One hundred and twenty-five men who were identified in 1968 as having the simple pneumoconiosis of coalworkers were re-examined nine years later when their mean age was 59.6 years. On both occasions the lung function and response to exercise were assessed. There was no evidence for progression of simple pneumoconiosis between the surveys, but 14 had developed small irregular opacities on their chest radiographs and 28 showed early changes of progressive massive fibrosis (PMF). After allowing for the effects of smoking and of exposure to coal dust, subjects with both p and r types of simple pneumoconiosis exhibited a reduced transfer factor compared with subjects having q-type opacities; subjects with r-type opacities also showed an increased pulmonary elastic recoil pressure. The presence of irregular opacities, independent of rounded opacities, was associated with a low transfer factor and decreased slope of phase III of the single breath oxygen test. Subjects who developed PMF between 1968 and 1978 had p or r opacities more often than q opacities: these subjects had an increase pulmonary elastic recoil pressure. The development of PMF was also associated with physiological evidence of airways obstruction. The changes in subjects with r opacities are consistent with the presence of space occupying lesions that may progress to PMF. Subjects with p opacities have physiological evidence of emphysema as do some subjects with established PMF. Irregular opacities may reflect the presence of both emphysema and diffuse fibrosis. There is need for more morbid anatomical evidence on the underlying pathology.
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