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Asbestosis in the industries of the Barcelona area.

This presentation is the result of the survey of eight industries with asbestosis risk in the Barcelona area (two of fibro-cement, three of auto brakes, two of textiles, and one of insulation materials). Of 1,472 workers, 271 or 18.5% have asbestosis. Pleural involvement in asbestosis is twice as common as that of the lung, 15.7% versus 8.5%. Pulmonary asbestosis without pleural participation is seen in only 2.6% of cases. Pleural plaques, calcified and not calcified, are detected in only a few cases. There is a definite correlation between the incidence of asbestosis and the exposure time: from 1% in the group of workers with less than five years of exposure up to 64.58% for those with 30 or more years of exposure. Clinical symptoms (cough, and/or expectoration, and/or dyspnea) were present in 68% of the studied population. Pulmonary crepitations are the most significant physical sign detected, observed in one quarter to one third of the patients. Pulmonary function tests in asbestos workers revealed restrictive and mixed type syndromes in 17% of the cases and obstructive syndrome in 36%. The percentages for those workers without asbestosis are 9% and 16%, respectively. It seems, therefore, that a bronchial factor plays a role in asbestosis. The bronchial pathology would be manifested clinically by the appearance or the exaggeration of the chronic bronchitis symptoms, and physiologically by the presence of the obstructive syndrome. There is no doubt that smoking enhances the incidence of asbestosis, aggravates the respiratory symptoms in those affected, and is a cause of further deterioration of pulmonary function.

Adolescent↗

Prevalence and features of advanced asbestosis (ILO profusion scores above 2/2). International Labour Office.

In this study, the author addressed the following question: Do workers with advanced asbestosis have a restrictive pulmonary physiology, and, alternately, do those who have restrictive physiological tests have advanced asbestosis? One group was identified by obvious radiographic measurements, and the other group was defined via physiologic measurements. Total lung capacity, vital capacity, and flows were measured in 12,856 men exposed to asbestos, of whom 3,445 had radiographic signs of asbestosis, as defined by the International Labour Office criteria. Radiographically advanced asbestosis-International Labour Office criteria profusion greater than 2/2 was present in 85 (2.5%) of men. An additional 52 men had physiologically restrictive disease. The author, who compared pulmonary flows and volumes of these two groups, used mean percentage predicted, adjusted for height, age, and duration of cigarette smoking. Men with radiographically advanced asbestosis had normal total lung capacity (i.e., 105.5% predicted), reduced forced vital capacities (i.e., 82.7% predicted), air trapping (i.e., residual volume/total lung capacity increased to 54.4%), and reduced flows (i.e., forced expiratory flow [FEF25-75] = 60.6% predicted, forced expiratory volume in 1 s = 78.0% predicted, and forced expiratory volume in 1 s/forced vital capacity = 65.5%). In contrast, men selected from the same exposed population for restrictive disease (i.e., reduced total lung capacity [72.6% predicted] and forced vital capacity [61.5% predicted]) also had airflow obstruction (i.e., forced expiratory volume in 1 s/forced vital capacity of 74.5% predicted) and air trapping (i.e., residual volume/total lung capacity of 46.7%). Only half of these men had asbestosis--and it was of minimal severity. In summary, advanced asbestosis was characterized by airway obstruction and air trapping, both of which reduced vital capacity but not total lung capacity; therefore, it was not a restrictive disease. In contrast, restrictive disease was rare and was associated with minimal asbestosis.

Aged↗

The effect of asbestosis on lung cancer risk beyond the dose related effect of asbestos alone.

AIMS: To determine if the presence of asbestosis is a prerequisite for lung cancer in subjects with known exposure to blue asbestos (crocidolite). METHODS: Former workers and residents of Wittenoom with known amounts of asbestos exposure (duration, intensity, and time since first exposure), current chest x ray and smoking information, participating in a cancer prevention programme (n = 1988) were studied. The first plain chest radiograph taken at the time of recruitment into the cancer prevention programme was examined for radiographic evidence of asbestosis according to the UICC (ILO) classification. Cox proportional hazards modelling was used to relate asbestosis, asbestos exposure, and lung cancer. RESULTS: Between 1990 and 2002 there were 58 cases of lung cancer. Thirty six per cent of cases had radiographic evidence of asbestosis compared to 12% of study participants. Smoking status was the strongest predictor of lung cancer, with current smokers (OR = 26.5, 95% CI 3.5 to 198) having the greatest risk. Radiographic asbestosis (OR = 1.94, 95% CI 1.09 to 3.46) and asbestos exposure (OR = 1.21 per f/ml-year, 95% CI 1.02 to 1.42) were significantly associated with an increased risk of lung cancer. There was an increased risk of lung cancer with increasing exposure in those without asbestosis. CONCLUSION: In this cohort of former workers and residents of Wittenoom, asbestosis is not a mandatory precursor for asbestos related lung cancer. These findings support the hypothesis that it is the asbestos fibres per se that cause lung cancer, which can develop with or without the presence of asbestosis.

