Justin Smarsh and his family used to kayak a few times a year on the rivers and creeks near their home in Cherry Tree, Pennsylvania. High on the Appalachian Plateau, northeast of Pittsburgh, he spent hours in the woods and taught his two sons to hunt. Today, Smarsh said, he gets “suffocated just walking.” He has a constant dry cough, and he loses his breath if he bends down to tie his shoes.

A few years after he graduated from high school and got married, Smarsh went to work in a coal mine in his home county, just as his father and grandfather had. “It was the best-paying job around,” he said. “It still is.” Now Smarsh, 42, has progressive massive fibrosis — the most severe form of coal workers’ pneumoconiosis, or black lung.

There is no cure for Smarsh’s condition. He tries to slow the progression with “piles of meds,” he said, but things will eventually worsen, potentially to the point of heart failure. In patients with advanced disease, a flu or common cold can lead to a kind of drowning as the lungs fill with fluid. Smarsh’s doctors say he won’t live to see 50.

“Most people think coal mining is a thing of the past,” said Deanna Istik, CEO of Lungs at Work, a black lung clinic in Washington County, Pennsylvania. “Meanwhile, we see more people being diagnosed with black lung disease than we ever have before.”

Between 2013 and 2017, hundreds of cases of severe black lung disease were identified at just three Virginia clinics.

Coal mining has always been a hazardous occupation. But today’s miners face a new danger because they’re inhaling something worse than the coal dust that settles in lungs, triggering immune cells to form nodules, masses, and scarified black tissue. Most of the large coal seams in the mountains of Appalachia are gone now. To reach smaller seams, miners must cut through much more rock with high levels of quartz, which gets pulverized into crystalline silica.

Read the full article about black lung surging in coal country by Kate Morgan at Yale Environment 360.