Silicosis treatment breakthrough at the Prince Charles Hospital

Trailblazing Queensland doctors have found a potential world-first cure for the lethal lung disease silicosis that is killing hundreds of young workers across the country. The Bulletin can reveal that since March, six silicosis sufferers have undergone trials as part of a Silicosis Research Program at The Prince Charles Hospital (TPCH) in Brisbane.

Four tradies with mild silicosis were virtually cured of the disease after undergoing a whole lung lavage or “lung washout”; a process that involves flushing 25 litres of water through each lung over a three-to-four-hour period.

The two other men, who have advanced silicosis, have renewed hope their condition will remain stable and potentially have a longer lifespan.

Cutting-edge research that led to the medical breakthrough was wholly funded by a $500,000 grant from The Common Good movement, an initiative of TPCH Foundation dedicated to funding researchers to undertake important medical discoveries.

But in order for the important work to continue, The Common Good is desperately trying to raise $5 million from the corporate sector, construction industry and any other industry that has an interested in saving the lives of tradies.

Spearheading the hospital’s Silicosis Research Program are Professor Dan Chambers and Dr Simon Apte, a Research Fellow of the TPCH Foundation and a senior lecturer at the University of Queensland (UQ).

Prof Chambers is a thoracic transplant physician at Prince Charles and Head of Research in the Queensland Lung Transplant Service. Crucially, he was heavily involved in the Queensland Government’s silicosis screening program when it started in 2017.

“Of the screened workers in Queensland, 85 per cent have a mild form of the disease and we felt we could completely remove the dust from their lungs and potentially cure their silicosis,” Prof Chambers said of the trials.

“In four of the patients, who had early silicosis, we saw a 16-fold reduction in dust in the lungs after the lavage and dramatic changes in the CAT scans; they’ve pretty much returned to normal.”
In Queensland alone, almost 200 young stonemasons have silicosis and many are already gravely ill.

The medical breakthrough comes on the back of Bulletin investigations that uncovered:

  • More young stonecutters are being diagnosed with silicosis every month;
  • Authorities knew what was killing the men but won’t ban engineered stone because it was “cheap and mass produced”;
  • Workers were scared to lose their jobs by speaking up as it was largely left to employers to ensure staff are screened;
  • Workplace Health and Safety Queensland was only re-auditing 166 stone benchtop workplaces — eight months after it said it would — after inquiries by the Bulletin.
  • Silicosis is a long-term lung disease caused by inhaling large amounts of crystalline silica dust, usually over many years. While it’s naturally occurring in many surfaces, engineered stone contains up to 95 per cent silica dust.

Prof Chambers said: “Back in 2018 when I started meeting dozens of young men diagnosed with silicosis, particularly from the Gold Coast, I saw just how terribly widespread the problem was and would become”.

Fortunately, Dr Apte was on the cusp of developing a world-first test to measure the amount of silica in a patient’s lungs, a test that could then be used to measure the success of a treatment called a whole lung lavage.

Traditionally used to treat a rare lung condition called pulmonary alveolar proteinosis, Prof Chambers realised he could repurpose this procedure to remove silica dust particle from lungs before they had the chance to cause irreparable damage.

“The work in the lab has been critical. The Eureka moment was probably when we saw the crystal inside these cells that are in the air spaces but yet to lodge in the lung tissues, that’s when we knew this would work,” he said.

Prof Chambers said Dr Apte and his team were collecting cells from patients with a view to determining a treatment for those with progressive massive fibrosis (PMF), a condition caused by long-term exposure to silica dust.

“We’re conscious that while we’ve potentially got a cure for people with early silicosis, we still need to look after those who have more advanced disease where there’s already scarring.
“It’s very likely this will involved repurposing an existing drug, once we understand how lung scarring happens.

“Australia is an advanced economy, we have great science and it’s just a matter of applying that to this problem.”

Dr Apte said using two $200,000 hi-tech machines donated by UQ, he and his team would undertake an advanced scientific inquiry into cells removed from silicosis patients.

“In our humble building with 1970s wallpaper, is one of the most cuttingedge lung research labs in the world, believe it or not,” he said.

“One of the unique benefits of our set-up is that our lab attached to the hospital.

“As far as we know there’s no one else doing this. Our colleagues in Melbourne and Sydney are not far away from replicating our work and we’ll be sharing cells and data with each other.”
Prof Chambers said the waiting list for the procedure was growing, but the hospital only had capacity for one lung lavage per week, meaning a maximum of 26 silicosis patients could be treated each year.

“We’ve had great support from Queensland Health but none of this would have been possible without funding from The Common Good,” he said.

“The main message is this disease is preventable with appropriate workplace safety measures in place. If this product is not used then there won’t be silicosis, but for those unfortunate enough to already have developed it there is a potential solution.”

WHY ARE SILICA CRYSTALS SO DANGEROUS

Silica crystals are small enough to inhale and to penetrated deep into the lungs, they’re also highly oxidising which is why they are so dangerous.
Once inside the lungs, the crystals are chewed up by lung cells which then can’t digest them and so the cells start to “panic” triggering scarring and fibrosis.

SILICOSIS

In early stages, symptoms are mild and include cough, sputum and progressive shortness of breath. As the scarring continues to worsen, the first real signs of a problem may be an abnormal chest X-ray and a slowly developing cough.

Once lung scarring is more severe, symptoms may include bronchitis-like symptoms such as persistent cough, shortness of breath and difficulty breathing as well as fatigue, fever, night sweats, leg swelling and bluish discolouration of the lips.

The longer silicosis goes without treatment, the more likely it is to develop a complication. Because the disease affects the immune system, silicosis patients are vulnerable to developing tuberculosis, lung cancer, COPD and kidney disease.

Lung transplants are a last resort because of the lack of donors, the length and risk of the operation and the fact patient outcomes aren’t always great.

THE WHOLE LUNG LAVAGE PROCEDURE

Usually it’s a three-to-four hour process that involves a general anaesthetic so doctors can insert a breathing tube that splits left and right with a balloon at the end of each side so the lungs can be isolated.

A ventilator breathes for the patient off one lung while the other one is washed out with about 25 litres of normal saline.

The water is gravity fed into the lung a few litres at a time and the patient wears a vibrating vest to make sure the water “sloshes around” the entire surface of the lung.

Once the water drains “a bit like a rinse cycle on a washing machine” the procedure is repeated until the “pretty mucky grey water eventually comes back clear”.

A team of eight medical professionals oversee the procedure that often requires an overnight stay. Afterwards the patient may experience excess coughing to rid their lung of any remaining water.

Generally a week or so later the procedure is performed on the other lung.

POST TREATMENT

A week or so after the procedure an X-ray of the lungs is taken and a camera test removes a biopsy of cells from the lung.

Using “crime scene level technology’ scientists determine the shape, size and mineral content of the retrieved dust/silica.
Interesting, after a whole lung lavage, the body produces new blood cells in the lung in place of the ones that have been removed.

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