JUST six months ago, US black lung specialist Dr Robert Cohen quoted an academic who said Australia had eliminated the disease.
"Australia was always held up to us as a shining example of what could be done if proper attention was paid to dust control," Dr Cohen said.
Now, six months and six confirmed Queensland cases later, Dr Cohen has been tasked to investigate what went wrong in the underground coal mines.
He's begun examining x-rays, alongside Professor Malcolm Sim from the Monash Centre for Occup- ational and Environmental Health, to decipher the extent of the issue.
"We'll review some 500 to a thousand x-rays to see what's going on," he said.
Dr Cohen said it was "very difficult" to tell the difference between black lung and emphysema caused by smoking.
He said he was too early in his research to say if that was a contributing factor to the lack of detection of black lung cases in Queensland.
"I will say that... it seems that people may not have been looking as carefully as they should have," he said.
"I think sometimes people get complacent and they think everything is okay and they don't look as hard as they need to."
Dr Cohen said the period of time the disease took to develop depended on the intensity of dust exposure.
"It's a pretty gradual, insidious process that creeps up on people," he said.
"The shortest period of time that I've seen has been four or five years (working)... but 10 or 15 years is an average timeframe before people might develop some symptoms."
One of the coal mine workers diagnosed in Queensland had been working underground for just eight years.
Dr Cohen said in the US, while 3% of miners developed the disease on average, a much smaller percentage developed the "disabling" black lung, preventing them from work.
Dr Cohen said there had also been a degree of complacency about black lung in the US.
"We had a situation where the rates of disease were declining. We had a dust control law passed in 1970," he said.
"Then, there was an upturn between 1990 and the present, we had a doubling in the rates of disease."
- Coughing up phlegm
- Shortness of breath
- If the disease progresses, sufferers can be short of breath even during rest.