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PubMed2006

Adverse effects of asbestos exposure and smoking on lung function.

BACKGROUND: Exposure to asbestos is a well-recognized cause of both malignant and nonmalignant diseases of lung parenchyma and pleura. This study was conducted to determine the adverse effects of exposure to asbestos and smoking on pulmonary function. METHODS: Four hundred and sixty-eight workers who were occupationally exposed to asbestos for an average of 13 years were selected from an asbestos-product factory in China. Of them, 85 workers were diagnosed with asbestosis. Additionally, 282 workers who had no experience of exposure to industrial dust were included as a control group. A questionnaire was administered during a face-to-face interview and spirometric maneuvers and single-breath CO diffusing capacity (DL(CO)) were performed. RESULTS: Multivariate regression analysis showed that exposure to asbestos was more strongly associated with decreased forced vital capacity (FVC) and DL(CO), and asbestosis more strongly associated with decreased FVC, while smoking was a major contributing factor to reduced FEV1/FVC. The results were confirmed by a further analysis where the subjects were grouped exclusively by smoking, asbestos exposure, and chest radiographic changes. No interaction or joint effect was observed between asbestos exposure and smoking. CONCLUSIONS: This analysis suggested that asbestos and smoking might play independent roles, in which asbestos caused mainly a restrictive impairment, and smoking was a major causal factor for airway obstruction in the workers who were intensively exposed to asbestos.

Adult↗

PubMed1981

Asbestos-related diseases in the Federal Republic of Germany.

Until recently, in the Federal Republic of Germany there has been a lack of epidemiological data on asbestos-related tumors. Only the numbers of occupational diseases accepted for compensation by the German industrial injuries insurance institutes (Berufsgenossenschaften) can be stated. These show, for 1979, 94 cases of asbestosis, 21 cases of asbestosis associated with lung cancer, and 34 cases of mesothelioma. Since 1972 employees exposed to asbestos dust have been included in a central register by the industrial injuries insurance institutes and are medically examined periodically. By December 31, 1979, 28,476 persons were registered. Of those, 6,582 were still being followed medically, although they were no longer working with asbestos dust exposure. In January 1, 1977, a prospective epidemiological study was started with these people who were formerly exposed to asbestos dust. Up to December 31, 1980, altogether 2,944 people were enrolled in the study. Besides several other enrollment criteria, the individual's permission was required to evaluate his personal data. Of the people enrolled, 85 had died by December 31, 1980. Even if five questionable cases of lung cancer are excluded (n = 80), the observed rates of about 43% tumours of all sites, with 15% lung cancer and 6% mesothelioma, seem to be comparable to the international epidemiological mortality pattern.

Adult↗

PubMed1986

Common problems in asbestos-related pulmonary diseases.

Exposure to asbestos is an important public health hazard in all industrialized societies. Although the pulmonary manifestations of prolonged asbestos fiber exposure are well known, there is considerable disagreement over specific clinical features and employment policies. Three of these controversies are the following: a) Can lung cancer be ascribed to asbestos exposure in subjects who lack evidence of asbestosis? b) Is there any clinical significance to benign asbestos pleural changes? c) Is it advisable to change jobs when evidence of asbestosis or benign pleural changes develop? The purpose of this presentation is to help develop a suitable public policy for Israel. Such a policy would have clinical importance as well as economic, legal, and social consequences for the individual and society as a whole.

Asbestos↗

PubMed1990

Asbestos-cement pneumoconiosis: first surgically confirmed case in Kuwait.

During the periodic medical examination of workers of the only asbestos-cement pipe factory in Kuwait, an early case of asbestosis was diagnosed. It was the first case of asbestosis to be reported and compensated in Kuwait. According to available information, it is also the first reported case to be confirmed by surgery in the Arabian Gulf countries. Recommendations are given in regard to diagnosis, the institution of very strict preventive and protective measures, and the system of compensation in Kuwaiti law.

Adult↗

PubMed1990

Study of asbestos bodies in Japanese urban patients.

