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If you work in a Queensland coal mine, mineral mine or quarry, the law requires regular checks on your lungs — a breathing test and a chest X-ray. Most workers are cleared and simply return at the next interval. If something looks different from expected, there is a set pathway of further tests, and your employer pays for them. Being sent for another test is not a diagnosis: it means the first result was not clear enough to leave, which is exactly what screening is for.
What mine dust lung disease is
Mine dust lung diseases (MDLD) are lung conditions caused by breathing in dust at work over time. They include silicosis from respirable crystalline silica, coal workers' pneumoconiosis (“black lung”), mixed dust pneumoconiosis, dust-related COPD and dust-related interstitial lung disease.
They share three features that shape the whole approach to them. They develop slowly and silently, so symptoms appear late. They are irreversible — damaged lung does not recover. And they are entirely preventable by controlling dust. That combination is why surveillance exists: the point is to detect change early enough to stop further exposure, not to treat established disease.
Why you are screened
Respiratory health surveillance is mandatory for Queensland coal mine workers under the Coal Mining Safety and Health Regulation 2017, and for mineral mine and quarry workers under the Mining and Quarrying Safety and Health Regulation 2017.1 Screening is arranged through the Coal Mine Workers' Health Scheme and carried out by a doctor appointed for the purpose — an Appointed Medical Adviser (AMA) for coal, or an Appropriate Doctor (AD) for mineral mines and quarries.
The pathway followed after an abnormal result is set out in the Mine Dust Lung Disease Clinical Pathways Guideline, published by Resources Safety and Health Queensland and now in version 3.0 (October 2026).1 Its stated purpose is to reach a diagnosis in a reasonable timeframe, reduce worker anxiety, and produce consistent outcomes across the state.
What the screening involves
A breathing test (spirometry)
You take the deepest breath you can and blow out as hard and as long as possible. It is repeated until at least three good blows are recorded. For surveillance the test must be performed by a provider approved by Resources Safety and Health Queensland, working to the TSANZ technical standards for spirometry, with operators trained to the matching competency standard.1,2,3 Results are compared against Global Lung Initiative reference values — and the triggers used in the pathway are based on your results before any reliever inhaler.1
If a technically good test cannot be obtained on the day — a chest infection, a cough, difficulty with the technique — repeating it in four to six weeks may be more appropriate than acting on a poor one.1 A note explaining an abnormal or missing result is not enough on its own; it has to be followed up.
A chest X-ray
Chest X-rays for surveillance are read by two certified readers, using the International Labour Organization classification for pneumoconiosis, with a second read and adjudication arranged independently.1 Two independent reads is deliberate: early dust change is subtle, and agreement between readers matters.
Importantly, a normal X-ray does not close the matter. If you report unexplained cough, wheeze, phlegm, breathlessness or blood in your sputum, that alone should trigger review even with a clear film.1
What happens if a result is abnormal
There is a defined sequence, and each step exists to answer a specific question.
| Step | What it adds | When it is used |
|---|---|---|
| Repeat spirometry | Confirms the first result was real and not a technical problem. | Where the original test did not meet the acceptability and repeatability standards. |
| Complex lung function testing | Gas transfer (DLCO) and full lung volumes — the measures spirometry cannot give. | Where spirometry, symptoms or exposure history suggest more detail is needed. Accredited respiratory function laboratories are recommended.1 |
| HRCT scan | A detailed CT of the lung tissue, to look for dust-related change directly. | To inform respiratory physician review, and to determine whether that review is needed at all.1 |
| Respiratory physician review | Diagnosis and an opinion on cause, informed by your work and exposure history. | Where the pathway indicates it. A physician experienced in occupational lung disease is preferred.1 |
The sequence can be adapted. If complex lung function testing is not available within three months — a real constraint in regional Queensland, where it often means travel — the doctor may bring the HRCT forward rather than let the whole assessment stall, and may arrange it locally.1 Where the pathway is departed from, the reason has to be documented and may be audited.
Where mild change is found on lung function but the HRCT is clear, the case can be managed by your AMA or AD rather than referred on.1
Who pays
Your employer covers the cost of all follow-up investigations needed to complete the respiratory health examination, including reasonable travel.1 That is the investigation, not the treatment: employers are not responsible for treatment costs under the surveillance programs.
If an occupational condition is diagnosed, you should be given a work capacity certificate and referred into the workers' compensation scheme, where medical and rehabilitation costs can be considered.1 If the condition turns out not to be work-related, treatment goes through your usual GP and the ordinary health system.
