Medical practitioners need to be aware that people of any age with a history of working with engineered stone may be at risk of accelerated silicosis. These workers or patients should be assumed to have been exposed to silica dust and even in the absence of symptoms should be assessed appropriately.

Telemedicine services may be available to support workers and healthcare professionals who are geographically isolated from the appropriate specialists. Specific action will depend on the results of initial specialist assessment.

The National guidance for doctors assessing workers exposed to respirable crystalline silica dust has been developed to help doctors identify and assess people at risk of silicosis caused by exposure to respirable crystalline silica dust.

A full occupational exposure history is required for all at risk workers in relevant industries. This should include:

• Have you undertaken any work that involves cutting, grinding, polishing or otherwise shaping the material used to make stone benchtops? If ‘yes’, how long have you undertaken such work?
• What measures were in place to control the dust produced from these activities?
• What respiratory protective equipment was used to protect your lungs?
• Smoking history.
• Respiratory symptom history.

Testing and investigations

Under the Occupational Health and Safety Regulations 2017 - REG 319ZD, the health monitoring of workers under a licensed engineered stone employer per the regulation must ensure that the health monitoring is carried out under the supervision of an occupational and environmental medicine physician, or a respiratory and sleep medicine physician (regulation 169).

Workers should undergo spirometry, diffusing capacity of the lungs for carbon monoxide (DLCO) testing and a computed tomography (CT) scan. Suspected cases should be referred to a respiratory medicine physician and/or an occupational and environmental medicine physician who can address all the relevant issues including workplace assessment and suitability for employment. Treatment and ongoing health monitoring should be coordinated by a respiratory medicine physician.

If workers are diagnosed with accelerated silicosis

• Occupational and environmental medicine physicians are best placed to discuss suitability for work with individuals on a case-by-case basis.
• Evidence indicates reducing harmful exposures to low exposure settings slows but may not arrest the natural progression of disease.
• As ongoing exposure to silica dust may contribute to the risk of disease progression, it's prudent to avoid further exposure.

National Occupational Respiratory Disease Registry

The National Occupational Respiratory Disease Registry commenced on 22 May 2024 and is an important component of a health monitoring strategy.

It's critical to establish case-based information to provide a more accurate understanding of the true extent of this deadly condition among workers. We've called for the establishment of a registry since 2018 to enable physicians and policy makers to identify trends. This will help the progress towards eradicating new cases of silicosis.

See more about the National Occupational Respiratory Disease Registry.