic imaging / Lung Diseases - epidemiology / Male / Medical imaging / Medical records / Medical research / Medicine / Medicine & Public Health / Medicine, Experimental / Middle Aged / Mine dusts / Miners / Mortality / Occupational Diseases - diagnostic imaging / Occupational Diseases - epidemiology / Occupational exposure / Occupational Exposure - adverse effects / Occupational health / Pathology / Physiological aspects / Pneumoconiosis / Pneumology/Respiratory System / Pneumonitis / Pulmonary arteries / Pulmonary artery / Radiology / Retrospective Studies / Sleep apnea / Smoking / Social aspects / Thoracic surgery / Thorax