Asbestosis is prevalent in a variety of construction industry trades

Our plain-English summary of Asbestosis is prevalent in a variety of construction industry trades, by G.I. Walters, A.S. Robertson, P.S. Bhomra, et al (NPJ Primary Care Respiratory Medicine, 2018).

The study

• Authors: G.I. Walters, A.S. Robertson, P.S. Bhomra, P.S. Burge
• Journal: NPJ Primary Care Respiratory Medicine
• Published: 2018;28(1):11
• Cited by: 10 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

A diagnosis of asbestosis, which is a long-latency, fibrotic lung disease, has implications for the patient in terms of prognosis, treatment and compensation. Identifying and quantifying asbestos exposure is difficult without a detailed occupational history, and the threshold dose of asbestos required to cause asbestosis is not well understood. We reviewed all cases of asbestosis diagnosed between 2001 and 2016 at the Birmingham Regional NHS Occupational Lung Disease Service to determine the industries and occupations most frequently implicated in causation, in order to help clinicians identify where asbestosis might enter the differential diagnosis for a patient with chronic respiratory symptoms. A variety of construction trades were frequently reported including carpenters and joiners, pipe fitters, laggers, labourers, painters and shop fitters. Traditionally heavily exposed occupations such as shipbuilding were not commonly seen.

In plain English

This brief communication described asbestosis cases recorded on the clinical database of the Birmingham Regional NHS Occupational Lung Disease Service, UK. The article gives the study end as both 2015 and 2016. There were 160 cases. 158 were men, the median age at diagnosis was 74, and 117 (73%) also had benign asbestos pleural disease. Construction was the most common industry where exposure occurred, with 71 of 160 cases (44%). Among construction workers, the most frequent trades were carpenters or joiners (12), laggers or lagger's mates (10) and painters or decorators (7). The text also lists 7 shop fitters in construction, but the table gives only 2 shop fitters in total. Across all cases, the most common occupations were pipe fitters or pipe fitter's mates (20), carpenters or joiners (17) and laggers or lagger's mates (16). Shipping and shipbuilding accounted for 6 cases (4%). The authors noted the study cannot measure risk by job and reflects one region. They concluded that asbestosis and a full occupational history are worth considering in construction workers with chronic respiratory symptoms.

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: Descriptive review of cases held on a regional clinical database (treated as a service evaluation), published as a brief communication
• Who was studied: 160 patients diagnosed with asbestosis at the Birmingham Regional NHS Occupational Lung Disease Service, UK, from 1 January 2001 to the end of 2015 or 2016. 158 (99%) were male, and the median age at diagnosis was 74 (IQR 69 to 79).
• Exposure: The industry and occupation in which asbestos exposure occurred. Fiber types and exposure doses were not reported.
• Main results:
  • Construction was the most common industry: 71 of 160 cases (44%)
  • Among construction workers, carpenters or joiners were the most common trade (12; 17%), followed by laggers or lagger's mates (10; 14%)
  • Among construction workers, the Results text lists painters or decorators (7; 10%) and shop fitters (7; 10%). Table 1, however, lists only 2 shop fitters across all cases, so the shop-fitter count is inconsistent within the article.
  • Across all 160 cases, pipe fitters or pipe fitter's mates (including fitter-welders) were the most common occupation, at 20 (13%), followed by carpenters or joiners at 17 (11%)
  • Shipping and shipbuilding accounted for 6 of 160 cases (4%)
  • At diagnosis, 117 of 160 patients (73%) also had benign asbestos pleural disease. 41 (26%) had asbestosis only, 2 (1%) had mesothelioma and 2 (1%) had bronchial cancer.
  • Compared with 2001 to 2005, construction was proportionally more common in 2006 to 2010 (p = 0.02) and in 2011 to 2016 (p = 0.15)
• The authors' conclusion: The authors concluded that it is worthwhile to consider asbestosis, and referral for a full occupational history, in patients with chronic respiratory symptoms who have worked in construction trades.
• Limitations the authors state:
  • Risk by job cannot be inferred or quantified without knowing when and how much exposure occurred, or how many workers were exposed
  • An increase in reported cases does not necessarily mean an increase in incidence; better CT imaging and team-based diagnosis may contribute
  • The data come from one regional UK centre, and employment patterns may differ in other regions
  • Future risk of bronchial cancer and mesothelioma cannot be extrapolated from these data

Topics

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

Medical terms in this study, explained in our Lexicon: Latency, Prognosis, Asbestos Exposure, Occupational History, Occupational Lung Disease, Causation, Differential Diagnosis, Insulator.

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• Occupation and work-related ill-health in UK construction workers — S.J. Stocks, S. Turner, et al. (2011)
• Chest CT scan findings in World Trade Center workers — R.E. de la Hoz, J. Weber, et al. (2019)
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