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PubMed1994

Specificity of high-resolution CT findings in pulmonary asbestosis: do patients scanned for other indications have similar findings?

OBJECTIVE: High-resolution CT findings in patients with asbestosis include subpleural curvilinear densities, subpleural density in dependent portions of the lung, parenchymal bands, thickened septal lines, and honeycomb lung. Our objective was to examine the prevalence of these CT findings in a random group of patients scanned for a variety of clinical reasons not specifically related to occupational exposure. MATERIALS AND METHODS: One hundred sixty-eight CT studies of the thorax were performed at six levels in 168 patients examined for a variety of clinical indications. The scans were evaluated by two radiologists for the presence of subpleural curvilinear densities, subpleural density in dependent locations, parenchymal bands, thickened septal lines, and honeycomb lung. RESULTS: CT scans of 11 patients showed pleural plaques suggesting previous exposure to asbestos. Among the 157 studies showing no evidence of pleural plaques, CT scans showed subpleural curvilinear densities in dependent areas in 32 (20%); subpleural curvilinear densities in nondependent areas in 19 (12%); parenchymal bands in 47 (30%); thickened septal lines in dependent areas in 93 (59%), and septal lines in nondependent areas in 67 (43%); subpleural density in dependent areas in 66 (42%); and honeycomb lung in five (3%). CONCLUSION: Subpleural curvilinear densities, subpleural density in dependent locations, parenchymal bands, and thickened septal lines occur as isolated and as combined CT findings in patients with a variety of underlying diseases or conditions unrelated to asbestosis and by themselves are nonspecific findings. Their occurrence, even in patients with CT evidence of pleural plaques, does not necessarily indicate the presence of asbestosis.

Asbestosis↗

PubMed1994

Is there an association between pleural plaques and lung cancer without asbestosis?

OBJECTIVES: A recent review or meta-analysis of epidemiologic studies concluded that persons with asbestos-related pleural plaques do not have an increased risk of lung cancer in the absence of parenchymal asbestosis. The reviewer inferred that this conclusion provided indirect supportive evidence for the proposition that asbestosis is a necessary precursor of asbestos-related lung cancer. The objective of the present communication is to contest these claims. METHODS: Finnish epidemiologic data and population statistics were used to estimate the apparent risk ratio of lung cancer associated with radiographic signs of pleural plaques. Power calculations were applied to compute the needed population sizes to demonstrate that the association is statistically significant. RESULTS: Unrealistically large population studies would be needed to observe the statistical relation between pleural plaques and lung cancer, quantitated as a risk ratio of 1.1, resulting from relatively low levels of environmental asbestos exposure. In realistic and valid epidemiologic studies on heavily exposed subpopulations, a two- or threefold risk can be identified. CONCLUSIONS: Uninformative studies should not be interpreted as providing suppressive evidence that pleural plaques are a noncausal risk indicator of lung cancer. Even for the null hypothesis, the inference that asbestosis is a necessary causal link between asbestos and lung cancer is illogical.

Adult↗

PubMed1978

Clinical features, mortality and survival of patients with asbestosis.

This paper describes the characteristic clinical features, mortality and survival rate of 202 patients diagnosed as having asbestosis by the Institute of Occupational Health between 1934 and 1976. One hundred and thirty-three patients were subjected to a clinical reexamination. Major findings included breathlessness in 118 (88.7%), persistent sputum in 95 (71.4%), crepitations in 77 (58.0%) and finger clubbing in 43 (32.3%). Of the 95 patients with persistent sputum, 19 (20.0%) were nonsmokers. Of the 174 men registered as having asbestosis, 56 had died, whereas the expected number of deaths among men of the same age in the Finnish general population was only 23.4. The respective figures for lung cancer were 19 observed and 2.1 expected. No excess mortality was found for other malignomas. Among men with asbestosis, the life expectancy was shorter for smokers than for non- and exsmokers.

Adult↗

PubMed1999

[Diagnosis of malignant pleural mesothelioma and asbestosis].

The incidence of malignant mesothelioma, the main consequence of exposure to asbestos, will increase considerably in the Netherlands in the coming decades. In the next 35 year, some 20,000 people will die from malignant mesothelioma. The diagnosis of malignant pleural mesothelioma in practice is based on histological examination in about 80%, on cytological examination in 15% and on other forms of examination, e.g., high resolution computer tomography (HRCT), in 6% of the cases. Using a combination of various noninvasive methods, such as anamnesis, physical and röntgenologic examination, HRCT and spirometry, the diagnosis of asbestosis is made erroneously in 5% of the patients examined. With regard to allowance of financial compensation to patients with pleural mesothelioma and asbestosis, a part is played by the fact that views differ internationally concerning the criteria on which the diagnosis should be based. For mesothelioma cytologic and histologic examination are the most important. For asbestosis, the Health Council considers HRCT as crucial, if necessary supplemented by histological examination, plus a history of exposure to asbestos and pulmonary dysfunction. In mesothelioma cytological and histological examination are the most important.

