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Occupational lung disease (OLD)

Red flags

Consider immediate referral for patients with the following:

Acute exacerbations of OLD showing the following features

  • Severely breathless (>24 breaths/min at rest)
  • Unable to walk between rooms (when previously mobile)
  • Unable to eat or sleep secondary to dyspnoea
  • Altered mental state
  • Worsening hypoxaemia or cor pulmonale
  • Oxygen saturation <90% (if not known to retain CO2)
  • Clinical signs of pneumonia
  • New signs of heart failure
  • New arrhythmia/chest pain

Other important information for referring practitioners

  • Clarify diagnosis and access specialist investigations (litigation can be an issue)
  • Management advice
  • Infective exacerbations

Occupational lung diseases

  • Silica related
    • Acute silicosis
    • Chronic silicosis
  • Asbestos related
    • Asbestosis
    • Asbestos related pleural disease
      • Pleural plaques
      • Pleural effusion
  • Coal related
    • Simple pneumoconiosis
    • Complicated pneumoconiosis/progressive massive fibrosis
  • Hard metal related
    • Tungsten carbide
  • Beryllium related
  • Hypersensitivity related pneumonitis (this is an extensive list – see links for more information)
    • Farmers lung (mouldy hay)
    • Bagossosis (mouldy pressed sugar cane)
    • Bird fancier’s lung (bird products)

Diagnosis

  • Diagnosis of OLD is primarily based on a history of current or previous dust exposure associated with respiratory symptoms. Cough (productive or non-productive) and SOBOE are the commonest symptoms. As most investigations performed in primary care are not diagnostic it is important to enquire about occupational dust exposure.

Prevention

  • Do not smoke as this increases the risk for OLD
  • Wear protective devices at all times during exposure
  • Regularly check spirometry in dust exposed workers

Treatment

  • Treatment is supportive. Use of bronchodilators and inhaled steroids may be of some benefit. Steroids are useful in hypersensitivity pneumonitis. In all cases removal of the causative agent is important.
  • Regular review of spirometry will chart any progression in disease. Lung cancer is more common in asbestos and uranium dust, tuberculosis is also more common in dust related diseases especially silicosis.
  • A multidisciplinary approach using physiotherapy, pulmonary rehab and optimising nutrition and exercise can help to improve QoL.

Referral requirements

A referral may be rejected without the following information.

Essential referral information

  • Reason for referral
  • History of OLD or symptoms
    • Duration
    • Severity
    • Nature of occupational exposure and circumstances
  • Management to date
    • Include last two specialist letters if seen previously at another centre
  • Other relevant medical conditions
  • Medications
    • Include previously tried medications if associated with treatment failure or problems
    • Include full medication list and allergies
  • Investigations
    • FBC (eosinophil count, anaemia, high WCC)
    • Spirometry
    • CXR
    • CT chest

Additional referral information (useful for processing the referral)

  • Allergy testing
  • Gas transfer studies

Out of catchment

Metro North Health is responsible for providing public health services to the people who reside within its boundaries. Special consideration is made for patients requiring tertiary care or services that are not provided by their local Hospital and Health Service. If your patient lives outside the Metro North Health area and you wish to refer them to one of our services, inclusion of information regarding their particular medical and social factors will assist with the triaging of your referral.

  • Impact on employment
  • Impact on education
  • Impact on home
  • Impact on activities of daily living
  • Impact on ability to care for others
  • Impact on personal frailty or safety
  • Identifies as Aboriginal and/or Torres Strait Islander

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can’t order, or the patient can’t afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

  • Presenting symptoms (evolution and duration)
  • Physical findings
  • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
  • Body mass index (BMI)
  • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
  • Current medications and dosages
  • Drug allergies
  • Alcohol, tobacco and other drugs use

  • Full name (including aliases)
  • Date of birth
  • Residential and postal address
  • Telephone contact number/s – home, mobile and alternative
  • Medicare number (where eligible)
  • Name of the parent or caregiver (if appropriate)
  • Preferred language and interpreter requirements
  • Identifies as Aboriginal and/or Torres Strait Islander

  • Full name
  • Full address
  • Contact details – telephone, fax, email
  • Provider number
  • Date of referral
  • Signature

  • Willingness to have surgery (where surgery is a likely intervention)
  • Choice to be treated as a public or private patient
  • Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)
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