Black lung, coal workers' pneumoconiosis (CWP), miners' asthma and most recently the all-encompassing term coal mine dust lung disease (CMDLD) are names given to lung diseases caused by overexposure to coal mine dust. Most of us studied these diseases in medical school, but were under the impression that they were relics of a bygone age. We believed that modern mining technologies and dust controls, which have been in place for decades, had eliminated this scourge.

We were wrong. Unfortunately, what we eliminated or weakened were essential components of public health surveillance and prevention programmes, leaving holes through which this disease has re-emerged. China is now experiencing an epidemic of CWP in association with its enormous domestic demand for coal and loosely regulated mining industry.1 The USA is in the midst of a resurgence of CWP that started in the mid-1990s after decades of reduction. Cases of advanced disease, including progressive massive fibrosis afflicting younger miners, have been found at alarming rates in some mining regions despite federally mandated dust limits.2 Now Australia, which had reported no new cases of CWP for over 30 years, has identified a number of cases in the state of Queensland, several of which were missed by their medical screening programme.3 Many countries lack well-developed medical surveillance programmes, and too often dust control measures are weak and poorly enforced.

Although ‘black lung’ has been observed in coal miners since at least the 17th …