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PubMed1992

Influence of cigarette smoking on bronchoalveolar lavage cellularity in asbestos-induced lung disease.

To investigate the influence of cigarette smoking on bronchoalveolar lavage (BAL) cellularity in asbestos-induced lung disease, we compared BAL cells in asbestos-exposed, nondiseased subjects (n = 20) with those with either asbestosis (n = 25) or asbestos-induced pleural fibrosis (n = 28). Patients with asbestosis (ILO greater than or equal to 1/0) had higher concentrations of BAL macrophages (p = 0.04), neutrophils (p = 0.003), and eosinophils (p = 0.01), while patients with asbestos-induced pleural fibrosis (circumscribed plaques and diffuse pleural thickening) had higher concentrations of BAL lymphocytes (p = 0.02). Within our study population, however, cigarette smoking (smoking status or pack-years of smoking) was strongly associated with BAL macrophages, neutrophils, and eosinophils but was not associated with the concentration of BAL lymphocytes. Using multivariate analysis, we found that although asbestosis remained associated with higher concentrations of BAL macrophages, neutrophils, and eosinophils, cigarette smoking had a far greater contribution to the concentrations of BAL macrophages and eosinophils than did asbestosis. Although cigarette smoking accounted for 17 to 18% of the variance of BAL macrophages and eosinophils, asbestosis was associated with approximately 6% of the variance associated with these cells. In contrast, the concentration of BAL neutrophils remained associated with asbestosis and was not influenced by smoking behavior. We conclude that cigarette smoking strongly influences BAL cellularity (macrophages and eosinophils) in our patients with asbestosis but does not appear to affect the type or concentration of BAL cells in patients with asbestos-induced pleural fibrosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Asbestosis↗

PubMedDate not supplied

Asbestos in Scotland.

This paper outlines the asbestos hazard in Scotland and draws upon a systematic oral history project to analyze from the workers' perspective the nature of exposure, the limitations of government regulatory initiatives, and the ramifications of contracting asbestos-related diseases for sufferers and their families. Current issues are investigated, stressing the agency of workers, trade unions, sympathetic local councils, and, especially, the victims' pressure groups. The occupational and environmental health threats of asbestos in Scotland remain significant, although recent E.U.- and U.K.-based decisions to ban further use of asbestos together with active campaigning by local activist groups have helped to reduce them. Mesothelioma mortality rates remain high, due to historic exposures, and much work remains to be done to reduce the number and plight of asbestos-exposed workers.

Asbestosis↗

PubMed1997

Pleural effusion during bromocriptine exposure in two patients with pre-existing asbestos pleural plaques: a relationship?

Two patients with pleural plaques developed pleural effusion and subsequent diffuse pleural fibrosis 50 and 39 yrs after their first exposure to asbestos. The diagnosis of benign asbestos pleural effusion was suggested, but the work-up finally suggested bromocriptine-induced pleural disease in both patients. These two cases illustrate that drug-induced pleural effusion is an important differential diagnosis of benign asbestos pleural effusion. It is, moreover, possible that pre-existing asbestos pleural lesions, or even asbestos exposure, increases the risk of developing bromocriptine-induced pleural disease.

Antiparkinson Agents↗

PubMed2005

Asbestosis in an asbestos composite mill at Mumbai: a prevalence study.

BACKGROUND: Of an estimated 100,000 workers exposed to asbestos in India, less than 30 have been compensated. The reasons for such a small number are: refusal by management sponsored studies to grant medical certifications to workers suffering from occupational diseases, lack of training for doctors in diagnosis of occupational lung diseases, deliberate misdiagnosis by doctors of asbestosis as either chronic bronchitis or tuberculosis and the inherent class bias of middle class doctors against workers. The aim of the study was to identify workers suffering from Asbestosis (parenchymal and pleural non-malignant disease) among the permanent workers of the Hindustan Composites Factory and assess their disability and medically certify them, whereupon they could avail of their basic rights to obtain compensation and proper treatment. METHODS: The study was conducted by the Occupational Health and Safety Centre and the Workers' Union. Asbestosis was diagnosed if they had an occupational history of asbestos exposure for at least 15 years and showed typical radiographic findings. RESULTS: Of 232 workers in the factory, 181 participated in the survey. 22% of them had asbestosis. All the asbestos affected workers had at least 20 years of exposure. 7% had rhonchi, 34% had late basal inspiratory rates, 82% had more than 80% of Forced Expiratory Volume in the first second (FEV1)/Forced Vital capacity (FVC) ratio and 66% had FVC less than 80% of the predicted value. On radiology 7% had only pleural disease, 10% had both pleural and parenchymal disease and 82% had only parenchymal disease. The association of pleural disease with chest pain was statistically significant. CONCLUSION: We found the prevalence of asbestosis among exposed workers to be less than that anticipated for the number of years of exposure due to "Healthy Worker Effect". We suggest that all affected asbestos workers (including those who have been forced to leave) in India be medically certified and compensated. We also recommend better control of asbestos use in India. We also implore the management to provide all information about the work process and its hazards, conduct medical checkups as mandated by law and give the medical records to the workers.

