Black lung disease, or coal miner’s pneumoconiosis, is caused by breathing in coal dust, which damages the lungs over time. Tiny dust particles reach deep into the lungs and cause scarring, breathing problems, and can lead to emphysema, chronic bronchitis, or even heart issues.

The disease, first called "miner’s asthma," became more common in the 1900s when machines created more dust. At first, many doctors and coal companies denied black lung was real. But by the 1960s, doctors and miners worked together to prove it was a serious illness. Their efforts led to state and federal laws in 1969 that recognized black lung as a disease and provided compensation.

In 2017, doctors began to see a new rise in serious cases, even in younger miners. This was likely caused by longer shifts and the cutting of thinner coal seams, which created dangerous silica dust, more harmful than coal dust.

By the early 2020s, West Virginia saw some of the highest rates of advanced black lung in the country.