Lisa Emery knows the pain behind the coughs and struggles of West Virginia’s coal miners. As a respiratory therapist and director of the New River Health Association Black Lung Clinic, she watches miners, some in their 30s and 40s, get sicker from black lung disease—a condition once considered something only older miners faced. Many come to her gasping for air, their lungs scarred from years of breathing in dust filled with harmful silica particles.
The rise in black lung cases has been linked to changes in mining practices. Miners now have to dig deeper, going through rock packed with silica, a dust far more toxic than coal dust. Scientists say silica hurts lungs the most, causing inflammation and permanent damage that leaves many miners weak, dependent on oxygen tanks to breathe. The numbers are alarming. Over half of the 11,500 miners from central Appalachia checked between 2020 and 2025 had signs of black lung, with rates climbing to 62% in the past year.
To fight this, the Mine Safety and Health Administration (MSHA) approved a new rule in 2024 to cut allowable silica dust levels by half. The idea is to protect miners better and reduce illness, but the rule is now under threat. Industry groups have challenged it in court, delaying its implementation. At the same time, the Trump administration has rolled back or stalled many health and safety protections for miners and other workers. Many employees at the National Institute for Occupational Safety and Health (NIOSH), which monitors black lung cases, faced major layoffs, weakening federal oversight.
This comes even as coal mining remains one of the most dangerous jobs. Wyoming and West Virginia, both heavily reliant on mining, had the highest worker death rates in 2023. Those worried about safety argue that cutting back on protections and staff only puts more miners at risk.
Coal miners and union leaders are pushing back. They want the government to enforce the silica rule and keep safety programs strong. Retired miners, some sick with black lung, are holding protests and asking for better enforcement and funding. Many feel forgotten amid political battles, fearing that promises made to protect them have been broken.
The history of black lung runs deep in Appalachia. Hard lessons from past disasters helped create laws decades ago to protect miners, but the challenges continue today. For Emery and her patients, every day is a fight against a disease that steals breath and life. She sees miners struggling to do simple things, like playing with their kids or walking across a room.
“If the rule goes into effect now, it will still take 15 to 20 years to see improvements,” Emery says. Meanwhile, miners keep hurting, and the pressure grows to save lives in these mining communities.