In severe cases, someone with black lung suffocates, unable to draw breath into organs left looking like a blackened sponge. It is a terrible disease, long thought eradicated in this country.
But now it's back.
It is a reminder that the coal industry has always demanded a human price in exchange for the power it gives.
Too long coal has taken a hidden ransom from the workers and surrounding communities to keep what is the most dangerous, the dirtiest, and now one of the most expensive ways of generating power going. And it is standing in the way of a just transition for communities
It isn't just those who work in the mines who are paying coal's human price.
With cheaper, cleaner and safer alternatives now available that toll has no place in society today.
This week yet another case of black lung was uncovered in Queensland, the twenty-second person stricken with this disease, with more likely to come.
"There's a long latency period before people are diagnosed with Black Lung, so it could be 10, 15, 20 years or it could be two years," Chair of the Coal Workers' Pneumoconiosis Select Committee, Labor MP Jo-Ann Miller, said.
"We're expecting there could be hundreds, if not thousands, diagnosed in the future."
The hundreds left with a disease eating away at their lungs are not the company's board members and executives, they are workers toiling hard to put food on the table for their families.
Workers like Stephen Mellor, who were trying to build a future but were instead left feeling like he'd been thrown on the "scrap heap" after contracting the disease.
"We bought all this new machinery to cut coal faster and crush it and what were we doing for the worker?" Mellor told media.
"The system has completely and utterly failed. The introduction of self-regulation saw mining companies allowed to have their own doctors, radiologists ... and a regulator asleep at the wheel."
And it isn't just those who work in the mines who are paying coal's human price.
The Black Lung disease committee has now expanded its terms of reference and is now seeking submissions regarding dust exposure risks in coal mining towns, coal ports, and rail workers involved in transporting coal.
This is a sobering announcement for the people of Newcastle who live and work in the shadow of the world's largest such coal port. It is a reminder of what a lot of them already know -- that the port is potentially doing them harm.
Last month locals hung their dirty washing in front of the facility in protest. They told media about their concerns that they were raising their children in a community where they discover a thin coating of dusty particulate on their windows and door jams.
Queensland University of Technology climate epidemiologist Professor Hilary Bambrick said at the time that the community's health was being risked and it was "estimated around 42 million kilograms of coal dust is distributed across the Hunter region each year, largely through the use of trains pulling uncovered coal trucks".
Not a single piece of coal is burned at the port.
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Instead the air is polluted with particulates shaken into the air as the black rocks rattle into the port on trains kilometres long to be sorted into immense dusty piles and loaded onto ships.
Figures released by the government's National Pollutant Inventory report in March this year found that particulates emitted by Newcastle's three coal terminals rose by 25 percent last year.
And these particulates kill people.
At the port tiny specks of PM2.5 particulate are shaken loose -- less than 1/30th the width of a human hair they are so small they can hang suspended in the air for weeks and travel hundreds of kilometres on even the gentlest breeze.
When inhaled these whispers of coal travel into the respiratory system, some stick to the sides of the airway while others travel deeper into the lungs. PM2.5s are so small they can reach into the deepest part of your lungs -- the alveolar. This is where oxygen is exchanged into the bloodstream. PM2.5 particles are so small they can pass into the blood along with the oxygen.
And so they do. The tiny pieces of coal now in the veins, arteries and capillaries that supply every part of the body with blood. Hitching a ride into the organs and heart.
A report last year found particulate pollution was strongly associated with increased cardiovascular disease such as heart attack, stroke, hypertension and atherosclerosis, and deaths from asthma, respiratory inflammation, jeopardized lung functions and cancer.
Too many premature deaths a year. This is part of the hidden cost of coal. It is a price it has always demanded.
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