James Muncy retraces his breathing problems until the 1990s, when he was still mining coal. "I could barely cut grass," he says. "When it's hot, [I] could not breathe."
In 2014, he was diagnosed with the advanced form of black lung disease, referred to as a complicated black lung or progressive massive fibrosis. "I know it will kill me," says Muncy, whose brother died of the disease in 2017. "I thought it would be a terrible death and that will probably be the case."
Last year, NPR and the PBS program Frontline interviewed dozens of miners in Appalachian black lung. The interviews with miners like Muncy were part of an investigation that said state inspectors could not protect the miner despite mounting evidence and severe warnings.
The miners talked to NPR and Frontline to fight a disease that is dramatically changing their lives, their communities and their families. Here they said it in their own words:
Paul Kinder had just graduated from high school when he started coal mining. "It was a good job," he says. "I loved the equipment and learned new things."
But after three decades in the underground, he was diagnosed with a complicated black lung and had to stop. Now, at 68, children say he does not have the breath to work in his garden.
"I can not follow a dog through the mountains these days, I had to give it all up," says Kinder. "The old adage says you lie down with dogs, you get up with fleas, and when you work in the coal mines, you'll get black lungs."
Jackie Yates has a family history of black lung. His brother died of the disease in 2015 and his father is still suffering from a black lung.
"It's like [it] your lungs become concrete," he says.
Yates was diagnosed with a complicated black lung in 2013 after two decades of mining. And at 50, he is still working in a coal mine. "Around here it's … a family tradition, coal mining, it's a way of life," he says. "It's as if I appreciate the farmers in the Midwest. It's family tradition."
At home in southeast Kentucky, 54-year-old Greg Kelly uses inhalers and an oxygen tank when he needs help breathing. But even with oxygen, he can not take in enough air to wander the mountains and play with his grandson, as he used to do.
"There are many scars and things in my lungs," he says. "This is something you do not want to expect, that no one faces you, but has to do hard to breathe, that's scary."
An underground miner, Jack Horne worked for a long time, sometimes as much as 80 hours a week. "Most of my health problems were probably because we stayed there a lot," says Horne, who found that after two decades in the mines, he had complicated black lungs.
Horne says some miners would leave work. "completely black" from the dust. "You can not tell me it's not in his lungs," he says. "Sooner or later it will take its toll."
In the twenty-three years Harold Dotson lived in the underground, he worked a lot of dust. As a roofer he operated machines that installed roof supports in the mine. "Every fool knows whenever you use a kind of machine … there will be dust in stone and coal," says Dotson, who was diagnosed with a complicated black lung in 2013.
Dotson looks back on his career The miners did not care about the mining companies he worked for. "They do not care if you live or die, that's the truth," says Dotson.
Charles Shortridge married young. After more than 40 years as a couple, he and his wife wanted to grow old together. For 2017 he was diagnosed with a complicated black lung. "I can not plan for tomorrow because I never know if I'll live tomorrow," says Shortridge.
Now he says he takes his life for a day. "There is no cure for me," he says. "It's a black lung, it's a death penalty."
The Howard Berkes of NPR and Benny Becker of Ohio Valley Resource contributed to this story.