Progressive Massive Fibrosis in Coal Miners From 3 Clinics in Virginia

Blackley DJ, Reynolds LE, Short C, Carson R, Storey,E, Halldin,CN, Laney AS. JAMA 2018;319(5):50-1. doi and PubMed citations unavailable at the time of this writing.

The authors are reporting a clustering of 416 cases of progressive massive fibrosis (PMF) among 11,200 observed coal miners in Appalachia. PMF was rarely observed in the 1990’s but a 2014 report documented an apparent increase in PMF. A high proportion of these cases had r-type opacities, category B and C large opacities, and coal mining tenure of less than 20 years, which are indications of exceptionally severe and rapidly progressive disease. PMF has no treatment other than supportive care and lung transplantation. Smoking seems to hasten the disease. The reason for the sudden increase in reported cases is not clear but may be partly explained by workers seeking compensation after economic hardship brought on by a decline in the coal industry. A 2014 federal rule improved protection for miners, including decreased allowable dust concentrations, changes in dust monitoring, and expansion of the health surveillance. Whether these added protections will decrease the apparent increase in PMF requires continued observation.