Silicosis. What is it?
The motion for change around working with engineered stone and other products that are high in silica has gained momentum over the last few years and has recently been in the spotlight. This is because of the increasing number of silica-related diseases and cases of silicosis in parts of Australia. These are directly linked with workplace exposure to crystalline silica dust, which becomes airborne and highly hazardous to those who are exposed to it.
Studies have shown that there is a strong correlation between those that work with materials and products that are high in silica and cases of occupational lung disease – which is significant due to the fact that there is currently no cure for silicosis. And while employers have a responsibility to provide silica health monitoring, Bodycare believes it is important for each individual to be fully informed and aware of any risks that may be present in their own workplace setting.
What is Silicosis?
Silicosis is a long-term lung disease that is the result of the body’s response to the presence of crystalline silica (silica) particles in the lungs which penetrate deep into the lungs and is known to cause scarring, or fibrosis resulting in lung damage and disease.
The three major types of silicosis are based on the length of time and nature of the exposure to silica dust, but all affect people in the same way (HealthDirect 2021). They are:
- Acute silicosis which can develop after just weeks or months after exposure to extremely high concentrations of silica dust.
- Accelerated silicosis which can be detected after three to ten years of high exposure levels.
- Chronic silicosis which may have a slower onset but is usually present if there have been more than ten years of moderate exposure.
What Causes Silicosis?
Silica forms a major component of most rocks and soils and can be found in a variety of materials including sandstone, quartz, concrete, plaster, grout and mortar. It is also present in high percentages in composite products such as artificially engineered stone, bricks, tiles and some plastics (SafeWork Australia 2023). The damaging crystalline silica dust is generated through the action or mechanical process of cutting, crushing, drilling, demolishing, polishing, milling, sawing, sanding, grinding or even sweeping any of these silica-containing products. Over time, the silica dust gets deposited deep in the lungs through inhalation by those exposed, leading to inflammation and scarring of the lung tissue, ultimately causing silicosis.
Who is at Risk of Silicosis?
Because crystalline silica is most dangerous to health when it becomes airborne in the form of invisible dust, those most at risk are workers performing tasks where they are likely to inhale it. Your chances of inhaling it are also based on how much silica dust you come into contact with, how long you are exposed to it and your level of protection by equipment or individual resistance.
Exposure to crystalline silica may occur in several industries and occupations due to its wide and varied use. You might be at risk of developing silicosis if your work involves the production of respirable silica dust particles through:
- fabrication and installation of composite (engineered or manufactured) stone countertops
- excavation, earth moving and drilling plant operations
- clay and stone processing machine operations
- paving and surfacing
- mining, quarrying and mineral ore-treating processes
- construction labouring activities
- brick, concrete or stone cutting; especially using dry methods
- abrasive blasting
- foundry casting
- angle grinding, jackhammering and chiseling of concrete masonry
- hydraulic fracturing of gas and oil wells
- pottery making.
What are the Symptoms of Silicosis?
Awareness of any previous or current exposure to hazardous agents in your occupational history is important when thinking about lung diseases such as silicosis. This is because its symptoms may not be noticeable until the disease has progressed, and it may be hard to detect in the early stages (except in acute silicosis).
The symptoms – which become more severe as the condition worsens – include shortness of breath after exercising, chest pain, dry or productive (sputum) cough, wheezing, tiredness and possible weight loss.
Silicosis can also increase the risk of getting other serious conditions such as tuberculosis, chest infections, emphysema, kidney damage and lung cancer.
How is Silicosis Diagnosed?
Symptoms of silicosis and progressive massive fibrosis may not appear for many years after exposure. This means that workers may be diagnosed with these diseases and not present with any symptoms, even at the point of initial diagnosis, which is why health monitoring is so critical.
Health testing for exposure to crystalline silica can be conducted before an employee is onboarded so that a baseline can be established and any changes to the worker’s health after commencing work can be detected.
Health monitoring required for respirable crystalline silica (RCS) involves a registered medical practitioner with experience in health monitoring examining and monitoring the health of workers to see if exposure to hazardous chemicals at work is affecting workers’ health.
