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PubMed2002

PiS and PiZ alpha 1 antitrypsin polymorphism and the risk for asbestosis in occupational exposure to asbestos.

Alpha 1 antitrypsin is a highly polymorphic anti-elastase enzyme, especially active in the protection of alveoli and liver. Here we studied the distribution of two deficient alleles Pi*Z and Pi* S, in 194 asbestos workers, of whom 100 were asbestosis cases, and 94 were controls without disease (exposed controls, EC). A second group of controls without asbestos exposure (non-exposed controls, NEC; n=122) was also included. Multivariate analysis adjusted by age and smoking habit showed ninefold risk for asbestosis in Pi*Z heterozygous individuals and 5.9-fold risk for Pi*S homozygous although differences were only significant in the first case (cases vs. EC: OR 8.9; p=0.04). Considering both genotypes (Pi*Z heterozygous, Pi*S homozygous) we obtained an OR of 8 (p=0.01). Our results suggest that the alpha 1 antitrypsin polymorphisms, especially Pi*Z, could help to predict asbestosis risk and confirm the high prevalence of the Pi*S allele in Spain.

Adult↗

PubMed1996

Differentiation of the ILO boundary chest roentgenograph (0/1 to 1/0) in asbestosis by high-resolution computed tomography scan, alveolitis, and respiratory impairment.

High-resolution computed tomography (HRCT) scans have been advocated as providing greater sensitivity in detecting parenchymal opacities in asbestos-exposed individuals, especially in the presence of pleural fibrosis, and having excellent inter- and intraobserver reader interpretation. We compared the 1980 International Labor Organization (ILO) International Classification of the Radiographs of the Pneumoconioses for asbestosis with the high-resolution CT scan using a grid scoring system to better differentiate normal versus abnormal in the ILO boundary 0/1 to 1/0 chest roentgenograph. We studied 37 asbestos-exposed individuals using the ILO classification, HRCT grid scores, respiratory symptom questionnaires, pulmonary function tests, and bronchoalveolar lavage. We used Pearson correlation coefficients to evaluate the linear relationship between outcome variables and each roentgenographic method. The normal HRCT scan proved to be an excellent predictor of "normality," with pulmonary function values close to 100% for forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), total lung capacity (TLC), and carbon monoxide diffusing capacity (DLCO) and no increase in BAL inflammatory cells. Concordant HRCT/ILO abnormalities were associated with reduced FEV1/FVC ratio, reduced diffusing capacity, and alveolitis consistent with a definition of asbestosis. In our study, the ILO classification and HRCT grid scores were both excellent modalities for the assessment of asbestosis and its association with impaired physiology and alveolitis, with their combined use providing statistical associations with alveolitis and reduced diffusing capacity.

Asbestosis↗

PubMed1978

TruCutR needle biopsy in asbestosis and silicosis: correlation of histological changes with radiographic changes and pulmonary function in 41 patients.

A percutaneous needle biopsy was performed with a TruCut needle on 41 patients with suspected pneumoconiosis. Patients selected for biopsy tended to have brief or unusual dust exposure, as well as questionable radiographic opacities. Sixteen had been exposed to asbestos, 13 to silica and 12 to mixed dust containing quartz, coal, iron, asbestos and talc. All patients in the asbestos group and most in the other two groups had a reduced transfer factor. Most patients in the asbestos group and about 25% of the other patients had restrictive ventilatory impairment. Chest radiographs were assessed according to standard films of the ILO U/C International Classification (International Labour Office, 1972). In 25 patients radiographic opacities were absent or acanty (categories 0--1/1). The dominant radiographic feature of many patients exposed to asbestos was a ground-glass appearance or a bilateral elevation of the diaphragm, or both, features difficult to assess according to the ILO U/C scheme. Most histological changes were those usually seen in pneumoconiosis. However, in only two patients with silicosis were silicotic nodules detected. The specimens of seven patients showed a granulomatous inflammation. The severity of alveolar wall involvement correlated well with the transfer factor value but poorly with radiographic changes. The profusion of radiographic opacities also correlated poorly with functional impairment. As a diagnostic tool the needle biopsy was valuable in asbestosis and slightly less so in mixed-dust fibrosis. The biopsy specimens showed changes compatible with asbestosis in 75% of the suspected cases and in 86% of those in which asbestosis was the final diagnosis. In the mixed-dust group pneumoconiosis was confirmed in 67% and 80%, respectively. In the diagnosis of silicosis an open biopsy is probably more reliable than a percutaneous one, particularly if radiographic changes are minimal. Histological changes in the needle biopsy specimen were compatible with silicosis in only 36% of the suspected cases and in 63% of those in which the final diagnosis was silicosis.

