Over the last few years, there has been significant discussion, reform and extensive raising of industry awareness on the potential health risks of occupational lung diseases. In a world first initiative, supported by the HIA Charitable Foundation, The Tradie Health Institute – an initiative of The Prince Charles Hospital Foundation (The Common Good) and a small number of researchers and experts – is hoping to change that.

One such expert is Professor Dan Chambers, senior thoracic physician and head of research at the Queensland Lung Transplant Service. ‘Chest X-rays, breathing tests and CT scans can show lung damage or changes in how well the lungs work, but they cannot directly tell us whether silica dust is triggering the harmful chemical changes that lead to silicosis,’ Dan explains. ‘By the time damage becomes visible, permanent scarring may already have occurred. We want to identify who is at risk before disease develops. That means collecting samples from the deepest parts of the lungs and looking for the earliest chemical warning signs. Until now, collecting these samples has generally required a hospital procedure called bronchoalveolar lavage, or BAL, which uses a small amount of fluid to wash and sample part of the lung, but that test is obviously not suitable to easily screen at risk workers.’

While bronchoalveolar lavage (BAL) provides valuable information about silica crystal burden and disease-related biomarkers in the lungs, it is too invasive for routine screening, particularly in healthy individuals. PExA offers a promising non-invasive alternative, allowing researchers to investigate biological changes in the small airways that could ultimately help detect silicosis earlier.

What is PExA?

The team is now investigating whether a machine developed in Sweden, called PExA—short for “particles in exhaled air”—could provide those clues through a simple breathing test. It collects tiny particles from the fluid lining the deepest airways, allowing researchers to look for chemical changes that could identify people at risk of silicosis before the disease develops.

Dedicated funding has enabled the purchase of Australia’s first permanent PExA machine, with industry investment, including a donation of $50,000 from the HIA Charitable Foundation (HIACF), accelerating the work.

Unlike bronchoscopy or bronchoalveolar lavage (BAL), the PExA platform non-invasively collects microscopic particles through a simple breath test. These particles contain biological material, including proteins, which can subsequently be analysed to search for early disease signatures.

‘This new technology can detect tiny particles from the deepest part of the lungs,’ Dan says. ‘It gives us a potential way to identify biological changes much earlier, before serious structural lung damage becomes apparent.’

Dr Simon Apte, Chief Scientist at the Queensland Lung Transplant Service Laboratory, leads the laboratory research underpinning the program. Working alongside Professor Chambers and the research team, he is helping develop new approaches to studying lung disease through non-invasive sampling and advanced molecular analysis.
‘Our aim is to move beyond simply detecting lung damage and start identifying the biological changes that occur much earlier. PExA offers an exciting opportunity to do that without the need for invasive procedures,’ Simon explains.

Another member of the team is research assistant Kiara Knuckey, who has been investigating whether proteins collected through PExA reflect those found in bronchoalveolar lavage (BAL) samples from patients with silicosis. This is an important first step in establishing whether PExA can provide a biologically meaningful sample from the small airways of the lungs.

‘Our goal is to identify molecular signatures that could eventually support earlier screening,’ Kiara says. ‘Using advanced technology capable of measuring around 11,000 different proteins, we found hundreds of proteins shared between PExA and BAL samples. These findings give us confidence that PExA has real potential as a non-invasive tool for studying lung health and disease.’

The team's world-first comparison was recently published in the peer-reviewed scientific journal Biomolecules, providing important evidence that PExA can capture proteins also found in samples collected directly from the lungs. The researchers are now building on these findings to investigate whether this less-invasive approach could eventually identify biological changes before established disease becomes apparent through conventional testing.

Read the published research: Knuckey et al., Biomolecules (2026).

Dan adds: ‘The possibility of identifying biological changes in the small airways before serious disease has developed very clearly demonstrates the potential we see in PExA technology.’

Further research continues

It’s fair to say that what Dan, Simon and Kiara are working on is of significant importance, locally and internationally. Their research also covers a registry of people who have undergone whole lung lavage in Australia and a control cohort in Spain.

‘We believe occupational lung disease research is very much about health monitoring. We can use our data to review exposed but non-diseased individuals. We aim to compare results of both groups to evaluate the potential benefits of the whole lung lavage as a potential treatment,’ Kiara explains.

Both groups of workers have similar age, demographics, smoking history and work exposure. However, the Spanish group have not had the lung lavage procedure. Over time, the researchers will review the differences in disease development between the two groups. The researchers hope this comparison will provide valuable evidence about whether whole lung lavage can improve longer-term outcomes for people with silicosis.

Dan is reflective about their discoveries. ‘When I started in the field of occupational lung disease 12 years ago, there was no treatment whatsoever. We contributed to the development of two drugs that we know slow the development of lung fibrosis. Now we’re focused on developing much better diagnostic techniques to identify early changes in lung biology and understand the role genetics might play. I could not have imagined what we would have today when I was at medical school. We're in an incredible position now to make a big difference for people.’

Kiara, with her studies only just behind her, feels the same way. ‘Early-stage research is critical to what we do. The data we are currently gathering will affect the lives of so many people around the world and their families.’

The research team also envisages a not-too-distant future where a machine like PExA can be portable for on-site screening of people working in high-risk occupations.

‘The Tradie Health Institute initiative supports this really important research to make sure that these discoveries don't remain unrealised,’ Dan says. ‘This early work with seed funding allows us to build upon what we have learnt and then undertake bigger trials. By backing pioneering research through the initiative, we can find new ways to detect occupational disease earlier, and better treatments can be developed.

‘Our ultimate aim is to improve the health and lives of Australian workers. I think it's eminently achievable. In the construction industry, the organ you really need to look after is your lungs. It’s a message that needs to be reinforced from the get-go – when someone starts their apprenticeship or starts labouring or whatever it is, just look after your lungs.’

When it comes to detecting and treating silicosis, breakthroughs require more than great science. With the support of industry, we can accelerate research with the potential to change the future of occupational health in Australia.

How the industry is helping

The HIA Charitable Foundation (HIACF) donated $50,000 to The Tradie Health Institute initiative to be directed towards the PExA machine and associated research. To learn more about the essential work being done or to find out how you can show your support, go to: Tradie Health Institute.