As coal miners suffer and die from severe black lung, a proposed fix may fall short

The gravesite in Danny Smith's vast and verdant yard is shaded by hulking trees. His parents' graves are adjacent and marked by a massive headstone. In summer, crickets chirp, birds sing, and leaves rustle in the breeze.

It is a peaceful spot for Smith's final resting place. And it's ready.

"I honestly never imagined it would get this bad," Smith, 51, wrote in a text message from his home in the coalfields of eastern Kentucky. His breathing is so labored at times, he wrote, that he wasn't sure he could get through a phone call.

"I have a hard time just walking to the kitchen without losing breath," he wrote. "I stay so tired and exhausted."

Smith's lungs are riddled with fibrotic tissue. When NPR and PBS's Frontline last visited in 2018, he tried to mow his lawn, but a fit of heavy hacking forced him to his knees. Coughing violently, he spit out what looked like moist and crusty bits of dark gray paper with black streaks — dead lung tissue, his respiratory therapist told us.

Smith suffers from progressive massive fibrosis, or complicated black lung, an advanced, incurable and fatal stage of black lung disease. It's caused by the inhalation of coal mine dust, especially exposure to highly dangerous silica dust.

Silica is one of Earth's most abundant minerals, and it's about 20 times more toxic than coal dust. It's typical in the quartz that surrounds coal seams, especially in central Appalachia. Mining machines cut through the rock to reach and to mine coal seams, grinding rock into fine, sharp and easily inhaled silica particles.

Exposure to silica dust likely explains Smith's complicated black lung diagnosis at the relatively young age of 39 and after just 12 years of cutting rock and coal underground.

"As bad as I feel now, and I never thought I would say it," Smith texted, "I so wish I had never stepped foot inside a mine."

The scale of a profound human tragedy

Concern over silica's role in black lung has been growing for decades, and mine safety advocates have urged regulators to act since 1974. And this summer, the federal (MSHA) finally issued a proposed new regulation to limit miners' silica dust