Adult↗

PubMed1981

Mortality of workers certified by pneumoconiosis medical panels as having asbestosis.

A mortality study has been carried out at the London, Cardiff, or Swansea Pneumoconiosis Medical Panels between 1952 and 1976 on people certified as suffering from asbestosis. The main analysis was of 665 men, 283 of whom had died. Of the deaths, 39% were from lung cancer, 9% mesothelioma, and 20% asbestosis. The observed mortality was compared with expectation based on the death rates for England and Wales. For all causes the observed number of deaths was 2.6 times expectation and for lung cancer 9.1 times expectation. After 10 years from first certification half of the men had died compared with an expectation of one in four. The excess death rates were apparent in the first year after certification and were still operating after 10 years on those who survived until then. The main factor influencing the mortality was the clinical state of the men at the time of certification, as indicated by the percentage disability awarded; the excess lung cancer rate and the mesothelioma and asbestosis rates all increased with percentage disability. Those awarded only 10% or 20% benefit were still at risk from all the three asbestos-related causes. For a man certified at age 55 it was estimated that his life expectation would be reduced by 3, 5, 8, or 12 years according to whether his rate of disablement benefit was 10%, 20%, 30% or 40% , or 50% or more respectively.

Adult↗

PubMed1991

Prediction of mesothelioma, lung cancer, and asbestosis in former Wittenoom asbestos workers.

Projections have been made of the number of mesotheliomas, lung cancers, and cases of asbestosis that might occur over the period 1987 to 2020 in former workers at the Wittenoom crocidolite asbestos mine in Western Australia. Predictions were based on the observed mortality to the end of 1986 and modelling of the mesothelioma rate. Elimination of crocidolite from the lungs was included in the model. Between the years 1987 and 2020 it is predicted that between 250 and 680 deaths will occur due to mesothelioma. This wide range is due to uncertainty on the functional form of the relation between mesothelioma rate and time, and insufficient data to estimate the elimination rate of crocidolite from the lungs. The most likely range is the lower half of this total range--that is, between 250 and 500. It is predicted that between 340 and 465 deaths will occur due to lung cancer. About 45% of these deaths would be attributable to exposure to asbestos. It is estimated that currently there are up to 200 cases of undiagnosed asbestosis. Of these about 50 will die of lung cancer or mesothelioma and are therefore also included in the figures above. Up to 60 former workers may develop the first signs of asbestosis in the future but any such cases are likely to progress to more serious disease at a much slower rate than the cases that have already been identified.

Adult↗

PubMed1991

Smoking, exposure to crocidolite, and the incidence of lung cancer and asbestosis.

In 1979 all former workers from the Wittenoom asbestos industry who could be traced to an address were sent a questionnaire to determine smoking history. Occupational exposure to crocidolite was known from employment records. Of 2928 questionnaires sent, satisfactory replies were received from 2400 men and 149 women. Eighty per cent of these had smoked at some time and 50% were still smoking. Since that time 40 cases of lung cancer and 66 cases of compensatable asbestosis have occurred in this cohort. The incidence of both lung cancer and asbestosis was greatest in those subjects with the highest levels of exposure to crocidolite and in ex-smokers. Statistical modelling of the joint effects of these exposures on the incidence of each disease indicated that crocidolite exposure multiplied the rates of lung cancer due to smoking and that smoking has no measurable effect on the rates of asbestosis. There was also some evidence that the incidence rate of lung cancer is falling with time.

Asbestos↗

PubMed1999

Asbestosis and small cell lung cancer in a clutch refabricator.

