title: Artificial stone-associated silicosis in Queensland stonemasons: a retrospective cohort study of lung function over time
Creators: name: Matula, Michael A
Publisher: name: Griffith University
Year: 2022
Subjects: subject: Silicosis
subject: lung disease
subject: stonemasons
subject: Australia
subject: cohort study

description: Background: Silicosis is an ancient and preventable occupational lung disease that has long been known to be caused by exposure to significant amounts of dust containing silica (1). Silica dust is now known to be made up of microscopic silicon dioxide (SiO2) crystals, termed respirable crystalline silica (RCS), which are small enough to be inhaled to the deep alveolar sections of the lungs where gas exchange occurs (2). Over time this exposure can lead to silicosis, which can significantly impact a person’s quality of life and lifespan (2). Recent attempts to understand the pathophysiology of this disease have been undertaken to better aid understanding of the disease process and potential targets for therapeutic interventions beyond prevention (3). Currently the only established intervention for silicosis is a lung transplant, though other therapies such as whole lung lavage are being trialed which could potentially slow down or halt the progression of disease (4). Aetiology: This condition has seen a sudden increase among young stonemasons (24-39 years old) in Australia since 2015 and even earlier in other developed nations such as Spain and Israel due to the recent and widespread use of artificial (or engineered) stone in kitchen and bathroom benchtops, which is a popular material due to its strength, affordability, water resistance and visual appeal (5, 6). An increased demand for artificial stone in new homes and renovations combined with a lack of effective workplace regulation of safe practices have led to a large number of stonemasons in Australia being exposed to dangerously high levels of silica dust, since the material contains much higher silica content than traditional stone (7). This has resulted in significant numbers of younger stonemasons contracting a form of silicosis which occurs after a shorter latency period than historical cases (8). These cases have been characterised by rapid deterioration in lung function and quality of life, sometimes leading to lung transplant or death (8, 9). Screening program: A large screening program in Queensland of all known stonemasons working in kitchen and bathroom benchtop workshops has been undertaken by the government agencies WorkCover Queensland (WCQ) and Workplace Health and Safety, commencing in late 2018. At the time of writing 1053 workers have been screened, 202 have been diagnosed with silicosis and an additional 33 with progressive massive fibrosis (PMF), a radiological finding indicative of the advanced stage of the disease (10). Most of these cases have been followed up in several specialist respiratory clinics in Brisbane and the Gold Coast. In Australia to date there have only been several published case reports of silicosis from artificial stone and to our knowledge there hasn’t yet been data published reflecting the true extent of this disease and its burden in Australia (11). Therefore, our research focus will be to thoroughly describe this cohort in order to understand who is affected, what background they have and how compromised by the disease they are.