Before it was known simply as black lung, coal worker’s pneumoconiosis had many names among those who worked in the nation’s coal mines: miner’s asthma, miner’s cough and so on.

Neither did the disease draw much attention. Dr. Donald Rasmussen of Beckley had barely touched it in medical school and knew next to nothing about it when he moved to West Virginia more than four decades ago.

“That was my medical education, and I didn’t have any other because no one really cared about coal miners,” he said.

That would change, thanks to efforts by Rasmussen and others to draw attention to the disease and advocate policies that would better protect coal miners. Their work led to the passage of the Federal Coal Mine Health and Safety Act in 1969, which established standards for coal and rock dust levels in mines.

Passage of the act led to a dramatic drop in black lung rates. But after more than three decades, those rates on appear to be inching back up, particularly among miners in southern West Virginia.

Not only are black lung rates the rise again, the disease appears to be striking miners at an earlier age than it has in the past, according to one health expert. It used to be a disease that was most common in miners who had worked in mines for 25 or more years. Now it is appearing in miners who have worked in mines for less than 25 years.

But not everyone is so sure that recently developed data and its interpretation are valid. A coal industry spokesman said more information would help the industry and regulators clarify what is occurring. A leading federal regulator said he questioned some recent black lung data.

Black lung is a serious disease that is treatable but not curable. It is caused by exposure to coal dust, which destroys lung tissue. It is related to but not the same as the respiratory disease silicosis, which results from prolonged exposure to silica dust from rock mining. Black lung cannot be caused by smoking, although smoking can exacerbate the illness.

At its mildest, black lung may lead to a shortness of breath when miners exert themselves. But when it is advanced, even the slightest efforts become a major undertaking. An action as simple walking across a room could leave a person wheezing for air, Rasmussen said.

And black lung is lethal. It starves the body of oxygen and forces the heart to work harder, causing heart attacks.

“It has caused a lot of early deaths,” Rasmussen said.

Black Lung Science

Black lung killed nearly 15,000 people in the United States from 1990 to 1999, according to the National Institute for Occupational Health and Safety. The median age of death was 78.

The number of deaths declined over those 10 years. A total of 1,975 people died from the disease in 1990. That number had shrunk to 998 deaths by 1999.

But something else happened during the 1990s. About 36 percent of miners who participated in NIOSH studies and had worked in the mines for 25 or more years in a mine had black lung in 1970, according to figures compiled by Dr. Edward Petsonk of NIOSH. That number declined until it reached 7 percent in 1995.

Since then, the number of cases has started to creep back up. The most recent data indicates that 13 percent of miners who had 25 or more years of experience had the disease.

The rise in black lung cases appears to be concentrated in mines in eastern Kentucky, western Virginia and southern West Virginia.

“It does appear that a great predominance of that increase is associated in the southern Appalachian region,” Petsonk said.

NIOSH looked at two West Virginia counties in particular. A survey of 109 miners in Raleigh County found 23 miners had some signs of the disease, with five having advanced cases. Another survey of 54 miners in Upshur County, located in central West Virginia, found five miners with some signs of the disease, including three with advanced cases.

Also, several miners reported in surveys they had chronic coughs, wheezing, chest tightness and other respiratory symptoms.

“In general, I think it is fair to say that southern West Virginia has an increased rate compared to the rest of the country, and that is coming from the various surveys that we have down there,” Petsonk said.

Black lung also appears to be striking miners earlier than it has in the past. The number of cases among those miners who have worked 20 to 24 years is rising, reaching about 6 percent in 2006. The number of cases among miners with less work experience did increase slightly since 1995, but overall it appears to be dropping.

Taking Action

One limitation of NIOSH’s research is that the health surveys are voluntary. Miners must volunteer to have chest X-rays so medical professionals can determine whether they have symptoms of the disease.

The lack of random sampling may bias the data, making it appear there are more miners with black lung than there really are. The testing may only attract those miners who believe there is something wrong with them in the first place, with healthy miners choosing not to participate.

“There is some question about how valid the numbers are,” said Richard Strickler, acting assistant secretary of labor for the federal Mine Safety and Health Administration.

However, he emphasized that doesn’t mean the agency isn’t paying attention to the numbers.

“We’re interpreting them to be an indication there is an increase in black lung disease, and we are doing everything we can to respond to that,” Stickler said.

