Thanks to the Coal Services Health & Safety Trust, a study is underway into lung function analysis aiming to detect harmful dust exposure and occupational lung disease before it’s irreversible.
Since 1991, the Coal Services Health & Safety Trust (Trust) has invested in projects and research that elevate health and safety standards for mine workers, operators, and the broader mining community. These projects transform innovative ideas into practical solutions, significantly impacting the lives of those within the coal mining sector.
Jay Horvat, Professor in Immunology and Microbiology at the University of Newcastle and the Hunter Medical Research Institute, and W. Alexander Donald, Professor in the School of Chemistry at UNSW Sydney, are the Lead Investigators in a three year study funded by the Trust to determine if introducing new lung function tests to Order 43 medical assessments will enable the identification of early stage lung disease in coal mine workers before it’s irreversible.
Jay was part of a previous study funded by the Trust which looked at the biological effects of the different types of dust found in coal mining operations.
“In that initial study we went out to all types of coal mining operations, open cut mines, longwall underground mines, even looking at the coal stockpiles,” said Jay.
“We took samples from them all and screened the coal down to PM10 and below which is the type of dust that can be inhaled into the airways. We then exposed mice to those different types of dust and what we essentially found is that different dust types from different locations had different effects on disease pathologies found in the airways.
“While they all ultimately led to features of lung disease, the type of lung disease was different depending on the type and location of where the dust came from.”
For that research project, in addition to assessing lung pathology following different lengths of exposure to different dusts, the team conducted lung function tests known as the forced oscillometry technique (FoT) and diffusion capacity of the lungs for carbon monoxide (DLCO).
“Using these lung function techniques, one of the most important things we found was that in the very early stages – before the mice had pathology changes to their lungs like the fibrosis and the scarring you see in diseases like pneumoconiosis (also known as black lung) and silicosis – was that these tests were able to pick up tell-tale disease changes prior to seeing these structural abnormalities to the lungs.
“Current Order 43 medical assessments use chest x-ray and spirometry tests which also pick up these structural and functional abnormalities in the lungs but often it’s too late by the time you see changes using these techniques. The research we did indicated that by using different types of lung function tests such as FoT, DLCO and fractional exhaled nitric oxide (FeNO), you could potentially pick up subtle changes before those permanent structural abnormalities occurred.”
That discovery led to the current research project which is aimed at determining if these more sensitive lung function tests – which are already being widely used in other testing of respiratory diseases – could be brought into the program of tests that are part of Order 43 medicals and help detect changes in the lungs prior to the development of irreversible lung damage and debilitating disease.
Assisting Jay in the project is Jemma Mayall, a lecturer and postdoctoral researcher at the University of Newcastle. Jemma has been managing the project with Happy Health who are facilitating the testing.
“We recently had our first participant through, which is very exciting,” said Jemma.
“For now I am performing the tests and the staff at Happy Health are observing but they will take over the testing as we get further into the study. Participants come in before their standard medical and we run them through a questionnaire and perform the tests which are very quick. The whole thing takes about an hour but if these tests were introduced to the Order 43s then that time would be a lot less, and if they replaced the spirometry test then the entire medical assessment would actually take less time than it currently does.
“Plus, one of the benefits of these tests is they don’t require forced breathing like a spirometry test which some people find difficult.”
As part of the same study the research is also looking at a completely new way for testing occupational lung disease.
Led by Professor W. Alexander Donald, it is a revolutionary new way of testing using the chemical analysis of breath, basically a breathalyser for testing changes in the volatile organic compounds that match up with occupational lung disease.
“They already have a fingerprint of volatile organic compounds they can pick up in the breath that matches up and can be used to diagnose silicosis,” said Jay.
“The main thing this research is trying to determine is whether that signature can be used for early stage lung disease in general and indicate that someone is on their way to lung disease before they actually have it.
“These studies that are testing the feasibility and effectiveness of incorporating new lung function tests into coal worker’s Order 43s have the same ultimate goal – to determine whether or not there is a better option than the current testing. Workers are still getting diseases, and we need tests that can identify problems before people get debilitating lung diseases. We want to protect families from losing their loved ones and we want to make sure that people working in the mining industry can do so safely and live long healthy lives.”
While these studies are focusing on coal mine workers Jay said there is the potential for them to be rolled out across other industries.
“There’s a lot of dusty jobs out there, such as people working in construction and demolition. If the breath test works out to be effective at picking up early stage exposure it will revolutionise the way in which we detect exposure in workers in all industries.
“But if we do find there is a chemical signature associated with disease it will still take a long time to work up that as a diagnostic technique. Think of how long it takes for a new drug to be developed from the initial conception, it’s often twenty years before it reaches the public. FoT, DLCO and FeNO are already proven technologies for monitoring lung disease so if we can show that it’s quick, effective and able to pick up things that spirometry can’t, and that it can be easily integrated into the Order 43s, then it can be brought into practice almost immediately.”
The study is a collaborative initiative between researchers at The University of Newcastle, University of NSW, Hunter Medical Research Institute, The Woolcock Institute and University of Sydney. The testing is being facilitated by Coal Services and Happy Health and Jay said without the two organisations supporting these projects it would never have been possible.
“Happy Health have committed so much in-kind time and resources to facilitate the FoT, DLCO and FeNO testing.
“We will soon be rolling out the chemical analysis testing through Happy Health and Coal Services and they are both playing important collaborative roles in helping to translate the research into a real-world outcomes for coal mine workers.”
Sanjiv Parmar, Happy Health CEO, said they were thankful to be part of the study as its goal of keeping workers healthy through preventive health checks aligns with their own mission.
“Happy Health aims to boost employee wellbeing through comprehensive health and wellness services, helping create healthier, happier workplaces.
“Many workers we see rarely visit a doctor, so pre-employment or periodic NSW Order 43 mining medicals may be their only chance to discuss health concerns with a qualified professional. We value the opportunity to perform these assessments and support workers in understanding and managing any new health issues.
“Testing new respiratory tools – FENO, FOT, DLCO and gas analysis – in real-world conditions may provide UON and HMRI with important data on their potential to detect lung disease early. This could help prevent serious illness and assess the possible value of these tests in mining medicals,” said Sanjiv.
Now what is needed is for as many people as possible to get involved in the testing. By giving up an hour of your time at your next medical you won’t just be looking after your own health but potentially helping improve health outcomes for all coal mine workers.
