Asbestos-related diseases of lung and pleura: clinical picture and illustrative cases

Our plain-English summary of Asbestos-related diseases of lung and pleura: clinical picture and illustrative cases, by B. Varkey, U.N. Kumar (Postgraduate Medicine, 1978).

The study

• Authors: B. Varkey, U.N. Kumar
• Journal: Postgraduate Medicine
• Published: 1978;63(6):48-66
• Type of article: Case report
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 002155).

Abstract

Exposure to asbestos may occur in any of a large number of occupations, and the latent period from exposure to appearance of clinical or roentgenologic evidence of related disease of the lung or pleura, or both, may be more than 20 years. A complete occupational history is therefore of paramount importance in the detection of asbestos-related diseases. Illustrative cases highlight the features of benign and malignant diseases of the lung and pleura for which a causal relationship to asbestos exposure is probable or established.

In plain English

This 1978 article was a clinical review, written for practicing physicians, of asbestos-related diseases of the lung and pleura. It was illustrated with five patient cases and was not a study of a group of workers. In the first case, a 62-year-old man who had loaded asbestos material for 18 months died of cardiorespiratory failure, with severe lung fibrosis (asbestosis) found at autopsy. A 70-year-old man, a pipe coverer for more than 40 years and a long-term smoker, had epidermoid lung carcinoma. A 61-year-old engineer, intermittently exposed about 35 years earlier, had a calcified pleural plaque on the diaphragm. A 52-year-old man who had handled raw asbestos for 11 years had a pleural effusion, with asbestos bodies seen near the pleura. A 60-year-old man who had been a steam fitter for 37 years had diffuse malignant pleural mesothelioma. The authors concluded that a causal relationship with asbestos was established or probable for asbestosis, pleural fibrosis and plaques, benign pleural effusion and malignant pleural mesothelioma. They also concluded that asbestos clearly greatly increases lung cancer risk for cigarette smokers, and they stressed taking a complete occupational history.

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: Narrative clinical review with five illustrative case descriptions
• Who was studied: Five illustrative patients, all men: aged 62 (asbestosis), 70 (bronchogenic carcinoma), 61 (pleural plaques; an engineer), 52 (pleural effusion) and 60 (pleural mesothelioma). The article does not state where or when the cases were seen.
• Exposure: Occupational asbestos exposure in general. The authors state chrysotile is the form most used in the US; crocidolite, amosite and anthrophyllite are also named. The cases involved: loading asbestos material for 18 months; pipe covering for more than 40 years; intermittent exposure over five years about 35 years earlier; handling raw asbestos in a factory for 11 years; and steam fitting in a pipe factory for 37 years.
• Main results:
  • Asbestosis case: a 62-year-old man who had worked 18 months as a loader of asbestos material ten years earlier had slowly progressive disease. He died of cardiorespiratory failure; autopsy showed severe pulmonary fibrosis and numerous asbestos bodies.
  • Bronchogenic carcinoma case: a 70-year-old man who had smoked more than a pack a day for 50 years and worked as a pipe coverer for more than 40 years had epidermoid carcinoma. He died four months after admission; autopsy also showed extensive lung and pleural fibrosis and asbestos bodies, some next to the carcinoma.
  • Pleural plaque case: a 61-year-old engineer admitted for heart failure had a calcified pleural plaque on the diaphragm on chest X-ray. Close questioning found intermittent asbestos exposure over a five-year period about 35 years earlier.
  • Pleural effusion case: a 52-year-old man who had handled raw asbestos in a factory for 11 years had a right pleural effusion (an exudate). Open pleural and lung biopsy showed pleural and lung fibrosis, with asbestos bodies close to the pleura.
  • Pleural mesothelioma case: a 60-year-old man who had smoked about a pack a day for 40 years and worked as a steam fitter in a pipe factory for 37 years died eight months after admission of gastrointestinal bleeding and pneumonia. Autopsy microscopy showed diffuse malignant mesothelioma.
• The authors' conclusion: The authors concluded that a causal relationship with asbestos exposure is established or probable for asbestosis (diffuse interstitial pulmonary fibrosis), pleural fibrosis with hyaline and calcified plaques, benign pleural effusion and malignant pleural mesothelioma. They also concluded it is clearly established that asbestos exposure greatly increases the risk of bronchogenic carcinoma for cigarette smokers, and that a complete occupational history is of paramount importance.

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, Occupational History, Asbestos Exposure.

Related studies

• Thoracic surgical problems in asbestos-related disorders — E.A. Gaensler, T.C. McLoud, et al. (1985)
• Asbestos related diseases from environmental exposure to crocidolite in Da-yao, China. I. Review of exposure and epidemiological data — S. Luo, X. Liu, et al. (2003)
• Diagnostic Performance of Ultra-Low-Dose Computed Tomography for Detecting Asbestos-Related Pleuropulmonary Diseases: Prospective Study in a Screening Setting — M. Schaal, F. Severac, et al. (2016)
• Asbestos-related diseases in automobile mechanics — J. Ameille, N. Rosenberg, et al. (2012)
• Asbestos-related chest diseases: plain radiographic findings — W.T. Miller, W.B. Gefter, et al. (1992)
• Asbestos-related pleuropulmonary diseases: benign and malignant — A. Lazarus, A. Massoumi, et al. (2012)

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