{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T05:50:44Z","timestamp":1776837044892,"version":"3.51.2"},"reference-count":37,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2021,3,25]],"date-time":"2021-03-25T00:00:00Z","timestamp":1616630400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["American J Industrial Med"],"published-print":{"date-parts":[[2021,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Rationale<\/jats:title><jats:p>We sought to determine if radiographic pneumoconiosis predicts abnormal gas exchange during exercise in coal mine workers with preserved resting lung function.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We analyzed data from former coal miners seen between 2006 and 2014 in a single clinic specializing in black lung evaluations. We limited the analysis to those with normal resting spirometry and an A\u2010a gradient at peak exercise\u2009\u226510\u2009mmHg. We used multivariable logistic regression to estimate predictors of A\u2010a gradient widened to &gt;150% of the reference value. We focused on chest radiographs consistent with pneumoconiosis, taking into account higher silica exposure mining activities and years underground, and adjusting for cigarette smoking, obesity, and coronary artery disease.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 5507 miners, we analyzed data for 742 subjects with normal spirometry and all key clinical variables available, of whom 372 (50.1%) had radiographic evidence of pneumoconiosis. All but 21 had small opacity profusion of less than 2\/1. The median A\u2010a gradient at peak exercise was 108% of reference value (interquartile range, 81%\u2013141%). In the multivariable analysis, radiographic pneumoconiosis was associated with increased odds of widened A\u2010a gradient (odds ratio [OR], 2.47; 95% confidence interval [CI], 1.7\u20133.7). Limited to 660 subjects with normal diffusing capacity for carbon monoxide, the odds were similarly increased (OR, 3.20; 95% CI, 1.5\u20133.6).<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>Among coal miners with preserved resting lung function, radiographic evidence of early pneumoconiosis more than doubled the odds of abnormal exercise physiology. Impairment in pneumoconiosis occurs in early disease and may only be evident on exercise testing.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ajim.23247","type":"journal-article","created":{"date-parts":[[2021,3,26]],"date-time":"2021-03-26T05:49:30Z","timestamp":1616737770000},"page":"453-461","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Early radiographic pneumoconiosis is associated with impaired exercise gas exchange among coal miners with normal resting spirometry"],"prefix":"10.1002","volume":"64","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3156-7619","authenticated-orcid":false,"given":"Sheiphali A.","family":"Gandhi","sequence":"first","affiliation":[{"name":"Department of Medicine, Division of Occupational and Environmental Medicine University of California San Francisco San Francisco California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert A.","family":"Cohen","sequence":"additional","affiliation":[{"name":"Environmental and Occupational Health Sciences, School of Public Health University of Illinois at Chicago Chicago Illinois USA"},{"name":"Division of Pulmonary and Critical Care Medicine Northwestern University Feinberg School of Medicine Chicago Illinois USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul D.","family":"Blanc","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Occupational and Environmental Medicine University of California San Francisco San Francisco California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Leonard H. 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