Occupational lung diseases

4 min read

Diagnosis

Any healthcare professional working in primary care is vital in identifying patients at risk of an occupational lung disease. The majority of patients typically present initially at a primary care setting.

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A detailed conversation about a patient’s work and environmental history is recommended. Occupational lung diseases can take a significant time to develop so a full employment history including current and past jobs is essential for diagnosis.

Diagnosing an occupational lung disease can be complex. A referral to a respiratory physician is needed to confirm a diagnosis and develop a treatment plan. An occupational physician can determine if the diagnosis is work-related and provide advice on returning to work or managing ongoing risks in the workplace. These specialists offer different expertise which may be needed at various times throughout a patient’s experience with an occupational lung disease.

Key topics to discuss with your patients

General health history

  • Are they experiencing any symptoms? If so, what are they?
  • How long have they experienced these symptoms?
  • Have their symptoms caused them to miss work?
  • Do their symptoms change when they are away from work?
  • Do they believe their symptoms may be linked to a specific hazardous agent?
  • Have they had any previous respiratory problems?
  • Do they smoke or vape, either currently, or in the past. Have they been exposed to second-hand smoke?
  • What medications are they currently taking, including any used to manage symptoms?

Current and past employment

It’s important to discuss a patient’s current role and any previous jobs where exposures may have occurred. Areas to cover include:

  • What types of employment have they had throughout their working life?
  • How long did they work in each role or industry?
  • What type of industry and work did they perform?
  • Are there any roles they think they may have been exposed to hazardous agents? Do they know which?
  • Did they work with or near any hazardous agents? If so what were they?
  • Have they participated in any health monitoring or surveillance schemes? Do they have the results?
  • Do they know if current or former colleagues experienced symptoms or were diagnosed with an occupational lung disease?

Exposure information

If a patient reports exposure to hazardous agents or works in a hazardous environment, ask more about their daily activities. Areas to cover may include:

  • A general description of their job processes
  • Materials used (such as engineered stone)
  • How often they are exposed to hazards
  • Do they wear personal protective equipment such as masks or respirators? Were they fit-tested for it? Did they receive training on how to use, clean and maintain it?
  • Are any other protective measures used at their workplace to reduce or manage exposure? (Such as local exhaust ventilation or wet cutting).

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

  • Engineered stone
  • Bioaerosols such as soil and animal dander
  • Dusts and fibres such as silica, coal, asbestos
  • Chemicals such as cleaning products, isocyanates
  • Fumes or gases, such as welding
  • Diesel engine exhaust
  • Mould, bacteria, viruses or other microorganisms.

Please note that this is not an exhaustive list of all hazardous agents.

Environmental non-occupational factors

  • Hobbies such as home renovations, woodworking, bird keeping
  • Pets.

Consider these self-management strategies:

  • Preventing further exposure to hazardous agents, particularly if the patient is still working in the industry that contributed to their disease or any industry where they are exposed to hazardous agents
  • Quitting smoking and/or vaping
  • Avoiding excessive alcohol and illicit substances
  • Exercising
  • Maintaining a healthy diet
  • Resting
  • Keeping their vaccinations up to date
  • Taking their medications as prescribed.

Investigating signs and symptoms

Initial diagnostic tests that may be performed when investigating an occupational lung disease include:

  • A physical examination
  • Spirometry tests
  • Chest X-ray
  • High-resolution CT scan (HRCT)
  • Laboratory tests (such as blood tests)
  • Serial measurement of peak expiratory flow (PEF)
  • Sputum cytology test
  • In some cases, your patient may need to be referred for the following 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
    • Lung biopsy
  • It’s important to note that many investigations particularly in the early stages of occupational lung disease may return normal results, as many of the diseases have a long latency period.

Refer a patient for support services

We have a team of specialist support professionals available who can support patients with an occupational lung disease. The service is free, confidential and designed to complement your plans for treatment, care and ongoing management. 

Occupational lung disease social worker
Our social worker can help your patient to navigate the practical and emotional impacts of living with an occupational lung disease.

Occupational lung disease support telehealth nurse
Our nurse can provide your patients with information about occupational lung diseases, including diagnosis and management, symptom management, and guidance on relevant support services.

CPD-accredited training for healthcare professionals

Lung Foundation Australia has collaborated with The Thoracic Society of Australia and New Zealand (TSANZ) and other clinical experts in occupational lung disease to create a free online course for health professionals.

This course, called Managing occupational lung disease: early detection, management and support“, was made to help all health professionals spot the signs of occupational lung disease and assist with early referrals and diagnosis.

By completing this training, you will be able to:

  • Identify people at risk of occupational lung diseases by understanding common causes and using appropriate screening questions to activate clinically relevant diagnostic and referral pathways.
  • Define occupational health monitoring and the role of the GP in assessing at-risk workers, as required by employers in at-risk industries under relevant regulations/legislation.
  • Describe the patient’s right to make a workers’ compensation claim and the support available to workers throughout the process, including referring patients to support services or seeking individualised care guidance from experts.
  • Outline the role of the multidisciplinary team in the care of someone diagnosed with an occupational lung disease.

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Last updated on July 9th, 2025 at 09:49 am

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