Anthracosis (also called coal workers’ pneumoconiosis) is a lung disease in which dust containing coal is deposited in the lungs. The disease, which is usually uncomplicated, occurs when a person breathes air contaminated with soot and coal particles over a long period of time. The disease was first researched at the beginning of the 20th century, when it was found particularly in workers in coal mines.
What is anthracosis?
Anthracosis (from Greek anthrax, “coal”) is a pathological change in the lungs. It is caused by inhalation of dust containing coal. Due to prolonged, excessive exposure of the affected person, the self-cleaning mechanism of the lungs is overloaded. As a result, the soot and charcoal particles that are inhaled with the air disperse in the lungs and become lodged. The storage takes place in the alveoli (air sacs), the intercellular spaces of the bronchi, and in the vicinity of blood and lymph vessels, as well as in lymphatic channels and nodes. The deposits cause the lungs to become increasingly dark in color. Anthracosis is a type of pneumoconiosis (Greek pneuma, “air” and konis, “dust”), also called pneumoconiosis. Here, the lung tissue reacts to various inhaled and stored dusts. The individual types of pneumoconiosis are differentiated according to the type of dust that triggers them. The coal dust itself inhaled in anthracosis does not damage the lungs. Also, simple anthracosis is usually not noticeable by symptoms. However, it can result in other, more serious diseases of the lungs.
Causes
The cause of anthracosis is inhalation of air contaminated with coal dust. People who have worked in a coal mine for several years are particularly affected. Other sources of the causative coal dust are exhaust fumes from internal combustion engines and cigarette smoke. If a person breathes in air that is heavily contaminated with soot and coal particles over a long period of time, this overtaxes the lungs’ self-cleaning mechanism: the bronchi and bronchioles (larger and smaller branches of the respiratory system) are lined with mucus-secreting cells and cilia. The mucus binds inhaled pollutants. The cilia continuously move the mucus with the foreign particles adhering to it out of the lungs toward the throat. There it is swallowed or coughed up. If the finest dust penetrates into the alveoli, macrophages (scavenger cells), part of the immune system, break it down. Under normal conditions, the lungs clean themselves in this way. However, if this mechanism is overloaded, the dust particles can no longer be flushed out or broken down. They spread throughout the lungs to the alveoli and become lodged.
Symptoms, complaints, and signs
If the inhaled coal dust distributes in the lungs, it can close the airways as the disease progresses. The deposits show up as small spots on chest x-rays. In the case of simple anthracosis, there are usually no symptoms. If there is an additional disease of the respiratory tract, for example bronchitis, there is increased coughing and shortness of breath. This is particularly the case in smokers. Coughing and shortness of breath also occur in severe anthracosis. If anthracosis leads to emphysema, the affected person suffers from shortness of breath. In advanced massive pulmonary fibrosis, which can also be caused by anthracosis, there is coughing and severe shortness of breath and even severe shortness of breath.
Diagnosis and course
Diagnosis of anthracosis is made by imaging techniques. The physician takes X-rays and performs a computed tomography scan of the chest. Anthracosis presents with characteristic spots in the lungs. The disease is usually uncomplicated. However, in a small proportion of those affected, it develops into a more serious disease. Anthracosis can lead to the formation of emphysema. In this case, hyperinflation of the lungs leads to irreversible damage. Anthracosis also favors other lung diseases, especially massive, progressive pulmonary fibrosis. In this case, an abnormal amount of connective tissue forms in the lungs, which impairs oxygen uptake. Pulmonary fibrosis can worsen even if the affected person no longer breathes air containing carbon dust.
Complications
Anthracosis usually results in severe lung and respiratory disease. In most cases, the course of the disease and its associated complications depend on how much carbon dust has become lodged in the patient’s lungs. Often, anthracosis is reversible, so there is no further subsequent damage. Anthracosis can cause acute respiratory distress and severe coughing in many patients. In suitable cases, hemoptysis also occurs. If the cough gets worse, shortness of breath may occur. In rare cases, anthracosis leads to death when the patient cannot breathe. If anthracosis is not treated promptly by a physician, irreversible damage to the lungs may occur. Often, the symptom recedes only slowly, even if the affected person breathes only clean air. Due to problems with the lungs, endurance activities can no longer be performed. This has a particularly negative effect on work and sports. In general, the patient’s everyday life is also made very difficult. As a rule, there is no treatment. However, in the case of anthracosis, the patient must no longer breathe in air containing carbon, thereby attenuating the symptom.
When should you see a doctor?