To study whether low-level exposure to asbestos contributes to lung cancer risk, the asbestos body (AB) content in lung tissue was measured in 476 patients with lung cancer and 369 patients with other diseases, all from a Japanese industrialized city. Eleven patients with histologically confirmed asbestosis were included. The findings were stratified into four groups. A significant number of patients with lung cancer were seen in the groups with high counts, as compared to controls. There was no significant difference in histologic type and site of lung cancer among four groups. The patients with lung cancer in high count groups were significantly younger than those with lower counts. A significant number of smokers were seen in the groups with high AB counts among patients with lung cancer as compared to controls, even if the patients with asbestosis were excluded. These findings suggest that there may be a positive interaction of smoking and exposure to asbestos relative to the incidence of lung cancer even at a low exposure level.

Adenocarcinoma↗

PubMed1990

Asbestos-related lesions of the pleura: parietal plaques compared to diffuse thickening studied with chest roentgenography, computed tomography, lung function, and gas exchange.

Lung function tests, tests of working capacity with gas exchange, and computed tomography (CT) with density measurements with the patient supine and prone were performed in 23 males with asbestos-related bilateral pleural lesions. Two had pulmonary asbestosis grade 1/0 or more; all the others had normal lung parenchyma. On x-ray, the pleural lesions were divided into plaques involving only the parietal pleura There was a and diffuse pleural fibrosis of various degrees involving the visceral pleura. There was a good correlation between the findings at plain chest roentgenography and CT, but more lesions were seen on the CT scan. However, a few pleural plaques seen on conventional films were not observed at CT. Individuals with plaques had slightly lowered lung function compared to reference subjects. Bilateral diffuse pleural fibrosis was associated with a marked decrease in pulmonary function. The two patients with radiologically evident pulmonary asbestosis were found in this group. Decreased lung function was also observed in subjects with pleural fibrosis of only grade 1 (involving less than one fourth of the hemithorax) and a normal exercise capacity. The study shows the importance of differentiation between various asbestos-related pleural lesions.

Adult↗

PubMed1992

Death certificates in epidemiological studies, including occupational hazards: inaccuracies in occupational categories.

We compared death certificates for asbestos-associated diseases (mesothelioma, lung cancer, asbestosis) in two asbestos workers' cohorts. One (insulation workers) had current or recent employment and a strong, continuing union support system which gave them much information about the effects of asbestos exposure. The second cohort, asbestos factory workers, had no such advantage. The factory had closed almost 30 years before, and its workers had dispersed into many areas of the state and nation. Accuracy of medical diagnosis was comparable in the two groups, but occupational listings were not. Three-quarters of the insulators' death certificates told of asbestos work, while virtually none of the factory workers' certificates provided such information, even for deaths of mesothelioma and asbestosis. The data indicate that disease categories, based on medical and pathological diagnoses, at least for asbestos-associated disease, tend to be accurate. Attempts to identify groups at risk by sorting occupational categories can give variable results, good for those with current exposures, much less satisfactory for those with long-past occupational exposures.

Adolescent↗

PubMed1994

Asbestos-related disease associated with exposure to asbestiform tremolite.

Tremolite is nearly ubiquitous and represents the most common amphibole fiber in the lungs of urbanites. Tremolite asbestos is not mined or used commercially but is a frequent contaminant of chrysotile asbestos, vermiculite, and talc. Therefore, individuals exposed to these materials or to end-products containing these materials may be exposed to tremolite. We have had the opportunity to do asbestos body counts and mineral fiber analysis on pulmonary tissue from five mesothelioma cases and two asbestosis cases with pulmonary tremolite burdens greater than background levels. There were no uncoated amosite or crocidolite fibers detected in any of these cases. Three patients were occupationally exposed to chrysotile asbestos; two patients had environmental exposures (one to vermiculite and one to chrysotile and talc) and one was a household contact of a shipyard worker. The tremolite burdens for the asbestosis cases were one to two orders of magnitude greater than those for the mesothelioma cases. Our study confirms the relationship between tremolite exposure and the development of asbestos-associated diseases. Furthermore, the finding of relatively modest elevations of tremolite content in some of our mesothelioma cases suggests that, at least for some susceptible individuals, moderate exposures to tremolite-contaminated dust can produce malignant pleural mesothelioma.

Adult↗

PubMed1995

Occupational respiratory cancer and exposure to asbestos: a case-control study in a cohort of workers in the electricity and gas industry.