OBJECTIVES: To present a case of asbestosis and small cell lung cancer caused by asbestos in a clutch refabricator. METHODS: Exposed surfaces of used clutches similar to those refabricated in the worker's workplace were rinsed, and the filtrate analysed by analytical transmission electron microscopy. Tissue samples were also analysed by this technique. RESULTS: Numerous chrysotile fibres of respirable dimensions and sufficient length to form ferruginous bodies (FBs) were detected from rinsed filtrates of the clutch. Bronchoalveolar lavage fluid contained many FBs, characteristic of asbestos bodies. Necropsy lung tissue showed grade 4 asbestosis and a small cell carcinoma in the right pulmonary hilum. Tissue analysis by light and analytical electron microscopy showed tissue burdens of coated and uncoated asbestos fibres greatly exceeding reported environmental concentrations (3810 FBs/g dry weight and 2,080,000 structures > or = 0.5 micron/g dry weight respectively). 72% Of the cores were identified as chrysotile. CONCLUSIONS: Clutch refabrication may lead to exposure to asbestos of sufficient magnitude to cause asbestosis and lung cancer.

Asbestos↗

PubMed2000

Asbestosis and lobar site of lung cancer.

OBJECTIVE: To assess the evidence for the hypothesis that lung cancer has a predilection for the lower lobes in workers with asbestosis. METHOD: A review of the available literature with relevant information. RESULTS: Six published reports were analysed. In four studies limited to series of cases with diagnoses of asbestosis, three showed lower lobe predominance of lung cancer whereas the fourth study included cases in which the radiographic readings did not meet the usual criterion of profusion for asbestosis. One cohort study showed lower lobe predominance; the other reported only 33% lower lobe cancers compared with 20% in unexposed controls. CONCLUSION: There is some support for the hypothesis but more studies are needed.

Asbestos↗

PubMed2003

Radiographic (ILO) readings predict arterial oxygen desaturation during exercise in subjects with asbestosis.

BACKGROUND: Exercise impairment is common in subjects with asbestosis. Arterial oxygen desaturation during exercise is an important contributor to exercise limitation. The International Labour Office (ILO) classification of plain chest radiographs correlates with resting pulmonary function, but its value in predicting abnormal ventilatory responses to exercise, including desaturation, has not been explored. AIMS: To determine in subjects with asbestosis (1) if radiographic profusion scores and the extent of small irregular shadows on plain chest radiographs correlate with resting lung function and abnormal ventilatory responses to exercise; and (2) if radiographic scores add value to resting lung function tests in predicting abnormal ventilatory responses to exercise. METHODS: Thirty eight male subjects with asbestosis were included. Plain chest radiographs were read according to the ILO classification independently by three observers. All subjects underwent assessment of lung function and an incremental exercise test. RESULTS: Profusion scores and number of affected zones correlated significantly with the percentage predicted values of single breath diffusing capacity (DLCO), forced vital capacity (FVC), and total lung capacity (TLC). Arterial oxygen desaturation occurred in 29% of the subjects. The severity of desaturation correlated significantly with profusion and the number of affected zones. The combined use of number of affected zones, FEV(1)/FVC ratio and DLCO predicted desaturation during exercise with an explained variance of 41%. VO(2)max was significantly related only to DLCO but was not predicted by the ILO score. CONCLUSION: Arterial oxygen desaturation correlated with the profusion and extent of parenchymal abnormality on chest radiographs. The addition of morphological indices to physiological measurements is valuable for predicting oxygen desaturation during exercise but not for VO(2)max. Refinement of the radiographic scoring system and the addition of more sophisticated imaging techniques may further improve the predictive power.

Aged↗

PubMed1983

Assessment of progression of asbestosis in the sheep model by bronchoalveolar lavage and pulmonary function tests.

