Diagnosis - Lung Foundation Australia

Occupational lung diseases can be difficult to diagnose. This is largely because symptoms are often vague and characteristic of other lung diseases or may even be attributable to ageing.

The critical role of primary care health professionals

Health professionals working in primary care are integral to identifying a patient’s risk of an occupational lung disease, as the majority of patients first present to primary care settings. A detailed discussion about a patient’s occupational and environmental history is recommended. Given the latency period of occupational lung diseases, a full employment history, inclusive of both current and past employment, is vital in establishing a diagnosis.

What to consider when diagnosing occupational lung disease

Diagnosing an occupational lung disease can be a complex scenario. Referral to a respiratory physician is needed to confirm diagnosis and form a treatment plan while an occupational physician will ascertain whether the diagnosis was work-related as well as providing advice about return-to-work plans or ongoing risks for health in the workplace. Each specialist is different and is needed at different times or in different context over the course of the disease.

Learn more

Key topics for discussion with the patients may include the following:

1. General health history

If the patient is experiencing any symptoms, and if so, what they are
When they have been experiencing symptoms
How long they have been experiencing symptoms
If they have missed any work due to their symptoms
Whether their symptoms change when away from work
Whether they think their symptoms may be related to a specific hazardous agent
Prior respiratory problems
Smoking and/or vaping history, including exposure to second-hand smoke
Current medications, including any used to manage symptoms.

2. Current and past employment

It is important to cover the patient’s current role as well as previous employment where exposures may have occurred. Areas to cover may include:

What types of employment they have had – include their whole working life
How long they worked in each role / industry
Type of industry and work performed
Any roles where they think they may have been exposed to hazardous agents, and which ones
Involvement in any health monitoring (or surveillance) schemes, and whether they have the results
If they know whether their current or former colleagues experienced symptoms, and whether their colleagues were diagnosed with an occupational lung disease.

3. Exposure information

If the patient has reported exposure to hazardous agents or they work in a hazardous environment, find out more about what they do each day.

Areas to cover may include:

A general description of job processes
Materials used (e.g., artificial stone)
Frequency of exposure to hazards
Whether they wear any protective equipment (e.g., masks or respirators) where required, including whether they were fit-tested for it, and whether they underwent training on how to use, clean and maintain it
Whether any other protective measures are implemented at their workplace to reduce or manage exposure (e.g., local exhaust ventilation, wet cutting)

It may be helpful to ask about common workplace respiratory hazards, to prompt the patient. Some of these may include:

Artificial stone
Bioaerosols (e.g. soil and animal dander)
Dusts and fibres (e.g. silica, coal, asbestos)
Chemicals (e.g. cleaning products, isocyanates)
Fumes / gases (e.g. welding).

Note: This is not an exhaustive list of all hazardous agents.

4. Environmental non-occupational factors

Hobbies (e.g., home renovating, wood working, bird keepers)
Pets

Source: https://gplearning.racgp.org.au/Content/Tempo/201908_Silicosis.html

Investigating signs and symptoms

Initial types of diagnostic tests that may be performed as part of investigation into an occupational lung disease may include:

A physical examination
Lung-function (breathing) tests
Chest X-ray
High-resolution CT scan (HRCT)
Laboratory tests (i.e., blood tests)
Serial measurement of peak expiratory flow (PEF)
Sputum cytology test.

In some instances, the patient will need to be referred for these tests to be performed.

After referral to a respiratory specialist, further testing may include:

Further chest imaging
Arterial blood gas analysis
Bronchoscopy
Endobronchial ultrasound
PET scan
6-minute walk test
Lung biopsy

It is important to note that many investigations, particularly in the early stages of occupational lung disease, may indicate normal results as many conditions have a long latency period.

Imaging for occupational lung diseases, including silicosis, is a specialist area and appropriately trained and experienced radiologists need to perform these tests.

Specialist referral

If an occupational cause of respiratory disease is considered, then it is recommended that the patient is referred to a respiratory physician to assess and confirm the diagnosis. If possible, refer to a specialist with experience in occupational respiratory disease.

If the occupational connection is uncertain, complex, or subject to dispute, then it is recommended that the GP or respiratory physician seek consult from an occupational physician to assess further.

Helpful links

National Guidance for doctors assessing workers exposed to respirable crystalline silica dust

Developed to help GPs identify and assess people at risk of silicosis caused by exposure to respirable crystalline silica dust.

View Link

Australia’s emerging occupational health epidemic – silicosis

Information on silicosis, including types, GP’s role in the silicosis epidemic, presenting features, referral for assessment, medical management and psychosocial support.

View Link

Health monitoring for registered medical practitioners guide

This guide is for doctors engaged by a person conducting a business or undertaking (PCBU) to carry out or supervise health monitoring.

View Link

GP education: occupational carcinogen exposure and cancer

Learn about common occupational exposures to cancer causing carcinogens and the processes that will help you, as a health professional, assist a patient in need.

View Link

TSANZSRS Education Hub

The Education Hub included a short course on occupational lung disease covering workplace respiratory surveillance, case vignettes and other topics on hazardous agents and disease progression. Register for on-demand access.

View Link