Cancers of the pleura, lung, and larynx between 1978 and 1989 among active male workers of Electricité de France-Gaz de France were studied in association with asbestos exposure using a case-control design nested within the cohort of workers of the company. The cohort included about 1,400,000 person-years, corresponding to a mean of 117,000 men per year. Exposure to asbestos and to some potential occupational confounders selected among agents from groups I, IIa, and IIb of the International Agency for Research on Cancer was assessed by a job-exposure matrix specific to the company. During the observation period, 12 cases of pleural cancer, 310 cases of lung cancer, and 116 cases of larynx cancer were registered in the cancer register of the company social security department. Four controls per case, matched for year of birth, were randomly selected among the cohort. Conditional logistic regression was used to estimate the odds ratios. A first analysis was conducted in order to assess the validity of the job-exposure matrix by investigating already known relationships between asbestos exposure and asbestosis. For asbestosis, a strong exposure-response relation was found with an odds ratio (OR) of 57.4 [95% confidence interval (CI): 17.0-194.0] in the highest exposure group. There was an elevated risk of pleural cancer (OR, 4.8, CI, 1.2-19.8). For lung cancer, significant ORs of 2.0 (CI, 1.3-3.2) and 1.9 (CI, 1.2-3.0) were found among the two highest cumulative exposure groups; adjustement for confounders slightly decreased the ORs. Squamous cell neoplasm of the lung was associated with asbestos exposure. The association between larynx cancer and asbestos exposure showed a tendency towards a nonsignificant increase in ORs in the highest cumulative exposure categories; this tendency disappeared when adjusting for occupational confounders. This study showed that occupational exposure to asbestos could increase the risk of pleural and lung cancer in a sector in which exposure levels are not considered to be high compared with other industrial settings.

Asbestos↗

PubMed1993

Bronchoalveolar lavage fluid proteins in human lung disease: analysis by two-dimensional electrophoresis.

Proteins of human bronchoalveolar lavage fluids, obtained by washing the epithelial lining fluid of the lungs with phosphate-buffered saline, were analyzed by two-dimensional electrophoresis under denaturating and reducing conditions. The two-dimensional pattern of bronchoalveolar lavage fluid proteins of healthy volunteers (controls) were compared with those of patients with idiopathic pulmonary fibrosis, sarcoidosis, and asbestosis. Particular interest was paid to the proteins present in minor amounts mainly in the low molecular weight region of the gels. Marked changes in single protein spots were observed. In idiopathic pulmonary fibrosis the spot intensity of the surfactant-associated protein, SP-A, showing isomeric forms both in charge and in molecular weight, was markedly decreased. In sarcoidosis, the immunoglobulins (IgG, IgA) and a group of protein spots at an isoelectric point of 4.5-5.0 and a molecular mass of 55 kDa were increased. An additional spot appeared at an isoelectric point of 4.5 and a molecular mass of 12 kDa. In particular in asbestosis, but also in some cases of idiopathic pulmonary fibrosis and sarcoidosis, the number and intensity of low molecular weight proteins were increased strongly.

Asbestosis↗

PubMed1979

Asbestos-associated neoplasms of B cell lineage.

Three different neoplasms of B cell lineage, chronic lymphocytic leukemia, immunoglobulin A (IgA) myeloma and immunoglobulin G (IgG) myeloma were detected in three patients who had heavy occupational exposure to asbestos dust. Two of the patients had coexistent pulmonary asbestosis, whereas the third patient had a pleural mesothelioma subsequent to his initial presentation with myeloma. Defective cell-mediated immunity and hyperactivity of B cell function have previously been noted in patients with asbestosis. We suggest the possibility that these asbestos-related immunologic derangements may predispose to the development of immunoproliferative and lymphoproliferative neoplasms, since such tumors have been observed in a variety of other settings, characterized by protracted hyperactivity of the immune system.

Aged↗

PubMed1983

Airway function in lifetime-nonsmoking older asbestos workers.