Aged↗

High resolution pulmonary computed tomography scans quantified by analysis of density distribution: application to asbestosis.

A new method for quantitative evaluation for high resolution computed tomography (HRCT) of the lungs was developed by assessment of the distribution of radiological densities within the lung slices. To enable effective reduction of data and improve the sensitivity of detection of abnormalities, the density distributions were analysed by curve fitting through the gamma variate model. The output of two variables proved most representative: the most frequent density (Hoansfield units; HU) and width of distribution (HU). The method was applied to seven patients with early asbestosis (positive histological finding and International Labour Office (ILO) profusion score up to 0/1), 15 patients with advanced stage of asbestosis (positive histological finding and ILO score above 1/2), and 13 normal controls. All patients with early asbestosis had isolated reduction of diffusing lung capacity to carbon monoxide (DLCO), whereas all patients with advanced asbestosis had reduced DLCO and restrictive disease; two of them also had an obstruction pattern. The most frequent densities were significantly greater in the advanced asbestosis group (-567 HU) when compared with both the early asbestosis group (-719 HU; p = 2 x 10(-6)), and controls (-799 HU; p = 0), and they also discriminated significantly between the early asbestosis group and controls (p = 0.0002). Significantly stronger linear correlations were established between DLCO and the most frequent densities (r = 0.86) than between DLCO and HRCT score (r = 0.57) or ILO score (r = 0.34). It is concluded that fitting the curve of the density distribution enables a more objective assessment of HRCT pulmonary scans, especially in the early stage of asbestosis.

Adult↗

Clinical predictors of mortality from asbestosis in the North American Insulator Cohort, 1981 to 1991.

Recorded mortality from asbestosis has increased markedly in the United States in recent decades, from 0.49 to 3.06 per million persons between 1970 and 1990. Although asbestosis is generally considered to be a slowly progressive disorder, little is known about how clinical and exposure parameters among individuals with asbestosis quantitatively predict subsequent risk of death from asbestosis. We followed 2,609 insulators from the North American insulator cohort 10 yr to determine cause of death and to relate clinical findings to risk of death. This group had undergone clinical and radiologic examination between 1981 and 1983 in 19 cities in the United States. Seventy-four (11.0%) of 674 deaths during the subsequent 10 yr were due to asbestosis, according to the best clinical and radiologic evidence available at the time of death. The 10 yr risk of death (expressed as a percentage) due to asbestosis rose sharply with increasing interstitial fibrosis as identified on the baseline chest X-ray, from 0.9% to 2.4%, 10.8%, and 35.4% for International Labor Office (ILO) profusion categories 0, 1, 2, and 3, respectively. Dyspnea, a low FVC, and/or physical examination findings typical of interstitial fibrosis (rales, clubbing, or cyanosis) raised the risk of subsequent death from asbestosis by 2- to 6-fold. The effect of cigarette smoking on risk of death from asbestosis was small and disappeared after adjustment for ILO profusion score.

Analysis of Variance↗

Controversies and uncertainties concerning the pathologic features and pathologic diagnosis of asbestosis.

Asbestos is a fibrous silicate mineral that has been known for decades to cause pulmonary scarring, referred to as asbestosis. The simplest definition of asbestosis is the presence of pulmonary fibrosis as a result of accumulation of airborne asbestos in the lungs. Not infrequently, the terms "asbestos" and "asbestosis" are used incorrectly (interchangeably) by medical personnel, and sometimes pleural fibrosis caused by asbestos is incorrectly referred to as asbestosis. The earliest lesion of asbestosis, as defined by the CAP-NIOSH Committee is peribronchiolar fibrosis, although controversy exists as to how specific this lesion is with respect to causation by asbestos, and whether this lesion progresses to grade 4 asbestosis. In addition, some authorities in the field suggest that the term "asbestosis" be used only for diffuse interstitial fibrosis. The mechanism by which asbestos causes interstitial fibrosis remains poorly understood, and in recent years, pathologic changes such as organizing pneumonitis-bronchiolitis obliterans, and lymphocytic interstitial pneumonitis, have been described in persons occupationally exposed to asbestos, suggesting that the pulmonary lesions caused by asbestos represent a wider spectrum than had previously been appreciated. By defining areas of uncertainty, medical science will eventually clarify areas of disagreement concerning asbestosis which will eventually lead to a better understanding of this disease.

