Question 1 of 10

    Anthracosis (Miner's Asthma)

    Miner spirometry (9253624711)[1]

    Anthracosis is a form of pneumoconiosis, a chronic pulmonary disease resulting from prolonged inhalation of dust. This condition results from prolonged inhalation of soot or coal dust particles which render the lungs black.

    The disorder is triggered by the following process: Poison.

    Presentation

    Because anthracosis results from prolonged exposure to coal dust or soot particles, diagnosis of this condition is largely based on anamnesis. Patients may report to have worked in coal mines, but any other occupation or living conditions associated with these risk factors may also hint at anthracosis. In one study, traditional indoor baking has been related with anthracosis [3]. The age at first exposure and its overall time should be taken into account. It is important to know if the patient smokes, since smoking may trigger or aggravate symptoms like chronic productive cough, dyspnea and reduced tolerance to exercise. In patients suffering from advanced anthracosis or anthracofibrosis, symptoms of right heart failure may develop [6]. These individuals may additionally suffer from fatigue, severe dyspnea even at rest, cyanosis, venous congestion and peripheral edema. Such severe cases of anthracosis are rare and the majority of patients is indeed asymptomatic.

    Entire body system
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  • respiratoric
    Chronic Cough
    • This is the most common type of anthracosis and may generate no symptoms or mild symptoms such as DYSPNEA (shortness of breath) with exertion and chronic COUGH.[beltina.org]
    • An 83-year-old African American male patient presented with chronic cough for many years.[hindawi.com]
    • Once COPD sets in or extensive fibrosis as is seen with complicated CWP, then a chronic cough and difficulty breathing (dyspnea) may become prominent.[healthhype.com]
    Chronic Productive Cough
    • Chronic productive cough, dyspnoea, haemoptysis, chest pain, fever and general weakness 1-2 .[radiopaedia.org]
    Cough
    • […] through the mouth abnormal crackling sound made during inspiration; typically indicates presence of fluid or mucus in the airways another term for wheezing; the sound made during expiration usually found in asthma or infection mucus or phlegm coughed[quizlet.com]
    • Symptoms include worsening cough and dyspnea.[beltina.org]
    • Medical Dictionary plural anthracoses play \ -ˌsēz \ : black discoloration of bronchi from carbon pigment that typically causes deformation and obstruction, may be asymptomatic or cause respiratory symptoms (such as cough and labored breathing), and is[merriam-webster.com]
    • Similarly, Mirsadree et al . [12] stated dyspnea in 95% and cough in 86% cases of anthracosis.[lungindia.com]
    • Symptoms of Black Lung Disease As with other types of pneumoconiosis, the symptoms of difficulty breathing , cough and sputum .[healthhype.com]
    Dyspnea
    • […] bluish tint of skin receiving insufficient oxygen or circulation to cough up blood or blood-stained sputum to breathe both too fast and too deep to breathe both too slow and too shallow two-pronged plastic device for deliviering oxygen into the nose dyspnea[quizlet.com]
    • Symptoms include worsening cough and dyspnea.[beltina.org]
    • Similarly, Mirsadree et al . [12] stated dyspnea in 95% and cough in 86% cases of anthracosis.[lungindia.com]
    • He reported mild progressive dyspnea on exertion improving with rest.[hindawi.com]
    • Most patients are presented with cough, dyspnea and sputum.[omicsonline.org]
    Productive Cough
    • Chronic productive cough, dyspnoea, haemoptysis, chest pain, fever and general weakness 1-2 .[radiopaedia.org]
    • More commonly, workers exposed to coal dust develop industrial bronchitis, clinically defined as chronic bronchitis (i.e. productive cough for 3 months per year for at least 2 years) associated with workplace dust exposure.[en.wikipedia.org]
    Sputum Production
    • He denied hemoptysis or sputum production.[hindawi.com]
    • Patients may report some sputum production with simple CWP but this can be transient.[healthhype.com]
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  • cardiovascular
    Chest Pain
    • Chronic productive cough, dyspnoea, haemoptysis, chest pain, fever and general weakness 1-2 .[radiopaedia.org]
    • Symptoms of Anthracosis No early symptoms Few symptoms Cough Chest pain Breathing problems more symptoms...»[rightdiagnosis.com]
    • pain with each breath another term for pleurisy testing the gases present in the blood x-ray of the lung after a radiopaque substance has been inserted into the trachea or bronchial tube injection of dye into a blood vessel for the purpose of taking[quizlet.com]
    Cyanosis
    • […] spasms of the bronchi (bronchospasms) abnormal enlargement of the bronchi, possibly due to infection malignant tumor originating in the bronchi adult respiratory distress syndrome acute respiratory failure in adults characterized by tachypnea, dyspnea, cyanosis[quizlet.com]
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  • Workup