Asbestosis↗

PubMed2002

Mortality study of workers compensated for asbestosis in Poland, 1970-1997.

The aim of the study was to assess the risk of asbestos-related malignancies among persons with diagnosed asbestosis. The study covered a cohort composed of 907 men and 490 women afflicted by asbestosis, diagnosed is 1970-1997. The follow-up of the cohort continued until 31 December 1999. In all, 421 deaths were registered and causes of death were retrieved for 93.3% of the deceased. A significantly increased mortality was observed both in the male 1300 deaths; SMR = 127; 95%CI: 113-142) and female (121 deaths, SMR = 150; 95%CI: 124-179) cohorts. The elevated number of deaths in the male and female cohorts were noted mainly due to respiratory diseases (men: 42 deaths; SMR = 344; 95%CI: 248-465; women: 20 deaths, SMR = 789; 95%CI: 482-1219) malignant neoplasms (men: 91 deaths, SMR = 146; 95%CI: 118-179; women: 34 deaths, SMR = 159; 95%CI: 110-222), including lung cancer (men: 39 deaths, SMR = 168; 95% CI: 119-230; women: 13 deaths, SMR = 621; 95%CI: 331-1062) and pleural mesothelioma (men: 3 deaths, SMR = 2680; 95%CI: 553-7832; women: 3 deaths, SMR = 7207; 95%CI: 1031-14612). Taking into account a cumulative dose of fibers, it was found that a significantly increased mortality from lung cancer and pleural mesothelioma applied to persons exposed to a dose above 25 f-y/ml. The results indicate that persons with asbestosis are at higher risk of developing malignant neoplasms, especially lung cancer and mesothelioma.

Adult↗

PubMedDate not supplied

[Compensated cases for asbestosis. A geographical analysis by Italian provinces].

During 1995-1999 among cases compensated by Italian National Institute for Insurance of Occupational Accidents (INAIL), asbestosis was classified as the second occupational disease after hypoacusia with the 7% of total cases. The present study describes the geographical distribution of 1.483 cases in men, notified to INAIL (and subsequently confirmed) during 1984-1992. Age-standardised incidence rates were calculated for the 93 Italian provinces. In addition, standardised incidence ratio (SIR) were computed, comparing the number of observed cases to the number of expected cases on the basis of age specific rates in the large geographical Italian areas (Northeast, Northwest, Centre and South and islands). Empirical Bayes estimates applying the Poisson-Gamma model were also estimated. The geographical distribution of standardised incidence ratios revealed a high excess risk for the province of Gorizia, Livorno, Massa Carrara, La Spezia, Trieste, Alessandria, Caltanissetta and a lower, but still significant, excess risk for the province of Siracusa, Ancona, Napoli, Genova, Reggio Emilia, Brindisi, Bergamo, Arezzo, Taranto, Pavia, Messina, Lecco and Varese. This study suggests the possibility to use the insurance files on asbestosis in order to estimate risks in Italy and to compare geographical clusters. Identification of provinces with significant excess number of compensated cases for asbestosis underscore the need for more detailed surveys aimed to detect conditions correlated with asbestos exposure and identifying persisting environmental pollution. Detailed enquiries are needed in particular in those provinces where excesses cannot be explained by current knowledge on circumstances of the presence of asbestos in the workplace.

Asbestosis↗

PubMed1992

Reactivity of bronchoalveolar space cells in lung asbestosis.

Preliminary studies to evaluate lymphocyte subsets bronchoalveolar lavage (BAL) and blood were carried out in a group of patients with lung asbestosis. The assessments were made by an indirect immunofluorescent method using monoclonal antibodies as a marker. The results were recorded on a flow cytofluorometer FASC-can. As compared with a control group, the patients with lung asbestosis showed a slight decrease in the total level of T lymphocytes (CD3) in BAL, however with a clearly disturbed proportion between T-helper (CD4) and T-suppressor (CD8) lymphocytes, which led to a decreased CD4/CD8 ratio. The blood level of T lymphocytes and their subsets in these patients approximated that in the controls. Heavy smoking was also found to enhance disorders in their number and proportion. The assessment of B lymphocytes (by using polyclonal antihuman immunoglobulins (sIg/FITC) showed a significantly high level of these lymphocytes in BAL with simultaneously low levels in blood in the same patients with lung asbestosis. We did not find a clear synergic effect of cigarette smoking on the levels of B lymphocytes in the studied group.

Adult↗

PubMed1990

[Endoscopic and morphological characteristics of the bronchi and lungs in asbestosis and dust-induced bronchitis in asbestos-textile industry workers].

