Serum Procalcitonin and Infective Exacerbations of Asthma

Enfi eld et al 3 at the University of Virginia also recently reviewed outcomes in 30 patients at multiple centers who underwent lung transplantation for severe CWP since 1987, using the database of the United Network for Organ Sharing. In the University of Virginia analysis, after account ing for age, lung allocation score, and type of transplant, 1-year survival after transplantation appeared to be signifi cantly lower in patients with CWP (61%) compared with non miner patients with COPD (82%) or interstitial lung disease (78%). However, independent of the exact prognosis of CWP after transplant, the reality of advanced CWP is that medical treatment may ameliorate symptoms but does not reverse the lung damage or halt the progressive fi brotic process. Because of this, we agree that lung transplantation must be considered an option, particularly for the younger miners who are now developing this disorder. 4 Dr Diaz-Guzman and colleagues encourage increasing awareness of advanced CWP and early referral to a transplant center, in recognition that massive fi brosis in coal miners often progresses even after removal from dust exposure. We concur that the medical community needs to be more effective in enhancing awareness of the continuing human toll from these dust diseases and in assuring optimal medical care and fair compensation for affected miners. Progressive massive fi brosis is entirely preventable, since it is virtually only caused by excessive dust inhalation and does not occur from tobacco use or other causes. Effective dust controls should have eliminated this type of lung disease in a modern mining industry, and the failure of the US industry to tackle this ongoing problem has been highlighted internationally. 5 In addition to drawing attention to the role of lung transplantation to improve survival and functional status in these patients, we hope our report’s fi ndings can motivate timely implementation of the necessary effective measures to reduce dust exposures and provide a healthful working environment for our country’s coal miners.