    If the medical history of a patients indicates a chronic exposure to coal dust or soot particles, anthracosis should be considered before confirming diagnosis of chronic obstructive pulmonary disease, asthma, tuberculosis or idiopathic pulmonary fibrosis [7]. The gold standard for the diagnosis of anthracosis is bronchoscopy, a technique that allows visualization of black depositions on respiratory mucous membranes and smooth narrowing of the bronchial tubes. Computed tomography scans often reveal enlargement and calcification of regional lymph nodes. Further characteristic findings include diffuse calcification, atelectasis, emphysema and pleural effusion [8] [9]. Mass lesions may require biopsy and histopathological analysis.

    Pulmonary function tests, particularly spirometry, should be carried out to assess the extent of lung damage.

    Of note, anthracosis possibly facilitates mycobacterial infections and large numbers of anthracosis patients also suffer from tuberculosis [5] [10]. Here, interferon-γ release assays, bacterial cultures and molecular biological confirmation of Mycobacteria spp. are the diagnostic measures of choice. Sputum samples obtained during bronchoscopy may be used for the latter.

    Pathology

    Biopsy
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  • Test Results

    Pulmonary Function Test
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  • Laboratory

    Serum
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  • ECG

    Axis
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  • Imaging

    X-ray
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  • Treatment

    Causative treatment for anthracosis is not available. Thus, therapy is palliative and aims at preventing exacerbation.

    In most cases, the source of coal dust or soot particles may easily be identified. If it persists, exposure should be reduced as far as possible. Unfortunately, job changes are often not an option. However, shifting the affected worker to an area with less exposure to volatile matter may be possible.

    Patients should be strongly advised not to smoke.

    Rehabilitation programs may improve dyspnea, tolerance to exercise, and overall quality of life. Exercise is an important part of such programs but should start slowly.

    Severe cases of anthracosis or anthracofibrosis, i.e., those presenting a very low arterial oxygen saturation, may require continuous oxygen therapy. Nocturnal oxygen desaturation may occur and blood gas analyses conducted at daytime may thus underestimate the risk for hypoxia. If desaturation at night is a problem, oxygen therapy should be applied while the patient is sleeping.

    Patients may additionally benefit from bronchodilators.

    If response to therapy is not satisfactory, patients should be considered for lung transplantation.

    In some countries, occupational rights may entitle affected workers to compensation [11]. Thus, they should be advised to invoke these rights, possibly after seeking legal counseling.

    Prognosis

    Prognosis depends on the severity of disease. Although the condition is not reversible, mild cases do not necessarily affect the quality of life. Anthracofibrosis has a poor diagnosis.

