Asbestosis occurring after brief inhalational exposure: usefulness of bronchoalveolar lavage in diagnosis

Our plain-English summary of Asbestosis occurring after brief inhalational exposure: usefulness of bronchoalveolar lavage in diagnosis, by R.G. Barbers, J.L. Abraham (British Journal of Industrial Medicine, 1989).

The study

• Authors: R.G. Barbers, J.L. Abraham
• Journal: British Journal of Industrial Medicine
• Published: 1989;46(2):106-10
• Type of article: Case report
• Cited by: 12 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 000051).

Abstract

A case of clinically and radiologically typical asbestosis manifesting in a 55 year old man occurred 36 years after a brief exposure period of less than one year. A transbronchial lung biopsy was performed but the samples were considered non-diagnostic. The diagnosis was supported by the use of bronchoalveolar lavage to obtain alveolar samples and scanning electron microscopy-energy dispersive x ray analysis of fibres found in the bronchoalveolar lavage fluid which showed a predominance of amosite.

In plain English

This was a case report about one man. In 1986 a 55-year-old oil company executive who had never smoked was evaluated for a productive cough. His known asbestos exposure lasted one year or less, in 1949 and 1950, as a trainee at a company making asbestos-containing pipe insulation. He worked in an office and recalled only occasional dust exposure on factory visits. Chest X-rays showed small opacities in both lungs plus pleural thickening, plaques and calcification, worsening on films since 1970, and his lung volumes were reduced. Lung biopsies taken by bronchoscope were non-diagnostic. Fluid washed from the lung (bronchoalveolar lavage) contained numerous asbestos bodies, about 13.4 per ml, and electron microscopy found fibres consistent with amosite. The authors concluded that lavage was useful for detecting asbestos exposure when the exposure history is in doubt. They stressed that lavage findings alone do not make the diagnosis of asbestosis. They also noted that his extensive pleural changes suggested he may have had significant exposure.

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: case report (single patient)
• Who was studied: One 55-year-old male oil company executive, a never-smoker, evaluated in 1986 for a productive cough (UCLA, Los Angeles)
• Exposure: Known asbestos exposure of one year or less (about six months in each of 1949 and 1950) as a chemical engineer trainee at a company manufacturing asbestos-containing pipe insulation. He worked in an office away from the factory, rarely visited it, and recalled occasional dust exposure without a mask on visits.
• Main results:
  • Chest radiographs in this patient showed bilateral small parenchymal opacities (ILO 1/1), diffuse pleural thickening on the right chest wall, pleural plaques on the left chest wall, and pleural calcification above the right diaphragm.
  • Earlier chest radiographs of this patient from 1970, 1977, 1979 and 1982 showed a progression of abnormalities.
  • This patient's lung function was reduced: FEV1 1.91 litres (61% of predicted), FVC 2.49 litres (58% of predicted), FEV1/FVC 77%, total lung capacity 3.24 litres (54% of predicted).
  • No asbestos bodies were seen on this patient's sputum cytology.
  • The transbronchial lung biopsies were non-diagnostic. One asbestos body was found in one small specimen, and minimal fibrogenesis was seen in another.
  • This patient's bronchoalveolar lavage fluid contained numerous asbestos bodies. The count was about 13.4 asbestos bodies per ml of lavage fluid, or 26.4 per million lavage cells.
  • Scanning electron microscopy with x-ray analysis showed the fibre cores of the asbestos bodies in this patient's lavage fluid to be consistent with amosite.
  • The lavage cell differential count was within normal limits.
• The authors' conclusion: The authors concluded that bronchoalveolar lavage is a useful means of detecting asbestos exposure when the exposure history is in doubt.
• Limitations the authors state:
  • The authors emphasised that lavage findings do not make the diagnosis of asbestosis. That diagnosis rests on exposure history and on clinical, radiological and physiological data.
  • Lavage does not give a direct tissue diagnosis.
  • Although the history suggested a small cumulative exposure, the authors noted that the extensive pleural changes suggested he may have had significant exposure.
  • No chest CT scan was done.
  • Chest films from before 1970 were not available.

Topics

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

Medical terms in this study, explained in our Lexicon: Bronchoalveolar Lavage (BAL), Biopsy, Scanning Electron Microscopy (SEM), Amosite.

Related studies

• Brief inhalation of asbestos compromises superoxide production in cells from bronchoalveolar lavage — J.M. Petruska, J. Marsh, et al. (1990)
• Bronchoalveolar lavage and 99mTc-DTPA clearance as prognostic factors in asbestos workers with and without asbestosis — N. al Jarad, A.R. Gellert, et al. (1993)
• Bronchoalveolar lavage cell and lymphocyte phenotype profiles in healthy asbestos-exposed shipyard workers — J.M. Wallace, J.S. Oishi, et al. (1989)
• Fibres and asbestos bodies in bronchoalveolar lavage fluids of asbestos sprayers — T. Tuomi, P. Oksa, et al. (1992)
• Association between neutrophil concentration in bronchoalveolar lavage fluid and recent losses in diffusing capacity in men formerly exposed to asbestos — M.R. Cullen, W.W. Merrill (1992)
• Gallium lung scanning and bronchoalveolar lavage in crocidolite-exposed workers — A.A. Hayes, B. Mullan, et al. (1989)

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