As coal mining grew in the 1900s, workers increasingly were showing signs of “miner’s asthma,” later called black lung. The introduction of larger machines created more coal dust, making the disease more common. From 1942 to 1968, miners had asked their union to get black lung recognized as a disease, but labor officials ignored them. After a 1968 mine explosion in Farmington killed 78 miners, anger grew. Miners in Fayette County, with help from doctors and activists, formed the Black Lung Association to push for change.

In early 1969, miners held meetings, strikes, and protests across the state. Thousands walked off the job and protested at the Capitol in Charleston. Their actions helped pass a stronger black lung law in West Virginia. Soon after, Congress passed the 1969 Coal Mine Health and Safety Act. It set dust limits and gave federal aid to miners and families affected by black lung.

Despite these laws, black lung problems began appearing in larger numbers again in the 21st century. In 2017, a rise in severe black lung disease (PMF) was reported in West Virginia, affecting younger miners with fewer years on the job. The main cause this time was silica dust—from cutting through rock in thin coal seams—which is more harmful than coal dust. By the early 2020s, PMF cases had reached levels not seen since the 1970s, with West Virginia making up nearly 30% of U.S. cases.