    Complications

    Anthracosilicosis
    • Applicable To Anthracosilicosis Anthracosis Black lung disease Coalworker's lung Type 1 Excludes Type 1 Excludes Help A type 1 excludes note is a pure excludes.[icd10data.com]
    • Anthracosis Coal miners' lung 515.1 Coal workers' pneumoconiosis Anthracosilicosis Anthracosis Black lung disease Coal workers' lung Miners' asthma 500 Coal workers' pneumoconiosis Anthracosilicosis Anthracosis Coal workers' lung J60 Silicosis Silicosis[www2a.cdc.gov]
    • This lung lesion usually occurs in coal miners, but can be seen in urban dwellers and tobacco smokers Applies To Anthracosilicosis Anthracosis Black lung disease Coal workers' lung Miners' asthma ICD-9-CM Coding Information 500 is only applicable to adult[icd9data.com]
    • Disease Topics Related To Anthracosis Research the causes of these diseases that are similar to, or related to, Anthracosis: Anthracosilicosis Anthracotic tuberculosis Anthracosis Simple coal worker's pneumoconiosis SCWP complicated coal worker's pneumoconiosis[rightdiagnosis.com]
    Caplan Syndrome
    • The presence of rheumatoid arthritis along with coal worker’s pneumoconiosis is known as Caplan’s syndrome .[healthhype.com]
    • Black Lung Benefits Act of 1973 Caplan syndrome NIOSH Mining Topic: Respiratory Diseases NIOSH Coal Workers' Health Surveillance Program NIOSH Faces of Black Lung video Mine Safety and Health Administration 42CFR27 Specifications of Medical Examinations[en.wikipedia.org]
    • Progressive massive fibrosis in association with rheumatoid arthritis is known as Caplan syndrome.[emedicine.medscape.com]
    Chronic Bronchitis
    • J40 Simple and mucopurulent chronic bronchitis Simple chronic bronchitis Mucopurulent chronic bronchitis Mixed simple and mucopurulent chronic bronchitis J41 Unspecified chronic bronchitis J42 Emphysema MacLeod's syndrome Panlobular emphysema Centrilobular[www2a.cdc.gov]
    • Read more on : Chronic bronchitis symptoms Emphysema symptoms[healthhype.com]
    • Bronchitis -- Rare Types Lung Cancer -- Rare Types Sinusitis -- Rare Types Cystic Fibrosis -- Rare Types Obstructive Sleep Apnea -- Rare Types more rare diseases...»[rightdiagnosis.com]
    • It is a slow-acting, chronic disease that takes one or two decades to cause symptoms, but its effects can be severely disabling, causing pulmonary emphysema or chronic bronchitis.[micro.magnet.fsu.edu]
    • At smokers the further aggravation of symptoms leads to chronic bronchitis and emphysema.[en.medicalmeds.eu]
    Pneumoconiosis
    • This research was known as the Pneumoconiosis Field Research (PFR).[en.wikipedia.org]
    • Coal worker’s pneumoconiosis may be categorized as simple CWP or complicated CWP .[healthhype.com]
    • J61 Pneumoconiosis due to asbestos and other mineral fibers J62 Pneumoconiosis due to dust containing silica J62.0 Pneumoconiosis due to talc dust J62.8 Pneumoconiosis due to other dust containing silica J63 Pneumoconiosis due to other inorganic dusts[icd10data.com]
    • pneumoconiosis, including unspecified Pneumoconiosis: n.o.s. due to: silicates n.e.c. talc 515.9 Pneumoconiosis, unspecified 505 Unspecified pneumoconiosis J64 ICD-9 (1979–1998) 2 ICD-10 (1999–present) 3 Condition Rubric Code Rubric Code Malignant Mesothelioma[www2a.cdc.gov]
    • Also called black lung disease , coal worker's pneumoconiosis , miner's pneumoconiosis.[medical-dictionary.thefreedictionary.com]
    Pulmonary Emphysema
    • It is a slow-acting, chronic disease that takes one or two decades to cause symptoms, but its effects can be severely disabling, causing pulmonary emphysema or chronic bronchitis.[micro.magnet.fsu.edu]
    • The early stages of the disease (when it is called anthracosis) usually have no symptoms, but in its more advanced form it frequently is associated with pulmonary emphysema or chronic bronchitis and can be disabling; tuberculosis is also more common in[britannica.com]
    Pulmonary Fibrosis
    • Caplan’s syndrome is when the massive pulmonary fibrosis (complicated CWP) occurs along with rheumatoid arthritis.[healthhype.com]
    • ) NOS Postinflammatory pulmonary fibrosis with anthracosilicosis J60 anthracosis J60 Lymphadenitis I88.9 ICD-10-CM Diagnosis Code I88.9 Nonspecific lymphadenitis, unspecified 2016 2017 2018 Billable/Specific Code Applicable To Lymphadenitis NOS anthracosis[icd10data.com]
    • Research of Anthracosis has been linked to Pneumoconiosis, Lung Diseases, Fibrosis, Silicosis, Pulmonary Fibrosis.[novusbio.com]
    Pulmonary Hypertension
    • With progression, perivascular and peribronchiolar collagen deposits will produce pulmonary hypertension.[pathologyatlas.ro]
    Pulmonary Tuberculosis
    • Other specified pulmonary tuberculosis Pulmonary tuberculosis, unspecified 011 Respiratory tuberculosis, not confirmed bacteriologically or histologically Tuberculosis of lung, bacteriologically and histologically negative Tuberculosis of lung, bacteriological[www2a.cdc.gov]
    • Conclusions: Anthracosis is associated with pulmonary tuberculosis.[lungindia.com]
    • The majority of the cases come from Asia with strong association with pulmonary tuberculosis, 31.4% of all reported cases to date [ 1 – 6 ].[hindawi.com]
    Respiratory Failure
    • failure in adults characterized by tachypnea, dyspnea, cyanosis, tachycardia, and hypoxemia type of pneumoconiosis that develops from the collection of coal dust in the lung another term for anthracosis another term for anthracosis type of pneumoconiosis[quizlet.com]
    Silicosis
    • Radiographically, CWP can appear strikingly similar to silicosis.[en.wikipedia.org]
    • People with silicosis are at high risk for developing tuberculosis (silico-tuberculosis).[pathologyatlas.ro]
    • It may also be seen in asbestosis and silicosis.[healthhype.com]
    • Silicosis Fibroid phthisis caused by the inhalation of silicous particles.[antiquusmorbus.com]
    • Silicosis Calcicosis Chalicosis 515.0 Pneumoconiosis due to other silica or silicates Pneumoconiosis due to talc Silicotic fibrosis (massive) of lung Silicosis (simple) / (complicated) 502 Pneumoconiosis due to dust containing silica Silicotic fibrosis[www2a.cdc.gov]
    Tuberculosis
    • Tuberculosis of intrathoracic lymph nodes Isolated tracheal or bronchial tuberculosis Tuberculous laryngitis Other specified respiratory tuberculosis 012 Miliary tuberculosis Acute miliary tuberculosis Other specified miliary tuberculosis Miliary tuberculosis[www2a.cdc.gov]
    • Tuberculosis should be confirmed by microbiological (smear or culture) or histopathological methods.[erj.ersjournals.com]
    • Relation of bronchial anthracosis with Mycobacterium tuberculosis .[journals.lww.com]
    • Conclusions: Anthracosis is associated with pulmonary tuberculosis.[lungindia.com]
    • CT differentiation of anthracofibrosis from endobronchial tuberculosis.[radiopaedia.org]
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  • Etiology