From the initial health monitoring date, a worker’s health should then be monitored annually through health surveillance. Where workers are exposed, suspected of being exposed or are concerned about exposure to crystalline silica, the person conducting the business or undertaking (PCBU) has a duty to arrange a health monitoring appointment for the worker(s) with a registered medical practitioner annually.
The first step to diagnosing silicosis is a discussion with your general practitioner, who will gather information on your medical history, work history and any symptoms you may have. To confirm a diagnosis, you may be referred to a respiratory specialist or occupational specialist doctor.
Through visits with these medical professionals, you may undergo several tests, including:
- Physical examination
- Lung function (breathing tests)
- Chest X-ray
- High-resolution CT scan (HRCT)
- Arterial blood gas analysis
- 6-minute walk test.
If a diagnosis cannot be made through medical and occupational history and radiological imaging, some further tests such as a diffusing capacity of the lungs for carbon monoxide (DLCO), bronchoscopy, endobronchial ultrasound and a biopsy may be required (Lung Foundation Australia 2021).
How is Silicosis Treated?
Although silicosis cannot be cured, there are several management strategies available to help reduce symptoms and potentially slow the progression of the disease.
- Medications like relievers which help to open the airways and make breathing easier.
- Oxygen therapy which may be prescribed if you have low blood oxygen levels.
- Lung transplantation may be recommended for an eligible candidate in the case of severe silicosis which is worsening.
- Whole lung lavage or ‘washing out’ of the lung using several litres of salt-water solution, with the intention of flushing out the damaging silica crystals. This procedure is currently in the trial phases.
Your doctor may also suggest you stop smoking (if you smoke), have regular tests to check for tuberculosis and have the annual flu vaccine administered.
How is Silicosis Prevented?
Since silicosis is irreversible with limited effective treatments available, prevention is key. As such, the only way to protect workers from developing silicosis is to control their exposure to silica-containing materials and dust. Workplaces have a duty to undertake independent assessments of personal workplace respirable crystalline silica dust levels, and all efforts must be made to reduce these levels.
If you are working with, or are exposed to silica dust, here are a few things you can do yourself to protect your lungs and reduce your own risk:
- Follow the Hierarchy of Controls/ health and safety advice – this refers to actions your employer must take to eliminate or minimise health and safety risks, which you have a responsibility to follow.
- Participate in health monitoring – also known as health surveillance, it is mandated under Workplace Health and Safety legislation. This aids in detecting early signs of silicosis in workers. (share details and specifications of occupational history).
- Know and report the symptoms – this will help with identifying impacted health sooner.
- Talk to your doctor – regular check-ups with a medical professional are important, even if you’re not experiencing any symptoms.
- Quit smoking or vaping – this will only increase your risk of many lung diseases.
- Practice good hygiene – wash your hands before eating and drinking and put any dusty clothing in a separate wash basket.
The Hierarchy of Controls
Source: Lung Foundation Australia (2021)
How does Silicosis Impact Lives?
Each person experiences silicosis differently. Some people remain stable for many years whereas others may face a rapid decline. Either way, early detection and reduction of further exposure to silica dust is vital. However, this may mean leaving your job or even your industry, which can be very disruptive to your livelihood. The financial loss from change in work can also be a real challenge for people living with silicosis. Depending on the state or territory, some compensation schemes may assist with medical expenses, loss of income or compensation for pain and suffering.
As well as physical health, silicosis can significantly impact your mental health and emotional wellbeing, as your family navigates a ‘new normal’ (Lung Foundation Australia 2021). It is equally important to access mental healthcare early so that you have a trusted source of support to turn to.
It is estimated that around 584,050 Australians are currently exposed to respirable crystalline silica dust at work. Around 10,390 of these workers are predicted to develop lung cancer in their lifetime as a direct result of being exposed to the dust (RACGP 2022). When extrapolated to silicosis (with modelling based on past ratios), the future burden of the disease stands at between 83,090 and 103,860 cases of silicosis that is attributable to current exposure to respirable crystalline silica (Curtin University 2022).
At the moment, approximately 350 Australians contract silicosis a year, and nearly one in four engineered stone workers who have been in the industry prior to 2018 have been diagnosed with silicosis or other silica dust-related diseases (Department of Health and Aged Care 2023). This number is predicted to rise in this industry as well as others, and so restrictions around protecting at-risk employees must continue to tighten.