Adult↗

PubMed2004

Emphysema findings associated with heavy asbestos-exposure in high resolution computed tomography of finnish construction workers.

Asbestos fibers are known to cause lung fibrosis, but their role in emphysema is unclear. We wanted to evaluate the relationship between asbestos exposure and emphysema by using high-resolution computed tomography (HRCT). Conventional and high resolution CT was performed on 600 smoking construction workers with an asbestos-related occupational disease. Emphysema subtypes (centrilobular, paraseptal, panlobular emphysema and bullae) were separately scored on a semiquantitative scale from 0 to 5, which scores were added up to yield the total emphysema score. Occupation, exposure duration, age, pack years and asbestosis diagnosis were analyzed in general linear models for possible associations with emphysema. The inter- (quadratic weighted kappa, kappa(qw)=0.46-0.72) and intraobserver (kappa(qw)=0.78-0.94) agreements for the subtype-scores and the reliability of the total score (Cronbach's alpha=0.87) were good. Insulators had a significantly higher paraseptal, panlobular and total score than the other occupational groups when adjusted for age and smoking. An asbestosis diagnosis was also a significant independent predictor of a higher total score. Emphysema was more common when workers had asbestosis or were heavily exposed to asbestos (insulators), but due to confounding factors the causative role of asbestos in emphysema needs further study.

Adult↗

PubMed1988

High-resolution CT of benign asbestos-related diseases: clinical and radiographic correlation.

We prospectively analyzed benign asbestos-related pleural and parenchymal abnormalities on high-resolution CT scans and correlated them with clinical diagnoses in 100 asbestos-exposed workers. All subjects had high-resolution CT scans in conjunction with conventional CT at the time of clinical evaluation. To evaluate for asbestosis, we ranked high-resolution CT scans as high, intermediate, or low probability of asbestosis on the basis of the multiplicity and extent of observed parenchymal changes. By linear regression analysis, the most distinctive high-resolution CT features of asbestosis included thickened nondependent interstitial short lines and parenchymal bands. In 45 subjects satisfying clinical criteria of asbestosis, high-resolution CT probability of asbestosis was high in 38 (84%), intermediate in five (11%), and low in two (4%). In 20 (36%) of 55 subjects without clinical asbestosis, parenchymal abnormalities indicative of a high probability of asbestosis were observed on high-resolution CT. High-resolution CT probability scores had a strong positive correlation with chest radiographic profusion scores (p less than .0001) and asbestos-related pleural thickening (p less than .0001). Significant inverse correlations were seen with forced vital capacity (p less than .006) and single-breath diffusing capacity (p less than .03), both functional measures of restrictive interstitial lung disease. Neither clubbing nor rales were sufficiently prevalent to have statistical correlation with high-resolution CT scores. High-resolution CT is sensitive in detecting both pleural and parenchymal abnormalities in the asbestos-exposed subject. Asbestos-related pleural changes are observed more frequently on high-resolution CT than on conventional CT or chest radiography. The probability of asbestosis based on high-resolution CT parenchymal features has a significant correlation with existing clinical determinants of disease, and high-resolution CT can detect abnormality when other methods are not diagnostic.

Adult↗

PubMed1993

Lobe of origin of lung cancer among asbestos-exposed patients with or without diffuse interstitial fibrosis.

The effect of asbestos exposure and asbestos-associated fibrosis on the lobe of origin of lung cancer was studied among 108 lung cancer patients. The asbestos-exposed patients had significantly more lower lobe tumors than the unexposed patients. Similar results were obtained when occupational history or lung fiber concentration was used as an indicator of past occupational exposure to asbestos. The predominance of lower lobe tumors occurred even among exposed patients with no histological signs of asbestosis in their lung specimens. Both bronchial and peripheral cancers showed a lower lobe predominance among the exposed patients. Smoking history did not affect the lobar distribution of the tumors. No significant differences occurred for the histological cell types of the tumors between the exposed and unexposed patients. Patients with asbestosis had, however, more adenocarcinomas than the unexposed patients. The results indicate that asbestos may increase the risk of lung cancer even in the absence of asbestosis.