    Anthracosis is a typical occupational disease of coal miners, although it has been reported in patients that have never been working below ground [3].

    In general, a young age at first exposure, prolonged exposure, i.e., several years of working underground or in any other environment loaded with high amounts of soot particles, and smoking are the main risk factors for this disease. There is a clear correlation between the aforementioned parameters and the severity of anthracosis.

    Additionally, the size of coal dust or soot particles affects the development of anthracosis. Both are generally estimated to measure between 1 and 100 µm, i.e., although many particles are retained at bronchial tube level, the smaller share of such particles may penetrate into the bronchioles and possibly even into the alveoli.

    Coal miners may work with distinct types of carbonaceous rocks that may contain more volatile material than others. In general, the older the coal, the more compact it is. Anthracite, for instance, comprises small amounts of volatile matter and thus exposure to it bears much lower risks of anthracosis than the same amount of exposure to lignite. Also, certain types of jobs within coal mines may involve greater exposure to volatile matter than others.

    Epidemiology

    Definitive diagnosis of anthracosis requires bronchoscopy. Since many patients suffering from mild to moderate anthracosis remain asymptomatic, black depositions on the respiratory mucous membranes are often incidental findings. Furthermore, there is no clear definition for the terms healthy respiratory tract and anthracosis. In smokers, this may be a very challenging question. Therefore, the overall prevalence of anthracosis may only be roughly estimated. In a large study comprising more than 14,000 bronchoscopies conducted in Iran, about 5% of all patients were found to show signs of anthracosis [4]. About one third of those patients suffered from anthracofibrosis. Of note, considerable differences in anthracosis prevalence between distinct geographical regions may exist. The true number of patients affected by anthracosis presumably depends on the occupation and life-style of the population, as well as on industry and air pollution of the respective country.