Previous studies of lung function in asbestos workers have documented airflow limitation in many of the workers, but the specific influence of asbestos exposure could not be clearly differentiated from the effects of the cigarette smoking habit. In this study, airway function was evaluated in lifetime-nonsmoking, long-term workers of the mines and mills of Québec. The 17 asbestos workers in this study had worked for an average of 28 years in the mines and mills of the local asbestos industry and did not have any other respiratory industrial dust exposure. They did not have a history of previous pulmonary disease and did not meet the usual diagnostic criteria for chronic bronchitis, emphysema, or asthma. Seven of the workers met the diagnostic criteria for asbestosis and 10 workers did not. The latter group of workers did not differ from a matched control group except in terms of a higher isoflow volume (p less than 0.05). The workers with asbestosis, however, had a restrictive pattern of lung function, increased isoflow volume, and increased upstream resistance at low lung volumes (p less than 0.01). Lung biopsy in three of the patients with the disease demonstrated peribronchiolar alveolitis and fibrosis with obliteration and narrowing of the small airways. These data on lifetime-nonsmoking, long-term asbestos workers provide further evidence of small airway obstruction associated with asbestos exposure and independent of the smoking habit. This airflow limitation was observed predominantly in workers with a restrictive pattern of lung function associated with peribronchiolar alveolitis. The lifetime-nonsmoking asbestos workers without restrictive patterns of lung function had minimal dysfunction of the peripheral airways.

Aged↗

PubMed1986

Electrolyte changes in mesothelioma.

Little has been reported concerning electrolyte changes among patients with mesothelioma. Two studies have suggested that hyponatraemia is particularly common among them and should lead to suspicion of inappropriate secretion of antidiuretic hormone in those patients (Perks et al. 1979; Siafakas et al. 1984). We reviewed serum electrolyte changes in three groups of patients: 48 cases of pleural mesothelioma, 89 of peritoneal mesothelioma, associated with asbestos exposure, and 149 of asbestosis. Five of 48 (10.4%) patients with pleural mesothelioma, 17 of 89 (19.1%) with peritoneal mesothelioma, and 23 of 149 (15.4%) patients with asbestosis without mesothelioma, had hyponatraemia. No statistically significant difference among the groups was found. These findings do not support the proposal that hyponatraemia is unusually common when mesothelioma is present, at least not among patients whose neoplasms are related to asbestos exposure.

Asbestosis↗

PubMed1983

Asbestos-induced lung injury in the sheep model: the initial alveolitis.

In order to study the cellular and biochemical changes in early asbestosis, three groups of sheep were repeatedly exposed to intratracheal instillations of either saline (controls), low doses of UICC chrysotile asbestos (LD), or high doses of the fibers (HD) until an alveolitis was observed in all HD sheep during the twelfth month of exposure. All sheep were studied bimonthly by transbronchial lung biopsy (LB), bronchoalveolar lavage (BAL), pulmonary function tests (PFT), and chest roentgenograms (CXR). While LBs of the HD sheep demonstrated large accumulations of monocyte-macrophages in the alveolar and interstitial spaces, those of controls and LD sheep did not. In BAL, there was no difference in total and differential cell counts between groups, but the BAL lymphocyte proliferative capacity was clearly depressed in all asbestos-exposed sheep. In the BAL supernatant, total proteins (mainly albumin, beta + gamma globulins) and lactate dehydrogenase were significantly elevated in the HD group only. This alveolitis was associated with a fall in vital capacity, lung compliance, diffusing capacity, and arterial PO2. Abnormalities on CXR appeared 3 months later. Thus, the cellular and biochemical features of early asbestosis are clearly distinct from those reported in idiopathic pulmonary fibrosis.

Alveolitis, Extrinsic Allergic↗

PubMed1984

Asbestos-exposed populations: prevention, care, and compensation.

In Israel, the prevention and care of asbestos-associated diseases with latency periods of one to four decades (asbestosis, mesothelioma, increased frequency of cancer of the lung and other sites) are not satisfactory, and new national policies are required. Such policies have three major goals: (a) elimination or reduction of exposure to asbestos dust; (b) measures to promote cessation or drastic reduction of cigarette smoking among those currently or formerly exposed; and (c) equitable compensation for the consequences of past exposures. The practical elements of a program to achieve these three goals include (a) exposure standards and control technology; (b) identification of sources, routes, and levels of exposure and groups at risk; (c) compensation and job security; (d) medical monitoring and follow-up; (e) smoking cessation; (f) selective substitution of other substances for asbestos; and (g) establishment of a panel for policy supervision and the overseeing of compensation programs. Delay in implementation risks higher death rates for asbestosis and cancer among previously exposed workers, greater exposure among current workers, loss of experienced workers from the work force, and unnecessary hardship for families not adequately compensated.