Adult↗

PubMed1986

Asbestos-related findings in chest radiographs of the male population of the county of Telemark, Norway--a cross-sectional study.

In order to investigate the prevalence of asbestos-related diseases, a cross-sectional population study was conducted among 28,216 men aged 40 years in nine municipalities of the county of Telemark, Norway. In a primary radiographic screening 10 X 10-cm chest radiographs were taken of 21,483 persons. In two independent readings of the radiographs, pleural changes were observed in 6.9 and 8.5% of the study subjects. Radiographic findings in the primary screening led to 1,431 subjects being selected for a reexamination. On the basis of occupational histories and 40 X 40-cm chest radiographs, it was concluded that 470 of these subjects (2.2% of the screened population) had radiographic changes consistent with an asbestos-related disorder. Among these, 86 had lung fibrosis (82 in combination with pleural plaques) and 384 had pleural plaques only. There were marked differences in the occurrence of asbestos-related disorders between the seven urban and two rural communities studied, and agreement was observed between the occurrence of such disorders and the degree and duration of the reported asbestos exposure. The study presents evidence that asbestos-related disorders may be more prevalent in the general male population than has been recognized earlier.

Adult↗

PubMed1999

[Social impact of screening and of medical surveillance on people exposed to asbestos].

A medical screening program has collective and individual impact. The collective benefit of medical screening for people exposed to asbestos would be financial (better compensation of occupational diseases related to asbestos). The cost of compensation would be attributed to the special assurance fund for occupational diseases. A medical screening of asbestos diseases would set an example for other Public health problems. It would be important for admission of social damage for the French nation. For individuals, social benefits would be better (compensation during work stop and annuities). But screening can have a negative psychological impact for asymptomatic persons. Persons exposed to asbestos and patients with asbestos diseases are able to quit their job for anticipated retirement. Is it a benefit for patients with mesothelioma or lung cancer? It is a very important benefit for asbestosis. The risk is to change the objective of medical screening into a social screening. The financial and medical benefits of screening for hyaline plaques is very poor. Awarding social damage is important for individuals.

Asbestosis↗

PubMedDate not supplied

[Occupational exposure to asbestos and recognition of pleural mesothelioma as occupational disease in the province of Genoa].

The present study compares the data of pleural mesothelioma (PM) patients resident in the province of Genoa (Italy) who, in the period 1994-1996, applied to the Italian National Insurance Institute for Work Accident (INAIL), for workers' compensation for asbestos-related diseases due to occupational exposure, with the dataset of PM patients collected by the Mesothelioma Registry of Liguria (REM) in the same period and in the same area. As PM is a malignant tumor of a prevalently occupational origin, it is recognized and acknowledged as such by INAIL when clinical and etiological characteristics are matched. Objectives of this study were to describe observed PM cases, to evaluate completeness of collected data and differences between those who requested compensation and those who did not. The REM describes the incidence of PM among Ligurian residents, proposing patients with a specific questionnaire to assess occupational, environmental and indoor asbestos exposures. The REM collected 199 new cases of PM among the residents of both the city of Genoa (1994-96) and the province of Genoa (1995-96). In the same period, INAIL received 48 (24%) applications for compensation. Among these, 43 subjects were included in a subgroup of 98 patients registered in the REM as cases with definite diagnosis and ascertained asbestos exposure; 32 were awarded compensation, while 11 are under evaluation. The data collected by REM do not show proven asbestos exposure and/or PM diagnosis for five other subjects (two compensated and three under judgment). This study reveals that: a) only a 24% of the patients with a diagnosis of PM and asbestos exposure apply for compensation; b) an exchange of information among institutions involved in primary prevention, in the evaluation of occupational exposures to carcinogens and in insurance compensation is useful.

Aged↗

PubMedDate not supplied

[Markers of fibrogenesis in bronchoalveolar lavage and in serum of workers exposed to asbestos].