What a diagnosis means for your work
A diagnosis does not automatically end a career. Work restrictions, enhanced surveillance and review intervals are considered against the Queensland Office of Industrial Relations guidance on returning workers with mine dust lung diseases to the workplace.1 The emphasis is on preventing further exposure while keeping you working where that can be done safely.
Alongside that, the advice you would expect: stopping smoking and vaping, avoiding other respiratory hazards at home and in hobbies, and weight management support where relevant.1 These matter because dust exposure and smoking compound each other.
Where physiotherapy fits
Physiotherapy does not reverse dust-related lung damage — nothing does. What it does is protect function and capacity around it. That means exercise-based rehabilitation to maintain fitness and reduce breathlessness, breathing strategies for exertion and for panic, airway clearance where sputum is a feature, and objective testing to track change over time rather than relying on how a person feels on the day.
We also see workers who have been told a result is abnormal and are waiting on further tests. That wait is uncomfortable, and staying active during it is both safe and useful.
Part 1 · References
- Resources Safety and Health Queensland. Mine Dust Lung Disease Clinical Pathways Guideline. Version 3.0. Brisbane: RSHQ; October 2026.
- Thoracic Society of Australia and New Zealand. SPC01: TSANZ Technical Standards for Spirometry in Australian Primary Care. TSANZ; 2026.
- Thoracic Society of Australia and New Zealand. SPC02: TSANZ Standards for Training and Maintaining Competency in Spirometry for Australian Primary Care. TSANZ; 2026.
References are numbered in citation order (Vancouver/BMJ style) and were current at the time of writing. Guidelines are living documents — verify against the latest version before clinical use.
Supervised exercise, breathing technique and self-management education are the mainstay of cardiorespiratory physiotherapy for this condition.
Clinical evidence
Part 1 covers the same condition without the technical detail. What follows is the evidence base behind it, written for clinicians — the literature, the reasoning and the gaps.
For clinicians: this summary supports clinical reasoning and is not a protocol. Check current guidelines and local policy before applying it, and read it alongside the key references and guidelines directory.
Scope and standing
The Mine Dust Lung Disease Clinical Pathways Guideline v3.0 (October 2026), published by Resources Safety and Health Queensland, governs follow-up investigation of Queensland coal mine, mineral mine and quarry workers with abnormal respiratory screening.1 It was first published in 2017 following the independent Monash review of the Coal Mine Workers' Health Scheme, and v3.0 incorporates legislative amendment, audit findings and stakeholder feedback, endorsed by the Resources Medical Advisory Committee.
It binds Appointed Medical Advisers under the Coal Mining Safety and Health Regulation 2017 and Appropriate Doctors under the Mining and Quarrying Safety and Health Regulation 2017. Deviation is permitted where clinically justified, but must be documented in the health assessment form and is subject to RSHQ audit; where no justifiable reason can be determined, corrective action is required.1
Testing prerequisites
- Provider approval. Spirometry for surveillance must be performed by RSHQ-approved providers, assessed against TSANZ SPC01 (technical standards) with operators trained to SPC02 (training and competency).1,2,3 For mineral mine and quarry workers, clinics must additionally satisfy QGL04.
- Reference values. GLI equations are mandatory, and the escalation triggers are pre-bronchodilator values.1
- BDR. Bronchodilator responsiveness testing should be considered where asthma or another obstructive condition is suspected, or where pre-bronchodilator FEV1, FVC or FEV1/FVC falls below the LLN (z-score −1.65), in line with the TSANZ standards.1
- Quality gate. Only acceptable and repeatable results should be interpreted. Where they cannot be obtained, repeat at 4–6 weeks. Documenting a temporary condition as the reason for an abnormal or missing result, without follow-up, is expressly not a correct application of the guideline.1
- Longitudinal comparison. Decline is assessed against the earliest available percent-predicted FEV1 or FVC, not the previous test. Prior records are available through ResHealth, or from the RSHQ Health Surveillance Unit.1
Early or mild lung function impairment — the definitions
This is the part of v3.0 most likely to change practice, because the categories are defined by combinations of absolute-versus-LLN comparisons and z-score position, not by a single cut-off. Any one of the following, with all its criteria met, constitutes early or mild impairment.1
| Category | Criteria (all must be met) |
|---|---|
| Rapid decline | Longitudinal decline since baseline in percent predicted FEV1 or FVC >15%, and absolute FEV1 ≥ LLN |
| Isolated mild diffusion impairment | DLCO z-score > −1.65 and < LLN |
| Early obstructive abnormality | FEV1/FVC < LLN (using FVC), and FEV1 ≥ LLN, and FVC ≥ LLN |
| Mild obstructive abnormality | FEV1/FVC < LLN, and FEV1 < LLN, and FEV1 z-score > −1.65, and FVC ≥ LLN |
| Mild mixed obstructive / restrictive | FEV1/FVC < LLN, and FEV1 < LLN, and FEV1 z-score > −1.65, and FVC < LLN |
| Mild restrictive pattern | FEV1/FVC ≥ LLN, and FVC < LLN, and FEV1 normal or < LLN, and FEV1 z-score > −1.65. Restriction is confirmed where TLC < LLN; where TLC ≥ LLN the picture is non-specific ventilatory impairment |
Two points are worth flagging for anyone applying this table. First, rapid decline qualifies even with a normal absolute FEV1 — a worker can be fully within the normal range and still trigger escalation on trajectory alone, which is the entire argument for keeping baseline records accessible. Second, the mild categories all require the FEV1 z-score to sit above −1.65 while the absolute value is below the LLN: these are narrow bands, and they cannot be evaluated from a percent-predicted printout alone.
