Examination of Pirfenidone (Esbriet®) Therapy in Coal Workers' Pneumoconiosis With Pulmonary Fibrosis

Inclusion Criteria: * 1\. Able and willing to provide informed consent and to comply with study protocol * 2\. Coal miners between the ages 40 to 79 years of age at visit 1with a minimum of 15 years in a coal mining environment * 3\. Chest CT Scan or Chest Xray (within 6 months) confirming diagnosis of CWP, complicated black lung disease/progressive massive fibrosis will be recorded. If CT not available must be obtained at Visit 1. * 4\. Evidence of Loss of lung function defined by decline in FEV1 or FVC or DLCO of 5% within the past 36 months prior to enrollment. * 5\. FEV1 ≤ 75% or FVC ≤ 80% or DLCO ≤ 70% or abnormal 6MWT with oxygen desaturation of 4% or greater than resting at screening or within past 6 months. * 6\. Former smokers and current smokers will be enrolled if documented evidence of CWP/PMF is present and meet PFT guidelines. Current smokers will be given smoking cessation counseling at each visit due to the effect on pirfenidone concentration and efficacy. Exclusion Criteria: * 1\. History of prior therapy with Esbriet or Ofev (pirfenidone or nintedanib) * 2\. Recent hospitalization (within 30 days prior to screening) for respiratory decompensation. * 3\. Patients using monoclonal antibody therapy or immunosuppressive therapy for other disease process will be excluded, except for the following: * Daily prednisone up to 10 mg daily (prescribed for lung disease or rheumatoid arthritis) will be permitted. Chronic use for 3 months prior to enrollment will be documented. * Methotrexate for rheumatoid arthritis will be permitted as long as chronic use for 6 months prior to enrollment is documented. * 4\. Elevation of liver function test at screening documenting AST, ALT or total bilirubin \> 3 x ULN or ALP \> 2.5 x ULN. * 5\. Patients who have other pulmonary pathology such as lung cancer, active tuberculosis or atypical mycobacterial infection requiring treatment. * 6\. Patients with recurrent malignancy requiring chemotherapy or radiation therapy. Individuals with a prior diagnosis of localized skin cancer, prostate cancer, localized bladder cancer will not be excluded unless undergoing active treatment. Patients with a prior diagnosis of malignancy treated greater than 5 years ago will be considered for enrollment. * 7\. History of alcohol or drug abuse that would impair or risk the patient's full participation in the drug study in the opinion of the investigator * 8\. Use of any investigational therapy within 4 weeks of enrollment. * 9\. Individuals with clinically significant unstable cardiac disease (ejection fraction ≤35%) or complex arrhythmias per PI discretion. Chronic atrial fibrillation will be permitted if heart rate is controlled. Historical values of ejection fraction will be accepted. * 10\. Individuals with poorly controlled diabetes per PI discretion (Hemoglobin A1c \>9). Historical values will be accepted. * 11\. Pregnancy or lactation.