The N-terminal peptide of type III procollagen (PIIIP) and fibronectin (FBN), two markers possibly implicated in the pathogenesis of pulmonary fibrosis, were determined in bronchoalveolar lavage fluid (BAL) and in serum of 27 subjects with a history of occupational exposure to asbestos, in 10 sarcoidosis patients and in 7 healthy controls. At the same time, the study of the cell populations and asbestos bodies count in BAL were also performed. In BAL of sarcoidosis patients the mean concentration of PI-IIIP was higher compared to that of the other two groups, and the difference was significant compared with the healthy controls. Among the group of asbestos workers, both PIIIP and FBN were significantly higher in subjects with radiological signs of pulmonary asbestosis compared with those with no signs of asbestosis. On the basis of BAL cytology, the asbestos-exposed were divided into two subgroups, with or without signs of alveolitis: the mean concentrations of BAL PIIIP was significantly higher in the subgroup with alveolitis. Moreover, in this subgroup there was a positive correlation between total number of cells and PIIIP, and between the number of asbestos bodies and PIIIP in BAL. Serum PIIIP values did not differ significantly among the various groups, with the exception of higher values in sarcoidosis patients. The results of this study seem to confirm the usefulness of PIIIP and FBN determinations in BAL, as indicators of the activity of the fibrotic process which, in particular cases, might also assume a prognostic significance.

Adult↗

PubMed1991

Computed tomography of asbestos-related pulmonary parenchymal and pleural diseases.

Computed tomography has acquired an increasingly central role in the evaluation of asbestos-exposed individuals. The advantages of increased contrast resolution and axial image display have extended our ability to interrogate areas of the pulmonary parenchyma and pleura that are inadequately seen on chest radiographs. The additional information to be gained from CT evaluation must be balanced by the additional expense and time required, particularly in view of the large numbers of asbestos-exposed individuals who will undergo screening over the coming decades. Ideally, imaging strategies that include CT should emphasize those problematic situations in which additional information will serve a differential or diagnostic function, alter the management or habits of the individuals, modify the working environment, or improve our understanding of asbestos-induced diseases. The chest radiograph is the mainstay in the imaging evaluation of asbestos-exposed individuals, providing an inexpensive and rapid appraisal of the presence of both focal and diffuse abnormalities of the pleura and lung parenchyma. Conventional (whole-thorax) CT may be an important adjunct in the following situations: (1) to clarify the presence of pleural thickening, particularly in distinguishing pleural disease from normal extrapleural soft tissues; (2) to stage and determine tumor extent in malignant pleural mesothelioma; (3) to identify optimal sites for biopsy of suspicious pleural changes; and (4) to detect and characterize lung cancers or other focal masses that may be obscured by extensive pleural or parenchymal fibrosis. Limited HRCT studies are roughly competitive in time and cost with four-view radiographic examinations. There is growing evidence that HRCT can detect interstitial disease in advance of conventional clinical or radiographic studies. However, the application of limited HRCT for large-scale screening is controversial. This issue will be resolved as we gain greater understanding of the specificity of HRCT and establish guidelines for standardizing the technique and image interpretation. At present, limited HRCT scans can supplement the evaluation of subjects in whom there is equivocal parenchymal or pleural disease on radiographs or unexplained abnormalities on pulmonary function tests. In individuals with significant pleural disease, HRCT can effectively define the presence and extent of interstitial fibrosis. In individuals with combined cigarette smoking-asbestos exposure in whom symptoms or functional abnormalities are present, HRCT may play a central role in distinguishing emphysematous lung destruction from the peripheral interstitial changes of asbestosis.

Asbestosis↗

PubMed1990

Asbestos review and update.

Concurrent with the widespread use of asbestos in buildings were noticeable increases in the incidence of certain types of lung disease and cancer among workers who mined, milled, manufactured, and applied asbestos containing products. OSHA and EPA initiated efforts to reduce exposure to asbestos in 1971 and 1973, respectively. The approach taken by these agencies can best be understood through knowing the epidemiology of asbestos. The role of the occupational health nurse is centered around prevention of exposure to asbestos by educating employees on the risks of exposure, implementing engineering controls, and enforcing OSHA standards.

Asbestosis↗

PubMed1989

[Asbestos screening of autopsy material].

UNLABELLED: This study was designed to provide basic data on the deposition of asbestos in human tissue in an urban area (Hamburg) with increased immission rates of fibres. The analysis of the unselected autopsy cases was carried out by light microscopy counting the typical asbestos bodies (method: wet digestion of tissue and filter technique). - RESULTS: a) The average concentration of asbestos bodies (AB) per ccm lung tissue (n = 80) amounts to 35 AB/ccm (men 38 AB/ccm, females 15 AB/ccm). b) Asbestos bodies could be found regularly in extrapulmonary tissues (n = 20, up to 13 different tissue samples per case), most frequently in lymph nodes, thyroid gland and spleen. c) Lungs of children in the age of 7 to 16 years (n = 40) showed asbestos bodies in 35% of the examined cases (with a range from 3 to 31 AB/ccm lung tissue).

