Lung cancer

New TSANZ guidance on respiratory surveillance for dust diseases

The TSANZ  has released new recommendations on respiratory surveillance to tackle the rapidly re-emerging threats of coal mine dust lung disease and silicosis in artificial stone workers.

Following recent serious outbreaks of mining-related pneumoconiosis and artificial stone (AS) silicosis, the TSANZ conducted a review to determine the best respiratory surveillance protocols for workers in these industries, based on the latest evidence and newest imaging technologies.

In its new position statement, published in Respirology, the TSANZ says the reappearance of the dust diseases represent failures in workplace systems to prevent dust exposure and to adequately implement recommended surveillance programs to identify workers affected by the diseases.

The new guidance is therefore intended to be a framework for surveillance  – separate from active case finding – to ensure identification of early respiratory disease, to help preserve lung function, reduce morbidity and manage further exposure to harmful silica dust.

The statement recommends that surveillance should move beyond spirometry and chest radiography to include recent improvements in lung function testing and imaging, such as diffusing capacity of the lung for carbon monoxide (DLCO) and low dose CT scans. Surveillance programs should also incorporate computerised data collection and analysis.

It also urges the adoption of improved dust sampling data collection and better quality interpretation of chest radiographs, such as via the B reader program as used in the US.

Its proposed improvements for respiratory surveillance include:

  • Potentially use low dose CT for surveillance of artificial stone dust exposure evaluate the role for ultra low dose CT for coal miners and artificial stone workers
  • Extend surveillance methods for all workers to include lung diffusing capacity at intervals of three years or less.
  • Flexible timing of surveillance of coal mine dust workers, including annual spirometry and DLCO if results are abnormal but do not yet fulfil diagnostic criteria for disease.
  • Active case-finding for artificial stone workers previously exposed to high respirable crystalline silica levels, using high resolution CT/spirometry/DLCO.
  • For artificial stone workers undergoing active case-finding without abnormal chest x-ray or high resolution CT, annual spirometry/DLCO and imaging 3-yearly or more often depending on individual factors and test results.
  • Using high resolution CT scans to complement surveillance with chest x-ray imaging, in  high-risk groups where borderline fibrosis is found.

However the  TSANZ position statement acknowledges there is as yet a lack of evidence for enhanced radiological surveillance in artificial stone workers, and more research is urgently needed.

In addition to surveillance there is a need for clinical pathways to expert respiratory specialist review, with a possible need for further investigations such as such as bronchoscopy, endoscopic bronchial ultrasound-guided or surgical lung biopsy

It proposes the establishment of a national registry for occupationally acquired lung diseases and an independent Occupational Lung Disease Advisory Group.

“This would facilitate the continued improvement in existing programs, reduce preventable respiratory disease and promote a positive and supportive workplace culture for Australian and New Zealand workers,” it concluded.

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