Asbestos-related radiographic abnormalities in elevator construction workers

Our plain-English summary of Asbestos-related radiographic abnormalities in elevator construction workers, by E.A. Bresnitz, M.J. Gilman, E.J. Gracely, et al (The American Review of Respiratory Disease, 1993).

The study

• Authors: E.A. Bresnitz, M.J. Gilman, E.J. Gracely, J. Airoldi, E. Vogel, W. Gefter
• Journal: The American Review of Respiratory Disease
• Published: 1993;147(6 Pt 1):1341-4
• Cited by: 11 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Elevator construction workers are exposed to asbestos dust during construction and refurbishment work on older buildings. We screened a cohort of workers, all with greater than 20 yr of employment in the industry, with clinical examinations, chest radiography ("B" reader interpretations), and routine spirometry. Twenty of the 91 workers (22%) had evidence of pleural disease, but none of them had an interstitial process consistent with asbestosis. Of those with pleural thickening, 15 had bilateral circumscribed plaques and five had unilateral plaque formation. There were no cases of diffuse pleural thickening, benign pleural effusions, or mesothelioma identified in our cohort. The difference in the mean body mass index of those with pleural abnormalities (29.18 +/- 3.95) and those without (27.7 +/- 3.86) was not statistically significant (p = 0.135). We conclude that elevator construction workers have an increased risk for the development of asbestos-related pleural disease.

In plain English

This study looked at chest X-rays and breathing tests from a screening held in November 1988. The screening covered members of the Philadelphia Local of the International Union of Elevator Constructors who had belonged to the union for at least 20 years. Ninety-one men took part, eight of them retired, and the authors later analyzed the data. The authors said the workers were at risk from asbestos sprayed on girders and other structures in elevator shafts of buildings built before 1973. The article does not name a fiber type. Twenty of the 91 workers (22.0%; 95% confidence interval 14-33%) had pleural abnormalities: 15 on both sides and five on one side. No X-ray showed interstitial shadows at ILO grade 1/0 or higher, and there was no diffuse pleural thickening, mesothelioma or benign pleural effusion. Pleural changes were not significantly linked to years worked, smoking, breathing test results or body mass index. There was no unexposed comparison group. The authors concluded that these workers have had a significant occupational exposure to asbestos, shown by an increased prevalence of pleural disease.

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: Cross-sectional screening (questionnaire, spirometry, chest X-ray read by three 'B' readers), analyzed retrospectively from previously collected data; no unexposed control group
• Who was studied: 91 men, eight of them retired, from the Philadelphia Local of the International Union of Elevator Constructors, all union members for at least 20 years, screened in November 1988; participation was voluntary
• Exposure: Asbestos dust from sprayed asbestos insulation on girders and other structures in elevator shafts of buildings built before 1973. Exposure was not measured, and no fiber type is named.
• Main results:
  • 20 of the 91 participants (22.0%; 95% confidence interval 14-33%) showed pleural abnormalities.
  • Of the 20 with pleural abnormalities, 15 had bilateral pleural plaques/thickening and five had unilateral plaques.
  • None of the 91 chest X-rays was classified as having interstitial opacities of ILO grade 1/0 or greater.
  • No participant had diffuse pleural thickening (ILO criteria), mesothelioma or benign pleural effusion.
  • Mean years worked was 29.2 among those with any pleural thickening and 26.5 among those without. The difference was not statistically significant alone (p = 0.067) or after controlling for age (p = 0.465).
  • There was no association between pleural abnormalities and cigarette smoking.
  • Mean spirometry values did not differ significantly between workers with and without bilateral or any pleural thickening.
  • Mean body mass index was 29.18 (SD 3.95) in those with pleural abnormalities and 27.7 (SD 3.86) in those with normal chest X-rays. The difference was not statistically significant (p = 0.135).
• The authors' conclusion: The authors concluded that elevator construction workers with 20 years or more of union membership have had a significant occupational exposure to asbestos, shown by an increased prevalence of pleural disease. They judged it likely that indirect exposure to asbestos dust produced the X-ray abnormalities.
• Limitations the authors state:
  • The cohort did not include all active, retired, former or deceased elevator workers, so the results may not generalize and the true prevalence may be estimated inaccurately. The direction of this bias is hard to predict.
  • No unexposed control group was screened.
  • Chest CT scans were not obtained, so pleural thickening could be argued to reflect obesity and fat deposition. The authors compared body mass index to address this.
  • Only workers with 20 or more years of union membership were screened. The authors said this selection bias likely explains why no link between duration of exposure and pleural disease was found.
  • The small number of subjects and low statistical power may explain why no lung function differences were found.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Asbestosis.

Medical terms in this study, explained in our Lexicon: Spirometry, Interstitial, Pleural Thickening, Bilateral, Diffuse Pleural Thickening, Pleural Effusion, Mesothelioma, Asbestos-Related Pleural Disease.

Related studies

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• Lung function and chest radiograph abnormalities among construction insulators — S.M. Kennedy, S. Vedal, et al. (1991)
• Pulmonary function, smoking habits, and high resolution computed tomography (HRCT) early abnormalities of lung and pleural fibrosis in shipyard workers exposed to asbestos — S. Neri, P. Boraschi, et al. (1996)
• Radiographic changes and lung function in relation to activity of the glutathione transferases theta and mu among asbestos cement workers — K. Jakobsson, A. Rannug, et al. (1995)
• Airways obstruction among older construction and trade workers at Department of Energy nuclear sites — J.M. Dement, L. Welch, et al. (2010)
• Surveillance of respiratory diseases among construction and trade workers at Department of Energy nuclear sites — J.M. Dement, L. Welch, et al. (2003)

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