Stickler pointed out that since the federal mine safety act passed in 1969, black lung rates have been on the decline. It has only been in recent years that they have started to rise again, and that increase appears to be in one part of the country.

MSHA inspectors conduct quarterly inspections of underground mines, searching for safety violations and sampling the air for coal dust and rock dust. The agency has responded to the apparent spike in the disease by stepping up its inspections throughout the affected area.

“We didn’t find an elevated number of violations in doing these inspections,” he said.

Strickler acknowledged that mine operators could behave as good actors when inspectors are on site but commit violations when no one is around. But he also pointed out the lawmaker had doubled fines for safety violations in 2006.

“By increasing the penalties, we hope we can bring about better compliance with the law even if MSHA is not on the job site,” he said.

Finding Causes

The reason black lung cases appear to be on the rise is hard to pinpoint. It has long been known that the disease strikes certain miners more than others, such as roof bolters and highwall drill operators, and that some people are more susceptible than others.

Petsonk believes that a likely reason for the rise is that coal miners in southern West Virginia are drilling into more rock to extract the coal. He said there is currently a tendency to drill fast using large equipment, and that may stir up silica dust, which is 20 times more toxic than coal dust.

However, Petsonk said he cannot be certain because coal mines are not allowing NIOSH researchers the access they need to figure out what is causing the spike in black lung cases. He wants the coal industry “to take a serious attitude toward this.”

“We would like the mine operators to welcome our research,” he said.

That would include making employees take tests to detect black lung and allowing researchers to monitor dust levels at various operations in the mines. Miners may be exposed to dust for relatively short periods of time, but if that dust is highly toxic, that exposure could be very harmful, he said.

Bruce Watzman, vice president of safety, health and human resources for the National Mining Association, said he is not sure what would be gained by having NIOSH conduct dust monitoring. He noted that dust levels already are monitored in accordance with federal regulations, and mines where silica dust is detected at higher levels must operate under a reduced dust standard.

“I don’t see what is to be gained. ... the information is already there,” he said.

Watzman noted that the association supports mandatory X-ray surveillance for miners rather than the voluntary program NIOSH now uses. He also said NIOSH could be more forthcoming in providing information about miner work histories, which may show whether there was any moment in their careers that put them at greater risk for black lung. That information isn’t provided because of privacy concerns.

“The more information all of us have, the better off we are in being able to make reasoned decisions about how to protect miners,” he said. “Some of us are working in a vacuum.”

Regulatory Changes

One thing that some advocates say can be done immediately to stem the apparent rise in black lung would be to lower the federal standards for the permissible amount of coal dust in underground mines.

The Federal Coal Mine Health and Safety Act mandates that coal dust in an underground mine should not exist in concentrations higher than 2 milligrams per cubic meter of air. That standard is stricter when the dust contains at least 5 percent silica.

Several groups have argued that the standard needs to be lowered. Among them is NIOSH and a congressional committee that in 1996 issued a report saying steps should be taken to reduce the standard. MSHA was on track to do just that until 2001, when President Bush took office and the agency dropped its plans.

The agency’s refusal to lower the standard has prompted a lawsuit from the Appalachian Center for the Economy and the Environment, which wants it set at 1 milligram per cubic meter of air.

“MSHA has known since the mid-90s the levels are too high,” said Nathan Fetty, the center’s staff attorney. “They are twice what they should be, and it needs to cut those levels in half to reduce and eliminate new cases of black lung.”

The lawsuit is currently before the Sixth Circuit Court, where a judge in Cincinnati is weighing a request by MSHA to dismiss it.

Phil Smith, communications director for the United Mine Workers of America, said the rise in new cases could mean one of two things: Either the current dust standard is too high and it needs to be lowered, or it isn’t being enforced.

He blamed the industry for fighting “tooth and nail” against federal efforts to resolve the problem and get benefits to miners with black lung.

“This isn’t just something that happens to people in their 60s or 70s,” he said. “This is something that has been happening to people working in industry for 20 years, and these people are in their 40s.”

At a state level, Ron Wooten, director of the West Virginia Office of Miners’ Health, Safety and Training, said his office was aware of the situation. He noted mines are required to undergo four inspections a year, but that doesn’t always catch violations because dust levels may vary from one day to the next.

“They can be in compliance one day and out of compliance the next,” he said.

Wooten said there have been discussions about black lung ever since the passage of the mine safety act in 1969. Those discussions are ongoing, he said.

“We continue to talk about it,” he said. “It is still obviously an issue.”