Asbestos↗

[Criteria for diagnosis of occupational asbestosis of the pulmonary parenchyma and pleura].

The criteria for acknowledgement of occupational parenchymal asbestosis were set out in the List of Occupational Diseases of 1983, under paragraph 26. In spite of this, some occupational health specialists and invalidity committees acknowledge the disease only when it meets the criteria recommended in the Conclusions of a Workshop on Asbestosis, held in former Yugoslavia, although such criteria were never legally implemented. According to these criteria asbetosis of the lung is recognized only when parenchymal profusion is subcategory profusion is subcategory 2/1 and higher, or at least subcategory 1/1 with visible pleural plaques and/or bilateral calcifications. In the Department of Occupational Health of the Institute for Medical Research and Occupational Health in Zagreb chest X-rays were taken and examined in 350 workers occupationally exposed to asbestos. In 51 (15%) of the workers lung fibrosis was excluded (profession of the parenchyma was subcategory 0/-) and in 53 (15%) fibrosis of the parenchyma could not be excluded or confirmed on the basis of the X-rays. In the remaining 246 (70%) the X-rays demonstrated clearly visible fibrosis and, depending on the parenchymal profusion, the finding was classified as subcategory 0/1 - 2/1 and higher, i.e. in 9% of the workers subcategory 1/1 was accompanied by visible bilateral pleural plaques. According to the Criteria from the Conclusions of a Workshop, on the basis of parenchymal profusion, asbestosis of the lungs would have to be acknowledged in 4% of those examined, while in 9% of the workers with parenchymal profusion of subcategory 1/1 or 1/2 asbestosis could be acknowledged only if visible bilateral plaques or pleural calcifications were present. On the other hand, according to the List of Occupational Diseases, only 15% of the examined workers offered no ground for acknowledging occupational parenchymal asbestosis. In another 15% of the examination, by which parenchymal asbestosis could be confirmed or excluded. Asbestosis of the lungs is a disease sui generis which should, with a positive work history, always be recognized as an occupational disease, after other etiology of the parenchymal fibrosis has been excluded. The extent of parenchymal profusion, other asbestosis-related diseases and/or impaired ventilatory or diffusive function of the lungs are not decisive.

Asbestosis↗

Autopsy cases of asbestosis in Japan: a statistical analysis on registered cases.

There are 525 (484 male, 38 female, 3 unknown) autopsy cases with asbestosis registered in the Annual of the Pathological Autopsy Cases in Japan, which is issued by the Japanese Society of Pathology for the years 1958-1996. The frequency of asbestosis (number of cases/total autopsy cases) was 0.017% (76/440,334) for the 1958-1979 time period, 0.058% (226/390,124) for 1980-1989, and 0.099% (223/225,801) for 1990-1996. There was a significant increase in asbestosis cases across the three time periods (p < .0001). The number of asbestosis cases increased markedly among individuals who worked with asbestos products, as well as among those employed in asbestos-processing factories. The frequency of malignant tumors associated with asbestosis was 61.0% (320/525), and the frequency also increased across the three time periods, from 43.4% (33/76) to 62.8% (142/226) and 65.0% (145/223), respectively. Among the 525 cases with asbestosis, there were 174 lung cancers (33.1%), 73 malignant mesotheliomas (13.9%), 29 stomach cancers (5.5%), 14 liver cancers (2.7%), 9 prostatic cancers (1.7%), 8 malignant lymphomas (1.5%), 6 laryngeal cancers (1.1%), 4 pancreas cancers (0.8%), 3 rectal cancers (0.6%), and 28 other cancers (5.3%). The frequencies of lung cancer, malignant mesothelioma, and laryngeal cancer were significantly higher in the cases with asbestosis than among the nonasbestosis cases. The number of malignant tumors related to asbestos exposure is expected to increase in the future.