A bronchofibroscopy study of cases with histologic investigation of the bronchi and pulmonary mucous biopsy of 29 asbestos-textile workers, revealed diffuse bilateral endo-bronchitis (DBE) with concomitant tracheitis at different stages. No correlation was found between the endoscopy pictures and the clinical manifestations of asbestosis and dust bronchitis. The asbestosis diseased patients displayed pulmonary fibrosis++ without granulomatous inflammation in the asbestos dusts zone. In some cases, bronchial epithelium diffuse metaplasia was diagnosed with some dysplasia elements, as well as papillomatosis and malignant tumours in the lungs. Dust bronchitis++ and asbestosis can perform precancerous conditions in the lungs, what should be taken into account in cancer prevention measures for asbestos industry workers.

Adult↗

PubMed1990

[Respiratory malignancies induced by asbestos exposure and evaluation of cases with typical pleural malignant mesothelioma and lung cancer with asbestosis].

Asbestos exposure induces lung fibrosis, i.e. asbestosis, and furthermore, pathological changes of pleura, i.e. asbestos pleurisy of pleural plaque. Generally, asbestosis is induced by massive exposure to asbestos and pleural changes are induced by low dose exposure to asbestos. The most important diseases which are induced by asbestos exposure are malignancies, especially malignant mesothelioma and lung cancer. Two cases, one malignant mesothelioma, the other lung cancer with asbestosis induced by asbestos exposure received almost the same dose of asbestos, as estimated from the period of asbestos exposure and occupational history and the same kind of asbestos (crocidolite) and had a smoking history. We do not know which elements may induce malignancies under asbestos exposure. Recently, some reports described that asbestos mediated the transformation of genes and this action induced malignancies. We should extend our study to the gene problem in cases of malignant mesothelioma and lung cancer induced by asbestos exposure.

Aged↗

PubMed1989

Validation of clinical criteria for diagnosing asbestosis in asbestos-cement workers.

The recently developed diagnostic criteria for asbestosis, including chest x-ray abnormalities and respiratory impairment consistent with interstitial lung fibrosis, were tested in 550 current asbestos-cement workers. The findings showed the correlation of x-ray ILO/UC scores for small irregular opacities (s, t, u) with duration of exposure, especially evident in relation to category of 1/2 and above ("cutoff category") detected in 48 subjects. An increasing x-ray score was accompanied by more functional abnormality, demonstrated by a restrictive defect in ventilation, followed by a fall in arterial oxygen pressure on exercise and impaired diffusing capacity. Amongst subjects working for at least 10 years, thirty met the roentgenographic and functional criteria for asbestosis. On the basis of these criteria, asbestosis could be diagnosed only in one subject employed for not longer than 5 years and two others working for not longer than 9 years, which can be explained by a false--positive effect.

Asbestos↗

PubMed1989

Special neutrophil elastase inhibitory activity in BAL fluid from patients with silicosis and asbestosis.

Pneumoconiosis is defined as the disease resulting from a chronic exposure to different inorganic dusts. In order to assess the lung defence against the effects of dust exposure, we studied the bronchoalveolar lavage (BAL) fluids from 30 silicotic patients (9 of them having a diagnosis of progressive massive fibrosis (PMF)) and 8 subjects with a diagnosis of asbestosis. Total protein content, N-acetyl-beta-D-glucosaminidase activity, free elastase-like activity, immunoreactive alpha 1-proteinase inhibitor (alpha 1PI) and neutrophil elastase inhibitory capacity (NEIC) were determined, and the values obtained were compared to those of 14 control BAL fluids. In all of the patients, our data showed a significant increase of total protein content and free elastase-like activity. In contrast, N-acetyl-beta-D-glucosaminidase activities did not reach statistical significance. Values concerning immunoreactive alpha 1PI and NEIC were significantly raised only in patients with PMF and with asbestosis. When the ratio NEIC/immunoreactive alpha 1PI was calculated, a significant difference was noticed in the asbestosis group; on the other hand, this ratio was significantly reduced in the group of PMF patients. After neutrophil elastase addition, an electrophoretic study by SDS-PAGE and immunoblotting was carried out; it showed more proteolysed alpha 1PI in the BAL fluids having a lowered NEIC/alpha 1PI ratio. These facts could be explained by the presence of inhibitors of neutrophil elastase different from alpha 1PI.

Acetylglucosaminidase↗

PubMed1987

[Morphological changes in the lungs in asbestosis].

Basing on the autopsy material from 23 deceased with occupational exposure to asbestos dust, morphologic features of asbestosis, as well as changes in the respiratory system were revealed and their role in thanatogenesis elucidated. Asbestosis is a fibrosing alveolitis of occupational nature. Two forms of asbestosis are distinguished and the diagnostic criteria defined.

Asbestosis↗

PubMed1977

Asbestosis -- a diagnostic enigma: a personal view.