To study the relationship between the results of bronchoalveolar lavage and pulmonary function tests during induction and progression of asbestosis, three groups of six sheep were exposed repeatedly by intratracheal injection to either saline (controls), low doses of Canadian chrysotile UICC asbestos (cumulative exposure 328 mg) (low-dose group), or high doses of the same fibres (cumulative dose 2282 mg) (high-dose group) until there was clear evidence of alveolitis from the lung biopsy specimens of all sheep of the high-dose group. During the course of this induction and for the following eight months lung biopsies, bronchoalveolar lavage and pulmonary function tests were performed at two-month intervals. At the time of initial alveolitis in the high-dose group there was no significant change in the cellularity of the bronchoalveolar lavage fluid, but static lung compliance (Cst), vital capacity (VC), arterial oxygen tension (Pao2), and diffusion capacity (DL/VA) were significantly lower than in the other groups. In the following months, as the alveolitis evolved into a fibrosing process, macrophages and neutrophils from the bronchoalveolar lavage fluid increased significantly and pulmonary function deteriorated. Proteins and enzymes in the bronchoalveolar lavage fluid also increased significantly in the high-dose group. These data show that in the sheep model of asbestosis simple tests of pulmonary function correlate well with histological changes and changes in the bronchoalveolar lavage fluid in the course of the disease and can be used to assess progression of asbestosis.

Animals↗

PubMed1983

Pleural thickening and gas transfer in asbestosis.

Anomalies in the ratio of transfer factor to effective alveolar volume as an indicator of pulmonary gas exchange in cases of asbestosis may be related to diffuse pleural thickening. To examine the effect of pleural disease on gas transfer the plain chest radiographs of patients with asbestosis were assessed by two observers for profusion of parenchymal opacities and extent of pleural disease and the results were related to lung function. In 30 cases of category 1 profusion of parenchymal abnormality (according to the ILO international classification of radiographs for pneumoconiosis) transfer factor was independent of the degree of pleural thickening. The ratio of transfer factor to effective alveolar volume correlated directly with the degree of pleural thickening as alveolar volume fell with increasing severity of pleural disease. The results indicate that correcting transfer factor for alveolar volume does not provide an accurate reflection of severity of diffuse parenchymal fibrosis in patients with asbestosis and even minor pleural disease.

Aged↗

PubMed1984

Serum interferon levels and natural killer cell activity in patients with asbestosis.

Natural killer cell activity and serum interferon levels were measured in 30 patients with asbestosis. The chest radiographs showed type 1 changes (ILO pneumoconiosis classification) in nine, type 2 changes in 19, and type 3 changes in two. Thirty control subjects matched for age, sex, and smoking habit were also studied. Patients with asbestosis had significantly higher serum interferon levels than the controls. There was no significant difference in natural killer cell activity between patients with asbestosis and normal controls.

Aged↗

PubMed1985

Asbestosis: assessment by bronchoalveolar lavage and measurement of pulmonary epithelial permeability.

Thirty two patients with asbestosis were assessed by means of bronchoalveolar lavage (27 patients) and the half time clearance from lungs to blood (T1/2LB) of an inhaled aerosol of diethylenetriamine pentacetate (DTPA) labelled with technetium 99m (32 patients). T1/2LB was also measured in 20 non-smoking normal individuals and 17 smokers without a history of exposure to asbestos. Thirteen patients (46%) showed an increase in the percentage of neutrophils with or without an increase in the percentage of eosinophils and eight (29%) showed an increased percentage of lymphocytes. The number of neutrophils plus eosinophils expressed as a percentage of the total count was positively correlated with the length of the history of disease (r = 0.53, p less than 0.025) and greater percentages were associated with more severe impairment of lung function. Smokers had lower percentages of lymphocytes than non-smokers (p less than 0.002) and showed increased proportions of neutrophils and eosinophils more often than non-smokers (p less than 0.05). In 18 non-smokers with asbestosis the mean T1/2LB was 33.8 (range 10.0-62.0) minutes, significantly less than 57.2 (30.5-109) minutes in 20 non-smoking normal subjects (p less than 0.002). In non-smokers shorter T1/2LB correlated with a longer time since first exposure to asbestos (r = -0.65, p less than 0.005), longer duration of exposure (r = -0.70, p less than 0.001), and a shorter time since last exposure (r = 0.59, p less than 0.01). Shorter T1/2LB was also associated with increased inflammatory activity as shown by higher bronchoalveolar lavage cell counts (r = -0.53, p less than 0.025) and higher combined percentages of neutrophils, eosinophils, and lymphocytes (r = -0.47, p less than 0.05). The techniques of bronchoalveolar lavage and measurement of inhaled solute clearance may be useful in assessing inflammatory activity in asbestosis.

Adult↗

PubMedDate not supplied

Asbestosis and probable microscopic polyangiitis.

