Black lung is an insidious but entirely preventable occupational lung disease. It was thought to have been eradicated in Australia but it has now reappeared with several cases being reported.

Coal workers’ pneumoconiosis or black lung was thought to have been eradicated but it reappeared when four Queensland coalminers were diagnosed with the disease in 2015. These were the first cases diagnosed in more than thirty years. A seventh case was recently reported and more cases are likely to be diagnosed. The ABC has reported that as many as one thousand Queensland miners could be affected by the disease.

What is black lung disease?

Black lung is a chronic and irreversible lung disease caused by a prolonged exposure to coal dust. Coal dust is inhaled into the lungs where it accumulates in the air sacs. Once the dust becomes lodged in lungs, the body is unable to remove it. Over many years of exposure the dust accumulates causing black lung disease.

Initially the disease appears in the lungs as small nodules. In this simple form of the disease there is no significant effect on lung function and sufferer may not exhibit any symptoms. With continued exposure to coal dust over many years, the disease can progress into a more serious form as nodules lump together to become much larger lesions. In this form significant lung damage is caused, which can lead to debilitating illness and premature death.

How is black lung detected and treated?

There is no specific treatment for black lung disease. Medical care is palliative. It is possible to slow or prevent the disease progressing to its more serious form by avoiding any further exposure to coal dust. Early detection of the disease, before symptoms become apparent, is possible by chest x-ray imaging.

Why has it reappeared and what should be done?

Coalminers rely on a safety system designed to protect them from black lung disease. Any credible safety system relies on defence in depth. Defence in depth acknowledges that no protective barrier is perfect so multiple barriers are required to reduce the possibility of cases of the disease occurring.

Coal dust is an inevitable outcome of coalmining. A credible black lung disease prevention programme recognises that coal dust cannot be eliminated and that defence in depth is required to eradicate the disease. These barriers include coal dust minimisation programmes, government regulation to enforce dust minimisation and the medical screening of coalminers exposed to dust. The reappearance of black lung disease in Queensland is the consequence of systemic failings that allowed all these measures to breakdown.

Dust minimisation programmes rely on two approaches to dust management, management controls to minimise dust generation and engineering controls to contain, suppress or collect coal dust. A combination of these controls are employed to ensure that coalminers are not exposed to excessive dust levels. Underground mines in Queensland have routinely exceeded allowable dust limits resulting in coalminers being exposed to prolonged periods of elevated dust levels.

Government sets and enforces regulatory limits on allowable coal dust exposure limits. In a recent report the Senate Select Committee on Health raised significant concerns regarding the Queensland mining regulator’s ability to monitor breeches of allowable dusts limits. It was also concerned about the regulator’s ability to ensure mining companies comply with directives to rectify excessive dust levels.

The medical screening of coalminers exposed of coal dust is another essential facet of defence in depth. Its purpose is to detect miners with early signs of black lung disease before any symptoms become apparent. An effective screening programme requires mandatory chest x-ray screening of all coalminers, and the use of specially trained radiologists who are able to diagnose the early signs of black lung. The recent diagnosis of seven cases of the more serious form of black lung disease clearly illustrates that medical screening in Queensland has failed. The Department of Natural Resources and Mines is now conducting a review to determine a strategy will that ensure that coalminers are effectively screened.

What can be done?

First and foremost the failings of each of the defence in depth barriers should be addressed. However, the only effective way to ensure that history does not repeat itself is to adopt a national systemic approach, where each of the defence in depth barriers is treated as a part of a single managed safety system. If not, what will be eradicated by corrective measures now will re-emerge in the next generation of coalminers.