Adult↗

Asbestosis and cryptogenic fibrosing alveolitis: a radiological and functional comparison.

This study compares the relationship between lung function and radiological abnormality in 46 subjects with asbestosis and 38 subjects with cryptogenic fibrosing alveolitis. Radiographs were graded separately by two observers according to the 1980 International Labour Organisation criteria for classification of the pneumoconioses. The correlation between the transfer factor of the lungs and the radiographic profusion of small parenchymal opacities was found to be greater in subjects with asbestosis than in subjects with cryptogenic fibrosing alveolitis. At any level of radiological profusion transfer factor was higher in cases with asbestosis than in cases with fibrosing alveolitis. As pleural thickening is seen commonly in asbestosis and may influence lung volumes and the ratio of transfer factor to effective alveolar volume, the results of these measurements were compared only in the cases showing absent or minimal pleural thickening. Both of these variables were higher in the subjects with asbestosis. The results indicate that despite pathological, functional and radiographic similarities, lung function for a given degree of radiographic parenchymal abnormality is better in subjects with asbestosis than in subjects with cryptogenic fibrosing alveolitis, and that changes in the plain chest x-ray appearances in asbestosis correlate more closely with the results of lung function tests.

Asbestosis↗

Effects of cyclophosphamide treatment in experimental asbestosis.

The potential role of immunosuppressive therapy in asbestosis was evaluated in the sheep model of experimental asbestosis. A diffuse peribronchiolar alveolar and interstitial fibrosing alveolitis was developed in 10 animals following 2 years of exposure consisting of slow intratracheal infusion of 100 mg Canadian chrysotile in 100 ml saline every 2 weeks. A control group of 10 sheep concomitantly receiving only 100 ml saline intratracheally was also enrolled in the study. One group of 5 control sheep and one group of 5 asbestosis sheep received 1 mg/kg cyclophosphamide in 10 ml saline iv every 2 weeks, the other 10 sheep receiving only saline. One year after beginning of therapy, survival rates were comparable in the 2 control groups and the asbestosis group without therapy at 80%, whereas it was significantly reduced at 20% in the asbestosis group with therapy. Deaths in the latter were associated with significant increase in peripheral blood and lung lavage neutrophils, increased intensity of fibrosing alveolitis, worsening of lung functions, and worsening in the radiographic diffuse lung opacities. This was documented on histopathology to be associated with more intense fibrotic disease and bacterial pneumonia in the group of sheep with asbestosis receiving the immunosuppressor drug. We conclude that cyclophosphamide therapy in experimental asbestosis accelerated the fibrotic process and reduced significantly the survival rate of the animals.

Animals↗

Influence of continued asbestos exposure on the outcome of asbestosis in sheep.

Clinical recognition of asbestosis is generally followed by exclusion of the worker from the active workforce and appropriate compensation. Given the better industrial hygiene conditions of the 1990s, and a recent report suggesting that low-level asbestos exposure may not affect progression of asbestosis, the medical rationale to pension asbestos workers with early asbestosis has been questioned in the legal courts. To study the influence of asbestos exposure after established asbestosis, we enrolled 25 sheep. Ten were normal controls (group A) and 15 had asbestosis, after 2 years of repeated 10-day interval, 100-mg chrysotile exposure (Eur Respir J 3:81-90, 1990). The asbestotic sheep were divided into a group of five without further asbestos exposure (group B), a group of five with continued exposure at induction doses (group C), and a group of five with continued exposure of 10% induction doses (group D). All were followed by chest radiography, lung function, and lung lavage at 3-month intervals and histopathology when appropriate. During the 12-month study, mortality occurred only in groups C and D (40% in both, P less than .02). Chest radiograph and lung function were worse in groups C and D. The enhanced macrophagic and neutrophilic alveolitis observed on lung lavage and the pathological findings in the deceased sheep suggested progression of asbestosis and bacterial infections as the major contributors to the higher mortality of sheep in groups C and D. In conclusion, asbestos exposure after disease recognition was associated with increased mortality in our sheep and this was largely associated with progression of asbestosis and added lung infection.

Animals↗

[Effect of age on asbestosis of the lung and/or pleura].