Several inorganic dust lung diseases (pneumoconioses) are associated with autoimmune diseases. Although autoimmune serological abnormalities are common in asbestosis, clinical autoimmune/collagen vascular diseases are not commonly reported. A case of pulmonary asbestosis complicated by perinuclear-antineutrophil cytoplasmic antibody (myeloperoxidase) positive probable microscopic polyangiitis (glomerulonephritis, pericarditis, alveolitis, multineuritis multiplex) is described and the possible immunological mechanisms whereby asbestosis fibres might be relevant in induction of antineutrophil cytoplasmic antibodies are reviewed in the present report.

Antibodies, Antineutrophil Cytoplasmic↗

PubMedDate not supplied

Asbestosis in the Republic of Croatia.

Croatians have been exposed to asbestos in the shipbuilding and asbestos-cement industries since 1945. The first cases of asbestosis were reported in 1961; 317 cases were recorded from 1990 to 2000. The Croatian Cancer Registry recorded 248 malignant pleural mesotheliomas between 1991 and 1997, two thirds of which were attributable to occupational exposures to asbestos. The Croatian Asbestosis Patient Association was founded in 1998 to help victims. Croatian law defines the employer's responsibility for work-related health damage and compensation, but average legal proceedings for asbestosis claims take about seven years. Croatian law does not ban the manufacture and import of asbestos. Croatia as a transitional country is subject to socioeconomic pressures. Future approaches to the asbestos issue will depend on revised regulations, which are expected to conform to recommendations of the European Union by 2005.

Asbestosis↗

PubMed1994

Environmental asbestosis complicated by lung cancer.

Diagnosis of asbestosis and bronchiolo-alveolar carcinoma was made in a 55-year-old Turkish woman who was a nonsmoker. She originated from and was living in an area with a high prevalence of environmental diseases attributed to tremolite asbestos. Mineralogic analysis of lung tissue revealed very high concentrations of asbestos bodies (1.64 x 10(6)/g of dry tissue) and tremolite fibers (173.7 x 10(6) of dry tissue). This case illustrates the following points: (1) In some areas, environmental exposure can lead to cumulated fiber retention comparable to occupational exposure and thus can represent a risk for lung fibrosis (asbestosis). (2) Lung cancer as a complication of environmental asbestosis also should be considered as a potential environmental disease.

Adenocarcinoma, Bronchiolo-Alveolar↗

PubMed1988

Chronic constrictive pericarditis associated with asbestosis.

Observation of chronic constrictive pericarditis associated with pulmonary asbestosis is reported here. Heart catheterization revealed typical patterns of cardiac constriction. The diagnosis of asbestosis was based on pathologic features associated with a long history of asbestos dust exposure without evidence for tuberculosis. The etiology of this constrictive pericarditis was related to an asbestosis pericarditis involvement.

Aged↗

PubMed1988

Asbestos-related pleural disease and asbestosis: a comparison of CT and chest radiography.

High-resolution CT (HRCT) has the ability to demonstrate both asbestos-related pleural disease and parenchymal abnormalities consistent with asbestosis. The role of CT in the diagnosis of asbestosis can be defined by comparing it with radiography. We evaluated 60 men who had a history of occupational exposure to asbestos and whose outside chest radiographs were considered abnormal. Chest radiographs (inside films) and HRCT were performed in all patients at our institution and were interpreted independently by experienced radiologists. Outside film results were compiled from the submitted reports. The final conclusion regarding the interpretation of the radiologic examinations was determined by consensus when disagreements existed. Positive predictive values (the likelihood that a positive report is correct) for pleural disease were: outside films 56%, inside films 79%, HRCT 100%. The positive predictive values for parenchymal disease were: outside films 51%, inside films 83%, HRCT 100%. The addition of HRCT to chest radiography is most useful in eliminating false-positive diagnoses of asbestos-related pleural disease caused by subpleural fat and false-positive diagnoses of parenchymal asbestosis in patients with extensive plaques or emphysema obscuring lung detail. The interpretation of chest radiographs in patients exposed to asbestos is often extremely difficult and subjective, and we recommend that positive findings (except calcified plaques) be confirmed with HRCT.

Asbestos↗