Coal workers' pneumoconiosis (CWP), as part of the spectrum of coal mine dust lung disease (CMDLD), is a preventable but incurable lung disease that can be complicated by respiratory failure and death. Recent increases in coal production from the financial incentive of economic growth lead to higher respirable coal and quartz dust levels, often associated with mechanization of longwall coal mining. In Australia, the observed increase in the number of new CWP diagnoses since the year 2000 has necessitated a review of recommended respirable dust exposure limits, where exposure limits and monitoring protocols should ideally be standardized. Evidence that considers the regulation of engineering dust controls in the mines is lacking even in high-income countries, despite this being the primary preventative measure. Also, it is a global public health priority for at-risk miners to be systemically screened to detect early changes of CWP and to include confirmed patients within a central registry; a task limited by financial constraints in less developed countries. Characteristic X-ray changes are usually categorized using the International Labour Office classification, although future evaluation by low-dose HRCT) chest scanning may allow for CWP detection and thus avoidance of further exposure, at an earlier stage. Preclinical animal and human organoid-based models are required to explore potential re-purposing of anti-fibrotic and related agents with potential efficacy. Epidemiological patterns and the assessment of molecular and genetic biomarkers may further enhance our capacity to identify susceptible individuals to the inhalation of coal dust in the modern era.

Smoke exposure from bushfires, such as those experienced in Australia during 2019-2020, can reach levels up to 10 times those deemed hazardous. Short-term and extended exposure to high levels of air pollution can be associated with adverse health effects, although the most recent fires have brought into sharp focus that several important knowledge gaps remain. In this article, we briefly identify and discuss the existing Australian evidence base and make suggestions for future research. Respirology (2020) 25, 495-501 496 CM Walter et al.AMI, acute myocardial infarction; CO, carbon monoxide; CV, cardiovascular; ED, emergency department; FPM, fine particulate matter (defined by Crabbe (2012) 4 as airbone particles with a diameter of less than 2 microns); IHD, ischaemic heart disease; IQR, interquartile range; LFS, landscape fire smoke; OHCA, out-of-hospital cardiac arrest; PM, particulate matter; RR, risk ratio.Respirology (2020) 25, 495-501

Adding a specialist cancer pharmacist to the outpatient lung cancer team led to significant improvements in patient medication adherence. Both patients and GPs were highly satisfied with the service. Medication misadventure and clinic attendances were reduced.

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A 77-year-old female with recurrent non-small-cell lung cancer presented to a hospital outpatient clinic with tremor, weakness, inability to coordinate motor movements, and confusion. It was suspected that the symptoms were due to possible central nervous system metastases; however, a CT scan of her head was unremarkable. The lung clinic liaison pharmacist took a medication history from the patient, complimented by extra information from the patient’s community pharmacy. The pharmacist suspected the rare side effect of serotonin syndrome was responsible for the patient’s presenting symptoms caused by the combination of oxycodone and citalopram. The patient’s symptoms resolved soon after oxycodone was changed to morphine.

Ambient (outdoor) air pollution is a key risk factor for health for which effective policy plays an important preventative role. Australian federal and related state air quality standards have historically relied on international evidence for guidance, which may not accurately reflect the Australian context. However, there has been a large increase in Australian epidemiological studies over recent years. The aim of this study is to provide an updated systematic literature review of peer‐reviewed epidemiological studies that examined the health impacts of outdoor air pollution in Australia, including short‐ and long‐term exposure. Following PRISMA guidelines, we conducted a systematic literature review. Broad search terms were applied to two databases (PubMed and Web of Science) and Google Scholar. Quality assessment and risk of bias were assessed using standard metrics. Included studies were summarised by tabulating key study characteristics, grouped by health outcomes. In total, 72 studies were included in the review. Sixty‐four (89%) studies used daily or hourly pollutant concentrations to examine short‐term exposure impacts, of which 59 (92%) revealed significant associations with one or more health outcomes, including cardio‐respiratory, all‐cause mortality or morbidity and birth outcomes. Eight (11%) studies used annual average pollutant concentrations to investigate the long‐term exposure finding significant associations with asthma, reduced lung function, atopy and cardio‐respiratory mortality across five studies. The remaining three studies found no significant association with asthma, mortality and a range of self‐reported diseases, respectively. Ambient air pollution has substantial health impacts in Australia. The body of domestic evidence has increased markedly since national air quality standards were first set in the 1990s, which could be drawn on by policy‐makers when revising the existing standards, or considering new standards.

Objective: To examine the co-location of childcare centres and their outdoor play spaces with car parks in Melbourne and Sydney, Australia. Methods: The co-location of childcare centre outdoor play spaces and car parks was examined through measurement of horizontal and vertical distances using Google Earth Pro satellite imagery. Results: One hundred and forty-two childcare centres were studied in Melbourne, with 133 accompanying car parks identified. Eighty-one (57.0%) centres had a significant size car park within 150 m and 43.7% had a car park within 100 m. Twenty car parks (15.0%) were found within 10 metres of childcare centres, of which 12 (9.0%) had more than 100 spaces. Twenty centres were examined in Sydney, with 31 associated car parks identified. Eighteen childcare centres (90.0%) had car parks within 150 m and 17 (85.0%) had car parks within 100 m. Conclusion: Australian childcare centres are located too close to car parks exposing children to pollution and likely impacting the development of chronic respiratory disease. Traffic pollution is an avoidable risk that must be considered when planning childcare centre location. Implications for public health: The co-location of childcare centres with large-scale car parks may have long-term impacts on the respiratory health of Australian children under the age of five.

e16538 Background: Medication misadventure contributes to unplanned hospital admissions in patients with cancer. Often, numerous medications are added to existing ones and general practitioners (GP) may lack experience in managing problems involving cancer related medication. A survey exploring the unmet needs of our lung cancer outpatients highlighted the need for more medication information. Inpatient clinical pharmacy services are known to impact on patient care and morbidity. This project aimed to evaluate the effects of extending this service to outpatients. Methods: An oncology pharmacist joined the lung cancer clinic team for 6 months. Consented patients completed assessments of medication adherence (using Morisky tool) and satisfaction with medicines information at baseline and within 30 days of review. Post pharmacist review, a medication list and plan (detailing recommendations/interventions) were provided to patients and community and hospital healthcare providers. Uptake of recommendations was evaluated 7 days after review. Assessment results (pre and post review) were analyzed using the matched pairs Wilcoxon test. Interventions were categorized and graded according to risk avoided. Unplanned admissions and clinic attendance rates were compared to the previous year and analyzed using the Rate Ratio Test assuming Poisson counts.GPs opinion of the service was evaluated via survey. Ethics approval was obtained from HREC. The project was supported by an educational grant from Roche Pharmaceuticals. Results: 48 patients were recruited. Medication adherence (p=0.007) and patient satisfaction (p<0.001) were significantly improved. 154 pharmacist interventions were made: 4.5% extreme risk and 43.5% high risk. Ratios of unplanned admissions and clinic attendances decreased; 0.3 to 0.26 (p= 0.265) and 3.32 to 2.98 (p=0.004) respectively. 31 of 48 general practitioners (GPs) completed the survey, 74% found the service useful. Conclusions: Adding a pharmacist to the outpatient lung team led to significant improvements in patient medication adherence. Both patients and GPs were highly satisfied with the service. Medication misadventure, unplanned admissions and clinic attendances were reduced.