This study included 97 subjects with parenchymal and/or pleural asbestosis and 100 controls. Data analysis included medical and work histories, X-ray clinical examination, and the measurement/calculation of ventilatory lung functions VC, FVC, FEV1,FEV1/VC and FEV1/FVC. Of 97 subjects with asbestosis, 30 (31%) were diagnosed parenchymal fibrosis, 33 (34%) pleural fibrosis, and 34 (35%) parenchymal and pleural fibrosis combined. These subgroups did not differ in smoking habit. All subjects with asbestosis showed symptoms of dyspnoea; two thirds showed dyspnoea on exercise and one third at rest as well. In contrast, only one third of controls showed dyspnoea on exercise only. All ventilatory lung functions were lower in subjects with asbestosis than in controls (P < 0.01), except for FEV1/FVC (P > 0.05). Slight, yet clinically significant drops in ventilatory function were observed in subjects with pleural (VC 79.73%; FVC 75.09%; and FEV1 78.52%) and combined asbestosis (VC 78.21%; FVC 75.01%; and FEV1 77.50%), while ventilatory changes in subjects with parenchymal asbestosis were clinically significant only for FVC (79.60%). It was not possible to discriminate between the effects of age and exposure duration in subjects with pleural and combined asbestosis.

Age Factors↗

Severity of pulmonary asbestosis as classified by International Labour Organisation profusion of irregular opacities in 8749 asbestos-exposed American workers. Those who never smoked compared with those who ever smoked.

The profusion of irregular opacities on chest roentgenograms by International Labour Organisation pneumoconiosis criteria was used to assess the severity of asbestosis in 8749 asbestos-exposed active and retired American workers. Seventy-eight percent had no asbestosis (category 0/0 or 0/1), 18.6% had slight asbestosis (1/0 to 1/2), 3% had moderate asbestosis (2/1 to 2/3), and 0.3% had advanced disease (3/2 or greater). Significantly more current smokers had asbestosis than did those who had never smoked, and their average profusion of opacities was higher. The mean age of current smokers with asbestosis was 60 years, whereas subjects with the disease who had never smoked had a mean age of 64 years, a significant difference. Cigarette smoking and asbestosis appear to act synergistically to produce irregular opacities on chest roentgenograms of asbestos-exposed American workers.

Asbestosis↗

[Basic principles of mass screening of patients with asbestosis].

Complex hygienic, clinical and epidemiologic studies were carried out at 2 enterprises producing asbestos-technical products. It was established that the workers engaged in the production of such products were exposed to relatively low levels of asbestos-containing dust. The course, complications and outcome of asbestos-associated fibrosis were studied in 110 patients. The study revealed that asbestosis was characterized by its slowly progressing development. Asbestosis complications included lung tuberculosis, chronic intersticial pneumonia, and lung cancer. Proceesing from the epidemiologic survey higher risk of malignant neoplasms of the lungs was established in patients with asbestosis in comparison with those exposed to asbestos-associated fibrosis were studied in 110 patients. The study revealed that asbestosis was characterized by its slowly progressing development. Asbestosis complications included lung tuberculosis, chronic intersticial pneumonia, and lung cancer. Processing from the epidemiologic survey higher risk of malignant neoplasms of the lungs was established in patients with asbestosis in comparison with those exposed to asbestos-containing dust but having no occupational disease. The study findings were used for the substantiation of dispensarization principles for patients with asbestosis. The number of follow-up, laboratory and other examinations along with basic curative and preventive measures were pointed out.

Adult↗

Asbestos disease in sheet metal workers: II. Radiologic signs of asbestosis among active workers.

A review of chest x-rays of 707 currently employed New York metropolitan area sheet metal workers found that 29.3% of the workers with 20 years or more of union membership (a surrogate for years of exposure) had radiologic abnormalities characteristic of parenchymal and/or pleural asbestosis, with 18.6% having abnormalities characteristic of parenchymal asbestosis (International Labor Organization [ILO] classification 1/0 or higher) and 17.4% of pleural asbestosis. The prevalence of abnormalities characteristic of either parenchymal and/or pleural asbestosis in the group as a whole was 16.4%, with 10.9% exhibiting signs of parenchymal asbestosis and 9.2% of pleural asbestosis. There was a strong, statistically significant relationship between years in the trade and the prevalence of radiologic abnormalities. These findings underscore the need for medical surveillance of all asbestos-exposed construction workers, including retirees and workers who have had past exposure but who are no longer exposed.

Adult↗

The additional risk of malignant mesothelioma in former workers and residents of Wittenoom with benign pleural disease or asbestosis.

