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Silicosis in young tradies – public health crisis

Important information on the silicosis public health crisis – ABC 7:30 tonight 

The Royal Australian College of Physicians (RACP) is alerting all Australian members to an important story expected to run on the ABC’s 7:30 program tonight, Oct 10th 2018.

RACP AFOEM Fellow Dr Graeme Edwards offers expert commentary in a story on silicosis, a lung condition historically encountered in the mining industry when airborne silica-containing dust isn’t adequately controlled.

It can take up to 40 years for workers to develop chronic silicosis. Queensland AFOEM practitioners are now seeing an increasing number of people who work with artificial stone materials used for kitchen, bathroom and laundry benchtops, diagnosed with accelerated silicosis after only three to 10 years.

URGENCY REQUIRED

The RACP  want an urgent call to screen and manage aggressive artificial stone lung disease affecting young tradies

Workers across Australia are at risk of developing an aggressive, debilitating and potentially lethal respiratory disease due to unsafe work practices in the manufacture and installation of artificial stone, commonly used for kitchen, bathroom and laundry benchtops. It is imperative that medical professionals act now to identify, diagnose, manage and support at-risk workers.

Accelerated silicosis is preventable with strict and appropriate work practices to control silica dust generation. Currently, there is major concern that dust control practices have generally been very poor in this industry resulting in many workers being exposed to extremely high levels of silica dust. This alert is intended to raise awareness of the severity of the problem and garner an immediate and proportionate response from health professionals and safety regulators.

Accelerated silicosis is an aggressive form of pneumoconiosis. It is caused by the inhalation of large amounts of respirable crystalline silica (very fine silica dust). This scars the lungs and causes progressive respiratory impairment. Accelerated silicosis progresses more quickly than chronic silicosis, developing within 3-10 years of exposure.

Symptoms

Once the disease has become established, symptoms include cough, breathlessness, tiredness and weight loss. These may developsilicosis after exposure to respirable crystalline silica has ceased, although continued exposure hastens the progression of the disease. There is currently no known treatment to arrest the progression of accelerated silicosis, apart from lung transplantation.

Historically, accelerated silicosis has been a rare disease in Australia. Now Australian jurisdictions are seeing a sudden spike in confirmed cases amongst workers involved in the production and installation of artificial stone benchtops. Cutting, grinding and polishing dry artificial stone exposes workers to respirable crystalline silica in far higher quantities than those found in natural stone. Installed benchtops present no risk to the general population.

In a recent health surveillance program in two Queensland stone masonry businesses, conducted by a senior occupational physician, one third (12 out of 35; 34%) of the workers assessed had accelerated or complicated silicosis.

At least 22 workers’ compensation claims for silicosis were lodged in Queensland in August – September 2018. Cases have also been diagnosed in NSW and Victoria. However, the prevalence and incidence of accelerated silicosis across Australia and New Zealand remain unknown.

The Australasian Faculty of Occupational and Environmental Medicine (AFOEM) and the Thoracic Society of Australia and New Zealand (TSANZ) recommend that medical practitioners and occupational nurses ask all attending building industry workers about work with artificial stone.

If a patient has been exposed to artificial stone medical professionals are advised to:silica dust risks

  • Ask about respiratory symptoms, bearing in mind that in the early stages of the condition the patient will be asymptomatic.
  • Assess the patient using chest x-ray (with ILO classification) and full lung function testing including diffusion capacity DLCO. Spirometry performed in a non-laboratory setting is associated with a significant false negative rate and may falsely reassure you and your patient.
  • A high resolution CT chest (non-contrast) should also be strongly considered if the patient has worked in this industry for over 3 years.
  • If there are any concerns to an occupational physician or respiratory physician for further assessment.

AFOEM and TSANZ also call for the establishment of:

(1) A national respiratory health surveillance program, with standardised methods of data collection; and

(2) A national occupationally acquired respiratory disease registry for notification of cases.

AFOEM and TSANZ have urged regulators throughout the country to follow the lead of the Queensland Government and immediately ensure silica dust levels are maintained at a safe level at all benchtop fabrication workplaces. Workplace silica dust levels must be measured independently to demonstrate compliance with the current regulations.

Detailed frequently asked questions about the prevention, diagnosis and management of accelerated silicosis are available on the RACP website.