    Due to the etiology of the disease, anthracosis is very rarely diagnosed in children. The mean age of symptom onset is 63 years [5]. Although there are more men among coal miners than women, anthracosis also affect females. In fact, many studies show even higher prevalence rates in women than in men [1].

    Sex distribution
    Age distribution

    Pathophysiology

    Inhalation of coal dust or soot particles initially leads to asymptomatic deposition on the mucous membranes of the respiratory tract. To a certain degree, this phenomenon can be observed in any smoker and in individuals living in urban environments.

    If foreign bodies entering the respiratory tract cannot be removed by means of ciliary movement, macrophages will try to remove them. When only small quantities of particles are present, this process leads to subsequent excretion of particles in the mucus or removal by means of the lymphatic system. However, macrophages accumulate on the mucous membranes if coal dust or soot particles cannot be removed efficiently due to excessive amounts that exceed the self-cleaning capacities of the respiratory tract. These macrophages release pro- and anti-inflammatory mediators and trigger fibroblast proliferation. Matrix metalloproteinases, tissue inhibitors of metalloproteinases, and distinct cytokines may be released in this process. Unfortunately, growth of fibrous tissue further complicates removal of foreign bodies. In most cases though, inhalation of coal dust or soot particles continues for extensive periods and more dust accumulates in the respiratory tract.

    Fibrosis does not only restrict the airways but may also contribute to the compression of vasculature and lymphatic vessels. This may lead to atelectasis and emphysema, and may also cause ischemic necrosis. All these processes worsen pulmonary gas exchange and arterial oxygen saturation and may ultimately provoke respiratory failure.

    Anthracosis patients are particularly susceptible to infections with Mycobacterium spp. Tuberculosis is a comorbidity that aggravates the aforementioned pathophysiological processes.

    Prevention

    Implementation and application of measures for occupational safety largely contribute to prevention of anthracosis. This is not restricted to coal mining but also applies to any other profession that involves significant exposure to dust. Individuals performing such jobs should undergo regular examinations and thoracic radiographies.

    Similarly, measures to reduce air pollution in general may be helpful to avoid anthracosis.

    Smoking is not recommended by any means.

    Summary

    Anthracosis is a type of pneumoconiosis, a term referring to any chronic pulmonary disease caused by inhalation of considerable amounts of dust. While pneumoconiosis may be develop in individuals who chronically inhale asbestos, silica, or cotton, patients suffering from anthracosis have been exposed to coal dust or soot particles for prolonged periods of time. Thus, anthracosis is commonly seen in coal miners, and the condition is often referred to as coal worker's pneumoconiosis or black lung disease. Since anthracosis is an occupational disease, its diagnosis may have legal consequences wherein patients may be possibly entitled to financial compensation.

    Deposition of coal dust on the mucous membranes of the respiratory tract may be an incidental finding. Majority of anthracosis patients are asymptomatic, whereas some develop chronic cough, dyspnea and intolerance to exercise [1]. Symptoms typically manifest in those individuals that have either been exposed to coal dust or soot for very long periods of time or those that have inhaled large amounts of dust in shorter time ranges. Smoking exacerbates anthracosis.

    If ciliary movement is unable to remove coal dust or soot particles from the airways by ciliary movement, macrophages will attempt to remove these particles. Activation of macrophages results in the release of pro-inflammatory cytokines and induction of fibroblast proliferation. Due to this effect, severe cases of anthracosis are often associated with progressive massive fibrosis [2]. Because the particles mainly deposit in the bronchial tubes, this condition is also known as bronchial anthracofibrosis.

    Pulmonary function tests can help assess the extent of the disease. Diagnostic imaging, particularly computed tomography scans, allows for an evaluation of pulmonary tissue and lymph nodes. Fibrosis and calcification are also common findings.

    Therapy is palliative and is aimed at symptom relief and prevention of further exacerbation. The most important therapeutic measures are avoidance of coal dust or soot particle exposure and smoking cessation.

    Patient Information

    Anthracosis refers to a chronic pulmonary disease characterized by deposition of coal dust or soot particles on the mucous membranes of the respiratory tract.

    Causes

    Usually, any inhaled small particle is transported back upwards by means of the ciliary movement of the mucous membranes. Prolonged exposure to coal dust or soot particles, however, exceeds the self-cleaning capacities of the lungs and results in the aforementioned condition.