AIMS: To examine the hypothesis that people with benign pleural disease or asbestosis have an increased risk of malignant mesothelioma beyond that attributable to their degree of asbestos exposure. METHODS: Former workers and residents of the crocidolite mining and milling town of Wittenoom are participating in a cancer prevention programme (n = 1988). The first plain chest radiograph taken at the time of recruitment into the cancer prevention programme was read for evidence of benign pleural disease and asbestosis, using the UICC classification. Crocidolite exposure of former workers was derived from employment records and records of dust measurements performed during the operation of the asbestos mine and mill between 1943 and 1966. Based on fibre counts, exposure for former residents was determined using duration of residence and period of residence (before and after a new mill was commissioned in 1957) and interpolation from periodic hygienic measures undertaken from personal monitors between 1966 and 1992. Cox proportional hazards modelling was used to relate benign pleural disease, asbestosis, asbestos exposure, and mesothelioma. RESULTS: Between 1990 and 2002, there were 76 cases of mesothelioma (56 of the pleura and 20 of the peritoneum). Cases had more radiographic evidence of (all) benign pleural disease, pleural thickening, blunt/obliterated costophrenic angle, and asbestosis than non-cases. Adjusting for time since first exposure (log years), cumulative exposure (log f/ml-years), and age at the start of the programme, pleural thickening (OR = 3.1, 95% CI 1.2 to 7.6) and asbestosis (OR = 3.3, 95% CI 1.3 to 8.6) were associated with an increased risk of peritoneal mesothelioma. There was no increased risk for pleural mesothelioma. CONCLUSION: The presence of benign pleural disease, in particular pleural thickening, and asbestosis appears to increase the risk of mesothelioma of the peritoneum, but not of the pleura beyond that attributable to indices of asbestos exposure in this cohort of subjects exposed to crocidolite.

Aged↗

Relation between asbestosis and bronchial cancer in amphibole asbestos miners.

In a necropsy series of 339 amphibole asbestos miners heavy smoking, age, and the presence of asbestosis were significantly associated with the presence of bronchial cancer. Of the 35 cases of bronchial cancer, 24 were associated with asbestosis. Eleven cases of bronchial cancer occurred in men without asbestosis; all were smokers. Standardised proportional mortality rates indicated no excess of bronchial cancer in 302 exposed men without asbestosis whereas these rates were progressively raised in men with slight or moderate/severe asbestosis. Of the four exposure variables introduced separately into a logistic regression model, "years of exposure" made a small but significant contribution; "residence time" marginally failed to achieve a 5% level of significance. Two other exposure variables tested including cumulative fibre exposure (fibre years) made no significant contribution. In the absence of asbestosis at necropsy a bronchial cancer in a man exposed to asbestos is unlikely to be due to asbestos.

Asbestos↗

Asbestosis and idiopathic pulmonary fibrosis: comparison of thin-section CT features.

PURPOSE: To identify differences, if any, in thin-section computed tomographic (CT) features between asbestosis and idiopathic pulmonary fibrosis (IPF) and to test the findings in a subset of histopathologically proved cases of usual interstitial pneumonia (UIP) and nonspecific interstitial pneumonia (NSIP). MATERIALS AND METHODS: Consecutive patients with a diagnosis of IPF (n = 212) or asbestosis (n = 74) were included. The relationships derived from the initial comparison were tested in a separate group of biopsy-proved UIP (n = 30) and NSIP (n = 23) cases. Two observers independently scored thin-section CT images for extent, distribution, and coarseness of fibrosis; proportion of ground-glass opacification; severity of traction bronchiectasis; and extent of emphysema. RESULTS: After controlling for extent of fibrosis, patients with asbestosis had coarser fibrosis than those with IPF (odds ratio, 1.52; 95% CI: 1.25, 1.84; P <.001). Compared with the biopsy-proved cases, the asbestosis cases involved coarser fibrosis (after controlling for disease extent) than the NSIP cases (odds ratio, 2.48; 95% CI: 1.49, 4.11; P <.001) but fibrosis similar to that in the UIP cases. A basal and subpleural distribution of disease was usual in all subgroups but significantly more prevalent (P, <.01 to.001) with asbestosis than with UIP or NSIP. CONCLUSION: The thin-section CT pattern of asbestosis closely resembles that of biopsy-proved UIP and differs markedly from that of biopsy-proved NSIP.

Asbestosis↗