Adolescent↗

PubMed1988

The fate of people with pleural hyalinosis (plaques): relationship to direct and indirect asbestos exposure.

A follow-up study of persons with pleural plaques was concluded in 1984. The first cohort was made up of employees and retired workers with direct absestos exposure in an asbestos factory (AZ factory) producing heat-resistant textiles, friction engine parts and heat-resistant boards. The raw material was imported chrysotile and small amounts of crocidolite. The follow-up was started in the 1950s. Our second cohort comprised residents selected by radiographic screening in a vast area surrounding the AZ factory who had had indirect asbestos exposure by airborn asbestos fibres. The follow-up period began in the 1970s. A control group consisted of employees and retired workers of a railway repair shop, without exposure to asbestos dust and within a corresponding age bracket. At the time of assessing our results, most of the subjects assigned to all the three groups were no longer alive so we were able to analyse data regarding their life and death. Hyalinosis complicata and pleural mesothelioma (peritoneal mesothelioma in one case) were present and resulted in death only in those with direct asbestos exposure. While lung cancer was among the causes of death in both cohorts with exposure as well as in the control group, its prevalence in the group with direct exposure was significantly higher than in the control group. By contrast, "other neoplasia" was found both in the control group and in exposed persons without any specific prevalence.

Aged↗

PubMed1988

Phenotypes of peripheral blood lymphoid cells in patients with asbestos-related pleural lesions.

Asbestos-related parietal pleural plaques develop slowly and are of little clinical significance. Other asbestos-related pleural reactions, for example acute exudative pleurisy and progressive pleural fibrosis, are of clinical importance. The pathogenesis of these reactions is unknown, but one hypothesis is that immunological disturbances are involved. To investigate this hypothesis a phenotypic characterization of lymphoid cells was performed in the peripheral blood of 45 patients with asbestos-related pleural lesions; 20 with pleural plaques (PP), 15 with diffuse pleural fibrosis (DPF), and 10 with benign asbestos pleural effusion (BAPE). Twenty-four healthy blood donors were used as controls. All asbestos groups together had a significantly higher percentage of B-cells than the controls. The percentage number of "helper/inducer" T-cells was significantly lower in the BAPE and DPF groups than in the control and PP groups. Thus, significant aberrations in peripheral blood lymphoid cells were found in patients with DPF and BAPE. This differed from patients with PP only who were similar to normals.

Aged↗

PubMed1986

Bilateral pleural plaques in Corsica: a non-occupational asbestos exposure marker.

The North-East quarter of Corsica being rich in asbestos deposits, we checked the chest radiographs of 1721 patients born in North Corsica, without occupational exposure to asbestos, in order to show an excess of asbestos pleural plaques in those born in the N.E. quarter. Of the 56/1710 patients with bilateral plaques, 53 were born in N.E., and three in N.W. The incidence of plaques was thus respectively 3.7% and 1.2% (p less than 0.05). The site of birth of these 56 patients was compared to that of 213 matched control patients without plaques, born in North Corsica. The percentage of patients with plaques born in villages with asbestos deposits was 94.6 per cent, versus 58.2 per cent for the control patients; the relative risk index is 12.7. This work is the first report of environmental asbestos plaques in Western Europe.

Aged↗

PubMed1986

Asbestos diseases and pulmonary symptoms and signs in shipyard workers and their families in Los Angeles.

Families of 338 male and 81 female shipyard workers (SYW), including 280 wives, 144 daughters, and 81 sons, were examined for diseases resulting from asbestos. The workers were initially exposed to asbestos at least 20 years prior to the study date. Radiographic signs of asbestosis (using standard criteria international Labor Office 1980) were found in 64% of 288 male SYW and 21% of 71 female SYW. After excluding those with any occupational exposure to asbestos, asbestosis prevalence was 11% in wives, 8% in sons, and 2% in daughters. Asbestos disease prevalence in workers and in wives increased with the number of years from initial exposure. Male SYW who had smoked had airway obstruction without volume loss. Nonsmokers had normal pulmonary functions. In SYW households prevalences of respiratory diseases, wheezing on physical examination, and symptoms of asthma and chronic bronchitis, exceeded those in the comparison (Michigan) population, even for the younger daughters and sons. These differences, and airway obstruction and distribution defects reported earlier were not explained by cigarette smoking or by asbestos exposure. Instead, they are tentatively ascribed to long-term exposure to ambient air pollution in Los Angeles.

Age Factors↗