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W. Alex Wade, MD; Edward L. Petsonk, MD, FCCP; Byron Young; Idrees Mogri, MD
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From the Section of Pulmonary and Critical Care Medicine, Department of Medicine (Drs Wade, Petsonk, and Mogri), West Virginia University School of Medicine; and the Occupational Lung Center (Mr Young), Charleston Area Medical Center.

Correspondence to: Edward L. Petsonk, MD, FCCP, West Virginia University School of Medicine, Box 9166, Morgantown, WV 26506; e-mail: epetsonk@hsc.wvu.edu


Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;140(5):1388-1389. doi:10.1378/chest.11-1624
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To the Editor:

We appreciate the input of Dr Diaz-Guzman and his colleagues at the University of Kentucky Transplant Center, who commented on our study of 138 cases of severe and fatal pneumoconiosis in West Virginia coal miners.1 Their letter reviews some of the recent trends in coal workers pneumoconiosis (CWP) in the United States and summarizes patient survival among eight coal miners with advanced and life-threatening pneumoconiosis who received single and double lung transplants at the Kentucky Center. Their center reports a 1-year and 3-year survival among patients with CWP that is similar to those with other indications for lung transplantation; six of the eight miners remained alive after a mean follow-up of 1,013 days after transplantation.2

Enfield et al3 at the University of Virginia also recently reviewed outcomes in 30 patients at multiple centers who underwent lung transplantation for severe CWP since 1987, using the database of the United Network for Organ Sharing. In the University of Virginia analysis, after accounting for age, lung allocation score, and type of transplant, 1-year survival after transplantation appeared to be significantly lower in patients with CWP (61%) compared with non miner patients with COPD (82%) or interstitial lung disease (78%). However, independent of the exact prognosis of CWP after transplant, the reality of advanced CWP is that medical treatment may ameliorate symptoms but does not reverse the lung damage or halt the progressive fibrotic process.

Because of this, we agree that lung transplantation must be considered an option, particularly for the younger miners who are now developing this disorder.4 Dr Diaz-Guzman and colleagues encourage increasing awareness of advanced CWP and early referral to a transplant center, in recognition that massive fibrosis in coal miners often progresses even after removal from dust exposure. We concur that the medical community needs to be more effective in enhancing awareness of the continuing human toll from these dust diseases and in assuring optimal medical care and fair compensation for affected miners. Progressive massive fibrosis is entirely preventable, since it is virtually only caused by excessive dust inhalation and does not occur from tobacco use or other causes. Effective dust controls should have eliminated this type of lung disease in a modern mining industry, and the failure of the US industry to tackle this ongoing problem has been highlighted internationally.5 In addition to drawing attention to the role of lung transplantation to improve survival and functional status in these patients, we hope our report’s findings can motivate timely implementation of the necessary effective measures to reduce dust exposures and provide a healthful working environment for our country’s coal miners.

Wade AW, Petsonk EL, Young B, Mogri I. Severe occupational pneumoconiosis among West Virginian coal miners: one hundred thirty-eight cases of progressive massive fibrosis compensated between 2000 and 2009. Chest. 2011;1396:1458-1462 [CrossRef] [PubMed]
 
Diaz-Guzman E, Hayes D, Mullett T, Bonell M, Maynard R, Kraman S. Lung transplantation in patients with coal workers pneumoconiosis [abstract]. Am J Respir Crit Care Med. 2010;181:A4317
 
Enfield KB, Floyd S, Peach P, Sifri CD, Lau C, Robbins M. Transplant outcome for coal workers pneumoconiosis. Abstract 1328. Presented at: American Transplant Congress. May 2, 2010; San Diego, CA
 
Attfield MD, Petsonk EL. Centers for Disease Control and Prevention Centers for Disease Control and Prevention Advanced pneumoconiosis among working underground coal miners—Eastern Kentucky and Southwestern Virginia, 2006. MMWR. 2007;5626:652-655 [PubMed]
 
Seaton A. Coal workers’ pneumoconiosis in small underground coal mines in the United States. Occup Environ Med. 2010;676:364 [CrossRef] [PubMed]
 

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References

Wade AW, Petsonk EL, Young B, Mogri I. Severe occupational pneumoconiosis among West Virginian coal miners: one hundred thirty-eight cases of progressive massive fibrosis compensated between 2000 and 2009. Chest. 2011;1396:1458-1462 [CrossRef] [PubMed]
 
Diaz-Guzman E, Hayes D, Mullett T, Bonell M, Maynard R, Kraman S. Lung transplantation in patients with coal workers pneumoconiosis [abstract]. Am J Respir Crit Care Med. 2010;181:A4317
 
Enfield KB, Floyd S, Peach P, Sifri CD, Lau C, Robbins M. Transplant outcome for coal workers pneumoconiosis. Abstract 1328. Presented at: American Transplant Congress. May 2, 2010; San Diego, CA
 
Attfield MD, Petsonk EL. Centers for Disease Control and Prevention Centers for Disease Control and Prevention Advanced pneumoconiosis among working underground coal miners—Eastern Kentucky and Southwestern Virginia, 2006. MMWR. 2007;5626:652-655 [PubMed]
 
Seaton A. Coal workers’ pneumoconiosis in small underground coal mines in the United States. Occup Environ Med. 2010;676:364 [CrossRef] [PubMed]
 
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