The new paper recounts a host of recent research that shows dust-induced lung disease develops more quickly and progresses much more quickly in coal miners than previously thought, especially among workers in Southern West Virginia and other parts of Appalachia.
Traditionally, physicians have focused on coal workers' silicosis and pneumoconiosis caused by a mixture of dust exposures, but the new paper encourages considering those as part of a spectrum that also includes chronic airway diseases such as emphysema and chronic bronchitis. And, they note data that say some forms of fibrosis not normally linked to coal dust exposure actually show up far more frequently in coal miners and should be considered "coal mine dust lung disease," or CMDLD, so that workplace diseases are accurately counted.
"The sum of the evidence really shows this is a worsening problem, instead of a problem that's getting better," said co-author Dr. Robert Cohen, a medical professor at John Stroger Jr. Hospital of Cook County in Chicago. "When you put it all together, it underscores the need to do something -- better regulations, more stringent regulations, and better enforcement."
In July 2012, a joint investigation by National Public Radio and The Center for Public Integrity reported on the resurgence of black lung and, with additional reporting by The Charleston Gazette, documented widespread cheating by mining companies on dust samples and inaction by federal regulators over the past quarter-century to address the problem.
In October 2010, MSHA proposed new rules as part of what the agency touted as an aggressive plan to end the disease. Among other steps, the MSHA proposal would reduce the legal limit for dust in underground mines from 2.0 milligrams of dust per cubic meter of air to 1.0 milligram of dust per cubic meter of air. A Labor Department advisory commission recommended the change in 1996, and NIOSH has been urging since 1995 that the limit be tightened. Industry officials argue that recent increases in black lung rates are a regional problem and don't require a new nationwide rule.
In August 2012, the federal Government Accountability Office issued a major report that supported MSHA's proposal to toughen coal dust limits to fight a resurgence of black lung. That GAO report's findings ended a block by congressional Republicans on issuance of the final MSHA rule, which was proposed two years ago, in October 2010.
Since the GAO report, though, MSHA has reported no significant actions on its proposed rule. A final version has not been recorded as being filed with the White House Office of Management and Budget, and MSHA officials refuse to say much about the topic.
In a budget document submitted to Congress last month, MSHA said agency officials would "take aggressive action" in the coming year to reduce miners' exposure to coal dust.
MSHA's 103-page budget document noted that the agency's strategy included "enhanced enforcement, education and training, and health outreach." MSHA promised special dust inspections and a review to ensure mine operators are properly monitoring dust levels in work areas.
"[MSHA] will continue to work with mining equipment manufacturers to identify the most effective engineering control measures and promote their use," the MSHA budget document said. "These activities will help ensure the respiratory health of the nation's miners."
A separate section of MSHA's budget on new regulations listed rules on exposure to silica, requiring proximity detection systems, and follow-up to the Upper Big Branch Mine disaster -- but not the agency's proposed rule to tighten coal-dust limits.
Louviere said the coal-dust rule is still high on the agency's agenda, though.
"The respiratory dust rule is on MSHA's regulatory agenda for 2013," she said last month.
Reach Ken Ward Jr. at kw...@wvgazette.com or 304-348-1702.