The SHIELD Whole Lung Lavage Study

Inclusion Criteria: * Males and females aged \>=18 years and scheduled for WLL at the study site as part of routine clinical care * History of exposure to respirable crystalline silica (RCS) while working in an at-risk industry (e.g. stonemasonry, construction, tunnelling, concreting, mining) * Elimination of workplace exposure to RCS for a minimum of 6 months * Ground glass nodularity \> extent of solid nodularity on HRCT, as judged by investigator or evidence of silica-induced bronchitis * Evidence of disease progression within the past 2 years, defined as any of * a relative decline in the FVC or FEV1 of at least 5% of the predicted value, * worsening of respiratory symptoms * increased extent of silicosis on high-resolution CT scan * Able to understand and sign a written informed consent form (or legally authorised representative) Exclusion Criteria: * Ongoing workplace exposure to RCS or removal of workplace exposure of less than 6 months * Progressive massive fibrosis, defined as areas of confluent fibrosis with diameter \> 10mm on HRCT. * FEV1 or FVC \< 50% predicted * DLCO \<50% predicted * Contraindication to WLL, as judged by the investigator * Actively or imminently listed for lung transplantation * Females with a positive pregnancy test at screening or currently breastfeeding * Any history of malignancy likely to result in significant disability or likely to require significant medical or surgical intervention within the next 24 months * Any condition ot…