Although the carcinogenic properties of asbestos are presently attracting a good deal of attention, asbestosis is still the earliest lung disease resulting from exposure to it and its incidence in an exposed population is the most useful indicator of the degree of dust control exercised over a period of time. The diagnosis of asbestosis depends upon: (1) An adequate occupational exposure history. (2) Physical signs of pulmonary fibrosis. (3) Progressive radiological changes. (4) Confirmatory measurements of altered lung function. Asbestosis is a clinical entity and is readily diagnosed when all the above-mentioned criteria are met. Problems in diagnosis are encountered when one or more of the diagnostic criteria listed above cannot be substantiated. At the present time every effort is made to diagnose the disease in its early stages in the hope that removal from further exposure will prevent the direct and indirect complications.

Asbestos↗

PubMed1984

Pulmonary asbestosis--an example of industrial diffuse lung disease.

This account reviews the clinical and pathological features of asbestosis, with a brief comment on the incidence of asbestosis in workers exposed occupationally to Western Australian crocidolite at Wittenoom Gorge. In keeping with common usage, the term "asbestosis" is restricted to pulmonary parenchymal fibrosis--with or without associated visceral pleural fibrosis--related to inhalation of asbestos fibres, thereby excluding parietal pleural fibrous plaques. The mechanisms underlying the development of the interstitial fibrosis are incompletely understood, but they appear to involve complex interactions of asbestos with alveolar macrophages, fibroblasts, lymphocytes and the complement system.

Asbestos↗

PubMed1983

Serum lysosomal enzyme activities in silicosis and asbestosis.

The serum activities of two lysosomal enzymes, beta-N-acetylglucosaminidase (EC 3.2.1.30) and beta-glucuronidase (EC 3.2.1.31) were analyzed for 28 silicosis and 34 asbestosis patients. The enzyme activities of the patients were compared with those of age-, sex- and exposure-matched controls with no radiological signs of pneumoconiosis, and with an additional reference group of blood donors. The serum activity of beta-N-acetylglucosaminidase was higher in the silicosis patients (32.5 +/- 11.7 U/l) than in the asbestosis patients (21.7 +/- 7.9 U/l, p less than 0.001), in the silica exposed controls (27.1 +/- 6.7 U/l, p less than 0.05) or in the blood donors (24.8 +/- 6.3 U/l, p less than 0.05). No significant differences were found in the serum activity of beta-glucuronidase in the studied groups. Although the mechanisms causing different levels of serum beta-N-acetylglucosaminidase activity in silicosis and asbestosis patients remain unresolved, they may be related to the different mechanisms of action of the two dusts on lung (10).

Acetylglucosaminidase↗

PubMed1980

Current views on pathological aspects of asbestosis (the unresolved questions and problems).

The present criteria for the diagnosis of asbestosis are discussed, as are previous attempts to correlate the pathological with the clinical and radiological findings and the problem of the variable distribution of asbestos forms in routine sections taken from undoubted cases of asbestosis. Establishing lesser degrees of asbestosis is important, and lower limits need to be defined. Evidence is presented, with illustrative examples, of the value of concentration techniques; even for diagnostic purposes there is occasionally a need for more sophisticated electron microscopy techniques. The occurrence and the extent of diffuse interstitial inflammatory changes as part of the biological effects of asbestos exposure are illustrated; and the difficulties inherent in cases where there has been exposure to other dusts as well as to asbestos are described.

Adult↗

PubMed1995

[The incidence of airway obstruction in asbestosis].

In a retrospective study we have examined the clinical data, radiographs and lung function of 382 men with an asbestosis, established by occupational exposure and typical findings in the chest x-ray, according to the ILO-classification from 1980. In particular the correlation between airflow limitation, asbestosis of lung and/or pleura and smoking habits was investigated. However the mean values of parameters were only marginally pathological, lifetime non-smokers showed a significant increase of airway obstruction in connection with advanced radiologic alterations. Current smokers with medium or severe radiologic alterations had on average a significant airway obstruction which was more pronounced in cases with pleural lesions than with pulmonary alterations. In conclusion an additive or even multiplying effect of smoking and asbestosis has to be considered.

Adult↗

PubMed1993

[The association of genetic and functional variability of alpha 1-antitrypsin in asbestosis].

The polymorphism and serum levels of alpha 1-antitrypsin (AT) were studied in asbestosis patients, the control and the workers exposed to mineral flax longer or less than ten years. M1S, M3S, M1Z and M2M2 phenotypes had low concentration of this protein. In the course of contact with mineral flax decrease in alpha 1-AT concentration was found. The phenotypes with low protein levels were very rare among workers contacting with asbestos for a long time, and one of them--M1S was more often encountered in asbestosis patients. The standard deviation from the alpha 1-AT concentration was significantly higher in asbestosis patients.

Asbestosis↗