A randomized controlled trial of the efficacy of cosmetic talc compared with iodopovidone for chemical pleurodesis

Our plain-English summary of A randomized controlled trial of the efficacy of cosmetic talc compared with iodopovidone for chemical pleurodesis, by R. Agarwal, A.S. Paul, A.N. Aggarwal, et al (Respirology, 2011).

The study

• Authors: R. Agarwal, A.S. Paul, A.N. Aggarwal, D. Gupta, S.K. Jindal
• Journal: Respirology
• Published: 2011;16(7):1064-9
• Type of article: Randomized trial
• Cited by: 34 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background And Objective: Talc is an effective and widely used agent for chemical pleurodesis. However, limited availability and high cost hamper the routine use of talc in resource poor countries. In this study, we compared the efficacy and safety of iodopovidone with that of cosmetic talc, for chemical pleurodesis.

Methods: Patients with recurrent pleural effusions and/or spontaneous pneumothorax were prospectively randomized to undergo pleurodesis with cosmetic talc (5g) or iodopovidone (20mL of a 10% solution) by tube thoracostomy. The cosmetic talc was pretested for impurities (asbestos-free) and particle size (20-60µm), using energy dispersive analysis by X-ray and scanning electron microscopy. The success rate (complete or partial), time to pleurodesis and safety of these two agents was compared.

Results: Pleurodesis was performed in 73 patients (39 with iodopovidone, 34 with cosmetic talc; 56 men, 17 women; mean age 51.7 years; 38 pleural effusions, 35 pneumothoraces). A complete response was obtained in all patients with pneumothorax in both the iodopovidone and talc groups. Among patients with pleural effusions, a complete response was observed in 16/19 and 15/19 patients in the iodopovidone and talc groups, respectively. A partial response was observed in two additional patients from each group. The time to pleurodesis was similar in the two groups. Minor side-effects (fever, chest pain) were observed with similar frequencies in the two groups. None of the patients experienced hypotension or ARDS.

Conclusions: Iodopovidone and cosmetic talc are equally efficacious and safe agents for chemical pleurodesis.

© 2011 The Authors. Respirology © 2011 Asian Pacific Society of Respirology.

In plain English

This randomized trial took place at the Postgraduate Institute of Medical Education and Research in Chandigarh, India, between January 2006 and June 2007. It compared two agents put through a chest tube to seal the pleural space (pleurodesis). The 73 patients had recurrent pleural effusions or pneumothorax. 39 received iodopovidone and 34 received 5 g of cosmetic talc (Johnson and Johnson baby powder, one batch). That batch was examined by electron microscopy and X-ray analysis. The authors reported particles of 20 to 60 micrometres and that the talc was asbestos-free. A complete response occurred in 36 (92.3%) iodopovidone patients and 30 (88.2%) talc patients. All pneumothorax patients responded. Among effusion patients, complete response was 16/19 with iodopovidone and 15/19 with talc. All patients had chest pain, nine had fever, and none developed ARDS or hypotension. The authors concluded the agents were equally effective. Where other agents or techniques were not routinely available, they preferred iodopovidone, because every batch of cosmetic talc should be checked for particle size and absence of asbestos. They noted the small sample size.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Prospective randomized controlled trial (described by the authors as a randomized pilot trial); allocation was by computer-generated sequence in sealed opaque envelopes, and blinding was not possible
• Who was studied: 73 patients (56 men, 17 women; mean age 51.7 years) needing pleurodesis for recurrent pleural effusions (38, mostly malignant, most often lung cancer) or spontaneous pneumothorax (35), treated in the chest wards of the Postgraduate Institute of Medical Education and Research, Chandigarh, India, January 2006 to June 2007; 39 received iodopovidone and 34 cosmetic talc
• Exposure: Pleurodesis by tube thoracostomy with either 20 mL of 10% iodopovidone in 80 mL saline, or 5 g of cosmetic talc (Johnson and Johnson baby powder, Lot B56496), sterilized by autoclaving; the talc batch was tested by scanning electron microscopy for particle size and by energy dispersive analysis by X-ray to confirm the absence of asbestos and other impurities
• Main results:
  • The batch of cosmetic talc used was reported as asbestos-free on energy dispersive X-ray analysis; its content was mainly oxygen (about 45%), silicate (25 to 29%), magnesium (16 to 18%) and carbon (8.5 to 13%)
  • The particle size of the cosmetic talc was 20 to 60 micrometres
  • Complete response overall: 36 (92.3%) patients in the iodopovidone group and 30 (88.2%) in the talc group; there were no failures among pneumothorax patients
  • Among patients with pleural effusions, complete response was 16/19 (84.2%) with iodopovidone and 15/19 (78.9%) with talc; partial response in two more patients in each group
  • A second procedure was needed in three patients with pleural effusions and was unsuccessful in all three
  • Median time to pleurodesis was 1 (IQR 1 to 1.25) day in the talc group and 1 (IQR 1 to 2) day in the iodopovidone group, not significantly different
  • All patients had chest pain; fever occurred in nine patients (four iodopovidone, five talc) and was self-limited; empyema occurred in two patients (one per group)
  • No patient in either group developed ARDS or hypotension
  • There were 11 deaths at the 6-month follow-up among patients with malignant pleural effusions
• The authors' conclusion: The authors concluded that iodopovidone and cosmetic talc were equally effective when instilled by tube thoracostomy. Because every batch of cosmetic talc should be checked for particle size and the absence of asbestos, they considered iodopovidone by tube thoracostomy the preferred method where other agents or techniques are not routinely available.
• Limitations the authors state:
  • Small sample size; the authors calculated that 404 patients (202 per group) would be needed for an equivalence comparison, so more data are required to confirm the results

Topics

The National Library of Medicine indexes this study under subjects our site covers: Pleural plaques and thickening, Talc and vermiculite.

Medical terms in this study, explained in our Lexicon: Cosmetic Talc, Pleurodesis, Talc, Pleural Effusion, Pneumothorax, Scanning Electron Microscopy (SEM).

Related studies

• Talc Pleurodesis: A Medical, Medicolegal, and Socioeconomic Review — I. Baiu, E. Yevudza, et al. (2020)
• Intrapleural talc for the prevention of recurrent pneumothorax — J.R. Milanez, F.S. Vargas, et al. (1994)
• Sterilization of talc for pleurodesis. Available techniques, efficacy, and cost analysis — L. Kennedy, L.M. Vaughan, et al. (1995)
• CT appearances of talc pleurodesis — S. Narayanaswamy, S. Kamath, et al. (2007)
• Pleural granuloma mimicking malignancy 42 years after slurry talc injection for primary spontaneous pneumothorax — S. Tenconi, L. Luzzi, et al. (2010)
• Development of a disposable spray canister for talc pleurodesis. A preliminary report — H.G. Colt, J.F. Dumon (1994)

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