More data still needed for occupational lung diseases

Not enough data is being collected about the incidence of occupational lung disease in Australia, according to researchers.

A narrative review published in the Medical Journal of Australia states that this lack of data is negatively affecting the development of targeted interventions and timely identification of new hazardous exposures.

“Currently, very little information is collected regarding actual cases of occupational lung diseases in Australia. Most assumptions about many occupational lung diseases are based on extrapolation from overseas data,” wrote the authors, Dr Ryan Hoy, a respiratory physician affiliated with Cabrini Medical Centre in Melbourne, and research fellow at Monash University’s Public Health and Preventive Medicine, and Associate Professor Fraser Brims, from Curtin Medical School and head of the Occupational and Respiratory Health Unit at the Institute for Respiratory Health at Sir Charles Gairdner Hospital in Perth.

With the exception of mesothelioma, about which data is collected by the Australian Mesothelioma Registry, there is “minimal systematic collection of data” about occupational lung diseases, which also include work-related asthma, chronic obstructive pulmonary disease, obliterative bronchiolitis, interstitial lung diseases (such as asbestosis, silicosis and coal workers’ pneumoconiosis), asbestos-related lung diseases and occupational lung cancer.

“Current data sources, such as workers’ compensation statistics, provide little insight into the problem and are insufficient to target prevention activities,” Hoy and Brims wrote.

“There is a pressing need to gather systematic data on the causes, prevalence, incidence and impact of occupational lung diseases, such as through a national occupational disease registry.”

The authors also recommended that general practitioners be meticulous in their history-taking, suggesting a series of questions designed to identify work-related factors:

• What kind of work do you do? Please be as specific as possible and tell me exactly what you do at work.
• Do you think your breathing problems are related to your work?
• Do your symptoms get better when you are away from work, such as during weekends and holidays?
• Are you now or have you ever been exposed to fumes, gases or dusts?

In another narrative review published by the MJA, authors led by Professor Bill Musk from Sir Charles Gairdner Hospital in Perth wrote that rates of mesothelioma in Australia would probably remain high in global comparison for “some decades”.

“The numbers of new cases ... have probably now reached their peak values in Australia, as in other most affected countries,” they wrote.

“The incidence of malignant mesothelioma commenced rising here in the 1960s, but the long latency between exposure to asbestos and the onset of disease (the risk increases continuously and exponentially after 10–15 years, with a mean latency of 30–40 years) means that the peak has only now been reached.

“Given the continuing legacy of asbestos-containing materials in many Australian homes and buildings, there is increasing concern about people being exposed to asbestos when performing domestic tasks and renovations, and it is likely that the elevated prevalence of malignant mesothelioma in Australia will persist for some decades.”

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