Adult↗

PubMed1990

Fiber exposure reassessed with the new indices.

The concentration of airborne fibers longer than 5 microns, thinner than 3 microns, and with an aspect ratio exceeding 3 as counted by phase contrast optical microscopy is the most widely used fiber exposure index. Recently, more adequate, specific exposure indices for asbestosis, lung cancer, and mesothelioma risk have been suggested by Lippmann (1988, Environ. Res., 46, 86-106). The consequences of using these indices are examined on the basis of calculations for a broad range of theoretical and published size distributions. Optical microscopy appears to be a good predictor of the exposure indices for asbestosis and for lung cancer after scaling. Only fibers longer than about 3 microns need to be counted in a transmission electron microscope. The lung cancer index still cannot explain the large differences of risk among chrysotile exposures. Both the mesothelioma exposure index and the ratio mesothelioma to lung cancer index ranks in order of increasing risk: wollastonite, glass and mineral wool, amosite, glass microfibers, chrysotile, and crocidolite. Amosite is thus not ranked according to epidemiological evidence. Detailed size information should be made available so that the size criteria can be adjusted. It may still prove necessary to use fiber type specific concentration limits.

Asbestos↗

PubMed1988

Asbestos exposure indices.

The ability of inhaled asbestos to produce asbestosis, lung cancer, and mesothelioma in both humans and animals is well established, and asbestos exposures in the occupational and general community environment are recognized as significant hazards. However, it has not been possible to establish realistic and credible dose-response relationships, primarily because of our inability to define which constituents of the aerosols produce or initiate the pathological responses. It is generally acknowledged that the responses are associated with the fibers rather than the nonfibrous silicate mineral of the same chemical composition. Available data from experimental studies in animals exposed by injection and inhalation to fibers of defined size distributions are reviewed, alone with data from studies of fiber distributions in lungs of exposed humans in relation to the effects associated with the retained fibers. It is concluded that asbestosis is most closely related to the surface area of retained fibers, that mesothelioma is most closely associated with numbers of fibers longer than approximately 5 microns and thinner than approximately 0.1 micron, and that lung cancer is most closely associated with fibers longer than approximately 10 microns and thicker than approximately 0.15 micron. The implications of these conclusions on methods for fiber sampling and analyses are discussed.

Animals↗

PubMed1989

Bronchoalveolar lavage analysis, gallium-67 lung scanning and soluble interleukin-2 receptor levels in asbestos exposure.

This study examined different markers of lung immunologic and inflammatory responses to previous asbestos exposure. We performed bronchoalveolar lavage (BAL) and gallium-67 (67Ga) lung scans and measured serum and BAL soluble interleukin-2 receptor (IL-2R) and angiotensin-converting enzyme (SACE) levels in 32 subjects with a history of significant asbestos exposure, 14 without (EXP) and 18 with (ASB) radiographic evidence of asbestosis. BAL analysis revealed increases in neutrophils in both ASB and EXP when compared to controls (P less than 0.01), which persisted after adjustment for smoking category. Although significant abnormalities of macrophage and total lymphocyte profiles were not found in the study population, lymphocyte subpopulation analysis revealed elevation of BAL T4/T8 ratios in the entire study group (ASB + EXP) when compared to controls (P less than 0.05), independent of smoking category. 67Ga lung scan activity was increased in 56% of ASB and in 36% of EXP: no correlations between positive scans and different radiological and functional parameters could be found. There was no significant elevation of mean SACE, serum, or BAL IL-2R levels in any of the study categories. These data suggest that asbestos exposure may be associated with parenchymal inflammation, even in the absence of clinical criteria for asbestosis. Abnormalities of gallium uptake and of BAL analysis reflect the clinically inapparent inflammation. The increased BAL T4/T8 ratios observed suggest that abnormal local pulmonary immunoregulation may play a role in the pathogenesis of asbestos-related lung diseases.

Adult↗