Asbestos, ergot drugs and the pleura

Our plain-English summary of Asbestos, ergot drugs and the pleura, by P. De Vuyst, P. Pfitzenmeyer, P. Camus (The European Respiratory Journal, 1997).

The study

• Authors: P. De Vuyst, P. Pfitzenmeyer, P. Camus
• Journal: The European Respiratory Journal
• Published: 1997;10(12):2695-8
• Type of article: Comment, Editorial, Review
• Cited by: 10 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Summary of the article

This editorial accompanied two reports in the same journal issue. Those reports described patients with past occupational asbestos exposure who developed exudative pleural effusion and/or pleural thickening while taking bromocriptine for Parkinson's disease. The pleural changes were largely reversible after the drug was stopped. The authors noted that neither report included a control group, so any interaction between asbestos and ergot drugs (ergolines) remained speculative. They reviewed the pleural lesions linked to asbestos and the pleuropulmonary changes caused by long-term ergoline treatment. Compared with asbestos-related changes, ergoline-induced changes rarely, if ever, calcified, developed more quickly, and were often accompanied by a markedly raised erythrocyte sedimentation rate (mean 55.0 versus 25.7 mm in two earlier series). The main difference was improvement after the drug was withdrawn. The authors described four situations in former asbestos workers taking ergolines. In the first three, pleural plaques, chronic thickening with calcifications and slowly developing thickening without calcifications, they favoured asbestos as the cause. In the fourth, pleural effusion, they called the work-up most difficult and proposed a stepwise approach that included pleural biopsy or thoracoscopy to rule out mesothelioma. They reported that steroids had shown no clear benefit. They concluded that epidemiological evidence was still awaited, and that progressive pleural disease in asbestos-exposed patients should prompt a search for reversible causes such as ergoline treatment.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.

In plain English

This article was an editorial, not a new study, and reported no original data. The authors wrote it to accompany two reports in the same journal issue. Those reports described patients with past occupational exposure to asbestos who developed pleural effusion and/or pleural thickening while taking bromocriptine for Parkinson's disease, and whose pleural changes largely reversed after the drug was stopped. Drawing on earlier published work, the authors compared pleural changes linked to asbestos with those linked to ergot-derived drugs (ergolines). They described ergoline-related changes as rarely, if ever, calcifying, and said the main difference was the improvement seen after the drug was withdrawn. They described sharp-edged plaques on CT as almost specific for asbestos. They called pleural effusion the hardest situation to sort out and set out a stepwise clinical approach. The authors stated that whether asbestos and ergolines act together remained speculative, without epidemiological proof or experimental support. They concluded that progressive pleural thickening or effusion in a person formerly exposed to asbestos should prompt doctors to look for reversible causes, including ergoline treatment.

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: editorial (commentary on two case reports/series published in the same journal issue, with a discussion of earlier literature); no original data
• Who was studied: No study population of its own. The editorial discussed patients described in two companion papers (Knoop et al.; Hillerdal et al.): patients with prior occupational asbestos exposure who developed pleural effusion and/or pleural thickening while on bromocriptine for Parkinson's disease. Numbers of patients are not given in the editorial.
• Exposure: Prior occupational exposure to asbestos (fiber types not specified) combined with treatment with ergot drugs (ergolines), mainly bromocriptine for Parkinson's disease
• Main results:
  • In the two companion reports (not this article's own data), the pleural changes were largely reversible after the drug was withdrawn.
  • Citing earlier work, the authors stated that pleural changes caused by ergolines rarely, if ever, calcify, unlike asbestos-related disease.
  • The authors stated that the major difference between the two causes lies in the outcome after the drug is withdrawn.
  • The authors stated that plaques with sharp margins on CT are almost specific for asbestos exposure and have not been described after ergoline treatment.
  • Citing two earlier series by other authors, the editorial gave erythrocyte sedimentation rates of 55.0 mm (ergoline-induced pleural changes, series by Pfitzenmeyer et al.) versus 25.7 mm (asbestos-induced pleural changes, series by Hillerdal). The authors added that a significant overlap probably exists.
  • The authors described pleural effusion as the situation in which working out the cause is most difficult.
• The authors' conclusion: The authors concluded that, while epidemiological proof is awaited, any progressive pleural thickening or effusion in a person with former asbestos exposure should lead pulmonologists to look for secondary, potentially reversible causes, including ergoline treatment.
• Limitations the authors state:
  • The companion reports included no control group, so the interaction or possible potentiation between asbestos and ergot drugs remained speculative.
  • There was no definitive epidemiological evidence that bromocriptine and asbestos act together.
  • There was no experimental support for a combined effect.
  • How ergolines behave in pleural fluid or tissue was unknown.
  • Whether examining tissue under the microscope can tell asbestos-induced from ergoline-induced pleural fibrosis was unclear.

Topics

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

Medical terms in this study, explained in our Lexicon: Pleura, Asbestos Exposure, Pleural Effusion, Pleural Thickening, Pleural Plaques, Pleural Biopsy, Thoracoscopy, Mesothelioma.

Related studies

• Asbestos, ergot drugs and the pleura — P. Camus, G. Hillerdal, et al. (1998)
• Low dose cabergoline induced interstitial pneumonitis — W. Frank, R. Moritz, et al. (1999)
• 'Black Spots' and hyaline pleural plaques on the parietal pleura of 150 urban necropsy cases — K. Mitchev, P. Dumortier, et al. (2002)
• Imaging of the pleura — N.L. Müller (1993)
• Asbestos and the pleura: a review — D.W. Cugell, D.W. Kamp (2004)
• Imaging of the pleura — E.J. Helm, T.N. Matin, et al. (2010)

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