    Coal miners inhale large amounts of coal dust that may be deposited on the mucous membranes. Similarly, anyone continuously exposed to smoke may develop this disease. Immune cells try to remove the inhaled particles and induce chronic inflammation and pulmonary fibrosis.

    Smoking and air pollution exacerbate the disease.

    Symptoms

    Most patients remain asymptomatic for years. Symptoms such as productive cough, breathing difficulties and intolerance to exercise typically manifest in patients aged 60 years and older. Severe cases of anthracosis may lead to right heart failure.

    Diagnosis

    The patient's medical history is of the utmost importance in the diagnosis of anthracosis and the choice of treatment. This condition is confirmed by performing bronchoscopy and visualizing black depositions on mucous membranes of the respiratory tract. Pulmonary function tests and computed tomography scans are helpful to assess the extent of lung damage. The latter also serves to rule out differential diagnoses.

    Treatment

    There is no causative treatment for anthracosis. If at all possible, the patient should avoid the source of coal dust or soot particles. Any reduction of exposure to this matter also prevents exacerbation of the disease. If a job change is not an option, it may be possible to change to a position that involves less exposure to dust.

    Smokers should stop smoking.

    Exercise programs may help to relieve breathing difficulties and intolerance to exercise. They should be realized under professional supervision.

    If the pulmonary gas exchange is strongly restricted, continuous oxygen therapy may be required. In some patients, blood oxygen saturation only drops at night and thus, oxygen supplementation is only necessary while sleeping.

    Additional medication may provide some relief by widening the bronchial tubes. However, if this is not the case and the patient is at acute risk of respiratory failure, they may be considered for lung transplantation.

    Of note, in some countries, occupational rights may entitle anthracosis patients to compensation.

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    References

    1. Mirsadraee M. Anthracosis of the lungs: etiology, clinical manifestations and diagnosis: a review. Tanaffos. 2014; 13(4):1-13.
    2. Laney AS, Petsonk EL, Hale JM, Wolfe AL, Attfield MD. Potential determinants of coal workers' pneumoconiosis, advanced pneumoconiosis open link open link, and progressive massive fibrosis among underground coal miners in the United States, 2005-2009. Am J Public Health. 2012; 102 Suppl 2:S279-283.
    3. Qorbani M, Yunesian M, Baradaran HR. Indoor smoke exposure and risk of anthracosis. Iran J Med Sci. 2014; 39(6):571-576.
    4. Sigari N, Mohammadi S. Anthracosis and anthracofibrosis. Saudi Med J. 2009; 30(8):1063-1066.
    5. Mirsadraee M, Saffari A, Sarafraz Yazdi M, Meshkat M. Frequency of tuberculosis in anthracosis of the lung: a systematic review. Arch Iran Med. 2013; 16(11):661-664.
    6. Agrawal A, Verma I, Shah V, Agarwal A, Sikachi RR. Cardiac manifestations of idiopathic pulmonary fibrosis. Intractable Rare Dis Res. 2016; 5(2):70-75.
    7. Laney AS, Weissman DN. Respiratory diseases caused by coal mine dust. J Occup Environ Med. 2014; 56 Suppl 10:S18-22.
    8. Kuempel ED, Wheeler MW, Smith RJ, Vallyathan V, Green FH. Contributions of dust exposure and cigarette smoking to emphysema severity in coal miners in the United States. Am J Respir Crit Care Med. 2009; 180(3):257-264.
    9. Ghanei M, Aslani J, Peyman M, Asl MA, Pirnazar O. Bronchial anthracosis: a potent clue for diagnosis of pulmonary tuberculosis. Oman Med J. 2011; 26(1):19-22.
    10. Mirsadraee MH, Asnashari AK, Attaran DM. Tuberculosis in patients with anthracosis of lung underlying mechanism or superimposed disease. Iran Red Crescent Med J. 2011; 13(9):670-673.
    11. Office of Workers' Compensation Programs, Labor. Black Lung Benefits Act: standards for chest radiographs. Final rule. Fed Regist. 2014; 79(74):21606-21615.

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    Media References

    1. Miner spirometry (9253624711), Public Domain

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