Before it was known simply as black lung, coal worker's pneumoconiosis had many names among those who worked in the nation's coal mines: miner's asthma, miner's cough and so on.
Neither did the disease draw much attention. Dr. Donald Rasmussen of Beckley had barely touched it in medical school and knew next to nothing about it when he moved to West Virginia more than four decades ago.
"That was my medical education, and I didn't have any other because no one really cared about coal miners," he said.
That would change, thanks to efforts by Rasmussen and others to draw attention to the disease and advocate policies that would better protect coal miners. Their work led to the passage of the Federal Coal Mine Health and Safety Act in 1969, which established standards for coal and rock dust levels in mines.
Passage of the act led to a dramatic drop in black lung rates. But after more than three decades, those rates on appear to be inching back up, particularly among miners in southern West Virginia.
Not only are black lung rates the rise again, the disease appears to be striking miners at an earlier age than it has in the past, according to one health expert. It used to be a disease that was most common in miners who had worked in mines for 25 or more years. Now it is appearing in miners who have worked in mines for less than 25 years.
But not everyone is so sure that recently developed data and its interpretation are valid. A coal industry spokesman said more information would help the industry and regulators clarify what is occurring. A leading federal regulator said he questioned some recent black lung data.
Black lung is a serious disease that is treatable but not curable. It is caused by exposure to coal dust, which destroys lung tissue. It is related to but not the same as the respiratory disease silicosis, which results from prolonged exposure to silica dust from rock mining. Black lung cannot be caused by smoking, although smoking can exacerbate the illness. At its mildest, black lung may lead to a shortness of breath when miners exert themselves. But when it is advanced, even the slightest efforts become a major undertaking. An action as simple walking across a room could leave a person wheezing for air, Rasmussen said.
And black lung is lethal. It starves the body of oxygen and forces the heart to work harder, causing heart attacks.
"It has caused a lot of early deaths," Rasmussen said.