Patients with chronic bacillary tuberculosis (TB) are a serious source of TB transmission and pose a great danger to society and families; the sputum negative rate is the main indicator of TB efficacy. How to diagnose, treat and manage these patients with chronic bacillary excretion, reduce and control the spread and development of tuberculosis, we analyzed 40 cases of patients with chronic bacillary excretion of coal workers’ pneumoconiosis admitted in the past five years to explore the influencing factors and prevention and control measures. Subjects and methods 1. Subjects In this paper, we retrospectively investigated 719 cases of coal workers’ pneumoconiosis TB patients who were hospitalized in our pneumoconiosis TB department from January 2002 to May 2007, among which 40 cases with persistent non-negative sputum bacteria throughout the course of treatment were male coal workers’ pneumoconiosis workers with an average age of (73±2.9) years. 2. Chemotherapy regimen Anti-tuberculosis chemotherapy (H: isoniazid, R: rifampin, L: rifapentine, Z: pyrazinamide, E: ethambutol, V: levofloxacin) was given after admission: 4-6HRZE/8-18HRE/6HR for primary treatment; 4-6HL 3ZE/3-12HL3 EV/3-12HL3 for repeat treatment (L3 was rifapentine taken three times a week); drug-resistant Determine the chemotherapy regimen according to the drug sensitivity test, and adjust individual chemotherapy drugs according to the condition during treatment. 3. Sputum tuberculosis test All cases were checked every 2 weeks for 3 times continuously, and sputum Mycobacterium tuberculosis rapid culture (Bactec mgit 960 system) and Roche culture were done once a month. 4.Investigation items Age, pneumoconiosis stage, initial treatment, drug resistance, sputum TB bacilli, comorbidities, pulmonary cavity, compliance with medication, and adverse drug reactions. 5. Definition Drug resistance refers to the development of resistance to any of the anti-tuberculosis drugs by the disease-causing tuberculosis bacteria. Multidrug resistance refers to resistance to more than one first-line antituberculosis drug, including isoniazid (INH) and rifampicin (RFP). Multidrug resistance is defined as resistance of the causative TB bacilli to at least both INH and RFP. Chronic excretion is defined as sputum excretion of Mycobacterium tuberculosis for more than 2 years after antituberculosis chemotherapy. Adherence was defined as the whole process of patients taking the prescribed dose of drugs within the prescribed time strictly according to the physician’s requirements. Results 40 cases of chronic mycobacterial excretion accounted for 5.56% (40/719) of the number of patients treated during the same period, and the number of cases of stage I, II and III coal workers’ pneumoconiosis combined with tuberculosis were 19 (47.5%), 14 (35%) and 7 (17.5%), respectively; 1 case (2.5%) was treated for the first time, 39 (97.5%) were retreated, 6 (15%) were non-drug resistant, 10 (25%) were multi-drug resistant, 24 (60%) were multi-drug resistant and 24 (60%) were multi-drug resistant. (60%), 27 cases of pulmonary cavitation (67.5%), 8 cases of combined diabetes mellitus (20%); 35 cases of adverse drug reactions (87.5%), 14 cases of non-compliance (40%); among the adverse drug reactions, gastrointestinal symptoms were the main ones. Discussion Patients with coal workers’ pneumoconiosis are severely disabled and are included in the national medical insurance for work-related injuries. Sputum-positive patients are strictly hospitalized according to the regulations, therefore, more attention is paid to these patients and the diagnosis and treatment are carefully organized; despite this, 5.56% of the patients are chronic detoxifiers, which is closely related to other factors such as old age TB, coal workers’ pneumoconiosis, and lagging development of new anti-tuberculosis drugs, but also interrelated with other factors. The results of the present investigation showed that the level of pneumoconiosis had little effect on the chronic rejection of coal workers’ pneumoconiosis patients, while the presence of drug resistance, especially multidrug resistance, the presence of relapsed tuberculosis, the presence of cavities in the lungs, the presence of diabetes mellitus, the presence of adverse drug reactions, and the compliance with medication were the main factors for chronic rejection in coal workers’ pneumoconiosis. For a given individual, these factors are combined; multidrug-resistant tuberculosis poses great difficulties in treatment, requiring constant adjustment of chemotherapy regimens with little success; most patients with relapsed tuberculosis have a long duration of disease, extensive lesions, repeated bacillary excretion, and drug resistance1; the formation of pulmonary cavities due to pneumoconiosis makes the local immune function and pharmacokinetics of the lung more affected than in non-cavitary patients, making treatment more difficult; diabetes mellitus can promote and aggravate tuberculosis. Diabetes mellitus can promote and aggravate tuberculosis and has a very significant impact on tuberculosis control2; the presence of adverse drug reactions often prevents the regular implementation of tuberculosis chemotherapy, the presence of gastrointestinal symptoms after taking drugs will lead to drug malabsorption, and tuberculosis patients with malabsorption of drugs lead to peak drug concentrations failing to respond to treatment , thus affecting the efficacy; for a variety of reasons3, elderly pneumoconiosis patients appear noncompliance with medication, and noncompliance with TB treatment is a major obstacle to TB control.4 Due to the complexity of pneumoconiosis TB pathology, pneumoconiosis TB and the multiplicity of TB foci in the lung, each foci are distributed with different growth rate TB colonies. The two main factors that cause TB bacilli to enter the resting or non-replicating phase are low oxygen partial pressure and the body’s immune response5; pneumoconiosis patients are most susceptible to these two factors, and TB bacilli in the resting or non-replicating phase are insensitive to anti-TB drugs, so that latent TB bacilli are activated and rested one after another, resulting in TB cases with persistent non-negative sputum. Therefore, in the prevention and treatment of pneumoconiosis with chronic bacillary excretion, it is important to actively seek potentially effective drugs, explore a comprehensive treatment model, reduce the occurrence of multidrug resistance, promote the early purification or closure of pulmonary cavities, prevent the occurrence of adverse drug reactions, strengthen clinical management, reduce the number of retreatment cases of tuberculosis, actively treat comorbidities, and educate patients to ensure a good compliance with anti-tuberculosis treatment. The patient’s compliance with anti-tuberculosis treatment is ensured. These will be important measures to effectively control the development of chronic exclusion in patients with coal workers’ pneumoconiosis.