Anthracosis should be investigated at the first signs of the disease. As soon as there is increased coughing and shortness of breath, a doctor must clarify the cause and, if necessary, treat it directly. Smokers and coal miners in particular should consult a doctor when they experience the typical symptoms. This is especially true if they are associated with health complaints or worsen the general condition. In case of severe shortness of breath and coughing attacks, an emergency doctor should be called. Sometimes severe respiratory distress also occurs, in which case first aid measures should be taken until the arrival of the emergency services. If anthracosis is suspected, a doctor must therefore be consulted in any case. Although the majority of treatment measures can be carried out independently, a clear diagnosis is necessary. In addition, those affected should be vaccinated against pneumococcus and influenza in order to reduce the risk of infection. If left untreated, pneumoconiosis can cause irreversible lung damage and further complications. In severe cases, anthracosis ends in death by suffocation.
Treatment and therapy
Anthracosis cannot be cured. However, the progression of the disease can be slowed or halted by minimizing the exposure of the affected person’s lungs to air containing carbon dust. If the sufferer experiences shortness of breath, it may be necessary to take medication to keep the airways open and thin the mucus.
Outlook and prognosis
The prognostic outlook for anthracosis depends on the degree of damage to the lungs as well as the airways. However, in modern times, the chances of recovery are generally considered good. If the contact with coal and coal dust is considered low, there is a significant reduction of the disease as well as serious problems. In most cases, the deposits of coal dust do not cause permanent damage to the lung tissue. Thus, in normal cases, no functional impairment of the lung activity is to be expected. As soon as the affected person is able to breathe in sufficient oxygen, the symptoms are alleviated and removal of the pollutants takes place. However, the respiratory tract is more easily susceptible to permanent damage. The vascular walls can be damaged by the soot particles. With medical care, the symptoms usually subside almost completely within a few weeks. A complete cure of anthracosis is then possible. A healing process is more difficult if there is additional consumption of other harmful or toxic substances. The consumption of tobacco or cigarettes, for example, worsens the healing process. Permanent damage to the tissue and cancer may result. Without treatment, there is a risk of life-threatening disease progression. With a complete renunciation of nicotine, a significant improvement occurs within a few months and freedom from symptoms after a few years.
Prevention
Since existing anthracosis cannot be cured, prevention is all the more important. Lung exposure to coal dust should be minimized by reducing coal dust emissions in the workplace.Ventilation systems and respiratory filters are also beneficial for cleaning the air we breathe, but do not provide complete protection. People who regularly handle hard coal are advised to have annual chest x-rays. In this way, possible disease can be detected at an early stage. In the event of a positive finding, the affected person should be transferred to a workplace where the air is exposed to as little coal dust as possible. This prevents the progression of the disease and advanced pulmonary fibrosis. Coal miners who smoke can reduce the risk of developing the disease by quitting smoking. In addition, coal miners can get pneumococcal and influenza vaccinations to protect against infections to which they may have an increased susceptibility.
Follow-up
Anthracosis patients usually suffer from health problems throughout their lives. After the disease has been treated out, they need to go for regular follow-up so that the progression of existing symptoms can be checked. The doctor will also ask the patient if there are any unusual symptoms, and if so, what they are. If coughing, shortness of breath or symptoms of bronchitis become noticeable, medication may need to be prescribed. In the case of chronic complaints, alternative treatment methods are usually tested, for example, special breathing exercises or the use of essential oils. If anthracosis is associated with psychological problems, the family doctor can consult a therapist. This person will support the patient in dealing with the disease in everyday life. Anthracosis follow-up also includes an examination of any permanent damage in order to evaluate possible compensation for the patient. The ENT physician who has already provided treatment is responsible for follow-up care. Follow-up visits should initially take place every one to two months. If there are no major complications and all insurance-related issues have been resolved, the intervals between appointments can be gradually extended. Anthracosis patients are permanently damaged and must have comprehensive follow-up visits at least every six months after completion of treatments.
Here’s what you can do yourself
Anthracosis is not curable, so prevention is especially important. The lungs should not be exposed to dust containing coal, or at least exposure should be kept as low as possible. In the workplace, coal dust emissions can be reduced by careful selection of the machinery and equipment used and by their proper placement. In the case of high-risk activities or in a heavily polluted environment, the use of special ventilation systems or respiratory filters may be indicated. People who regularly come into contact with large quantities of coal dust, for example because they work in the coal and steel industry, should undergo screening at least once a year. If anthracosis has already been diagnosed, it is important to exclude further exposure of the lungs to coal dust as far as possible. This may require a change of workplace or occupation. Affected persons should also stop smoking to avoid putting additional strain on the lungs. Vaccination against pneumococci and influenza pathogens can also reduce the risk of infection. In the event of severe shortness of breath and persistent coughing attacks, the emergency physician must always be called immediately in the case of anthracosis, as there is an acute risk of suffocation for the patient. The symptoms of the disease, in particular permanent irritation of the cough or severe mucus production, can be treated with mild home remedies in addition to the medication prescribed by a doctor. Steam baths with salt water or chamomile tea are helpful. Ribwort plantain has proven effective against severe coughs.