Escalation sequence
- Complex lung function testing — single-breath DLCO and lung volumes, performed to current ERS/ATS standards; accredited laboratories should be considered.1 The AMA/AD may refer directly here after initial spirometry where findings, medical history or exposure history warrant it.
- HRCT — required to inform respiratory physician review, and used in mild impairment to determine whether that review is needed.1
- Respiratory physician review — with the specific reason for referral plus work and exposure history supplied. The physician may consult the AMA/AD or an occupational physician on causality.1
The access workaround is explicit in the guideline, not an improvisation. Where complex lung function testing cannot be completed within three months, the AMA/AD may progress to the next stage — for example arranging HRCT locally, or at the same location as the eventual lung function testing.1 In regional Queensland this is the common case rather than the exception.
Radiology requirements
- Imaging clinics must be RSHQ-approved. Chest radiographs are classified using the ILO International Classification of Radiographs of Pneumoconioses by at least two NIOSH-certified B-readers approved by RSHQ, with the RSHQ-engaged provider completing the second read, adjudication and final report.1
- Mineral mine and quarry workers require clinics and radiologists meeting QGL04.1
- A negative film does not close the assessment. Where a worker has ILO <1/0 but reports significant unexplained respiratory symptoms — cough, wheeze, haemoptysis, recurrent phlegm, breathlessness — this should trigger review in accordance with the spirometry pathway.1
Who manages the case
Mild lung function impairment with no HRCT abnormality may be managed by the AMA/AD, who records any MDLD diagnosis on the health assessment form.1 Work restrictions, enhanced medical surveillance and review periods are considered against the Queensland Office of Industrial Relations' guidance on returning workers with mine dust lung diseases to the workplace, which also advises on occupational physician involvement.1
Management advice to the worker sits with their treating practitioner and should emphasise smoking cessation (including e-cigarettes and vaping), avoidance of other environmental and avocational respiratory hazards, and weight management where relevant.1
Attribution in smokers with COPD
Appendix B of v3.0 provides a structured guide to estimating occupational contribution in workers with a smoking history diagnosed with COPD — the attribution question that determines compensability and is the one most often contested.1 Where an occupational condition is diagnosed, a work capacity certificate and referral to the workers' compensation scheme follow; non-occupational conditions return to usual care.
Costs sit with the employer for all follow-up investigation required to complete the examination, including reasonable travel — but not for treatment under the surveillance programs.1
Implications for physiotherapy
Three practical consequences. Objective measurement matters more than symptom report in this population, since escalation can hinge on a 15% trajectory change in someone who feels well. Test quality is a clinical variable: an unacceptable or unrepeatable spirometry session is not a result, and repeating at 4–6 weeks is the correct action rather than interpreting a poor blow. And rehabilitation is the available intervention — dust-related change is irreversible, so exercise capacity, breathlessness management and airway clearance where indicated are where function is actually protected. See silicosis and occupational lung disease for the disease-specific evidence.
References for the clinical evidence summary
- Resources Safety and Health Queensland. Mine Dust Lung Disease Clinical Pathways Guideline. Version 3.0. Brisbane: RSHQ; October 2026.
- Thoracic Society of Australia and New Zealand. SPC01: TSANZ Technical Standards for Spirometry in Australian Primary Care. TSANZ; 2026.
- Thoracic Society of Australia and New Zealand. SPC02: TSANZ Standards for Training and Maintaining Competency in Spirometry for Australian Primary Care. TSANZ; 2026.
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