‘Almost complete resolution’: Australian doctors report on lung lavage for silicosis

Doctors in Queensland have reported positive findings from the first six silicosis patients who underwent whole lung lavage (WLL) in November last year.

The procedure, which involves washing the lungs out with saline, could become key in stemming the looming silicosis health crisis.

Rates of silicosis in Australia have exploded in recent years with the introduction of cheap engineered stone, which can be more than 90% silica. The dust that comes from cutting silica stone, which is commonly used for kitchen benchtops, can cause the potentially deadly lung disease.

With no cure or effective treatment available to halt disease progression, Brisbane researchers began looking into WLL for treating early stage silicosis.

The procedure, mostly used in pulmonary alveolar proteinosis (PAP), was adapted for silicosis at Brisbane’s Prince Charles Hospital and is being hailed as a potential breakthrough in treatment. 

Head of Fibrosis research at the hospital, Professor Dan Chambers, and colleagues carried out the procedure on more than a dozen patients diagnosed with early stage disease, publishing the results of the first six in the journal Respirology.

Listen: Professor Dan Chambers talks to the limbic about the procedure that could treat the deadly disease. Story continues after post.

All six male patients involved in the safety and feasibility trial had worked in the artificial stone countertop fabrication industry without adequate dust suppression or personal protective equipment.

Workers had to have been removed from occupational exposure for at least 12 months, and had to have either worsening symptoms, worsening lung function or both.

Each underwent bilateral lavage with a median lavage volume of 26.8 L (15–30.8) per lung. The only complications were radiological pulmonary oedema in the lavaged lung (n = 4), vocal cord irritation (n = 1) and chest wall soreness (n = 3).

None of the patients who experienced pulmonary oedema had respiratory distress and all were managed with overnight nasal prong supplemental oxygen, the researchers reported.

The procedure led to ‘significant radiological improvement’ with ‘almost complete resolution’ of the semi-solid centrilobular nodules characteristic of early stage disease.

WLL was also associated with reduction in occupational and environmental respiratory disease score in all but one patient who had significant upper zone reticulation bordering on progressive massive fibrosis.

Speaking on the limbic podcast Professor Chambers said whether the radiological improvements translate into better long-term outcome in terms of quality of life and mortality remains the focus of longer term follow up.

“We were very conscious that there was a group of young men who needed our help and that’s what we set about doing … but the  job is not even half done.

It’s an important milestone to demonstrate the feasibility and safety of this approach and indeed we’ve demonstrated very marked improvements in CT appearance, which is pleasing, but of course what we want is to make a big difference to these guys in terms of their quality of life, longevity and morbidity and so the next objective is to collaborate with other centres in Australia who will be commencing this program soon.”

While many centres around the country will have long standing experience with WLL for PAP he said more staff will need to be trained in the procedure as silicosis cases picked up through national screening programs are set to increase demand.

“The volume of cases mean that we [are] going to be doing a lot more lung lavage than we’d ever done before. We were typically doing 2-4 whole lung lavage per year in Brisbane for pulmonary alveolar proteinosis so it means up skilling a whole group of individuals from the core team who [are] very experienced in the procedure to training other groups including cardiothoracic, anaesthetic and physiotherapists in the procedure.”

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