Benign asbestos pleural diseases

Our plain-English summary of Benign asbestos pleural diseases, by S.J. Chapman, W.O. Cookson, A.W. Musk, et al (Current Opinion in Pulmonary Medicine, 2003).

The study

• Authors: S.J. Chapman, W.O. Cookson, A.W. Musk, Y.C. Lee
• Journal: Current Opinion in Pulmonary Medicine
• Published: 2003;9(4):266-71
• Type of article: Review
• Cited by: 40 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

The global incidence of asbestos-related lung diseases is expected to continue to rise. Although much attention is devoted to malignant diseases induced by asbestos, benign asbestos pleural diseases (pleural plaques, benign asbestos-related pleural effusion, diffuse pleural thickening, and rounded atelectasis) are common in clinical practice and often produce diagnostic difficulties. The authors describe the clinical features of benign asbestos-related pleural disease, before focusing on recent advances in radiology and on controversies surrounding the pathogenesis of asbestos-induced pleural injury. Advances in computed tomography have assisted the understanding and diagnosis of these diseases, and increasing evidence suggests radiologic appearances on computed tomography can predict impairment in pulmonary function tests. The pathogenesis of asbestos-induced pleural diseases has also been subject to extensive investigation. Asbestos fibers can provoke pleural inflammation from direct toxicity to mesothelial cells. Inhaled asbestos fibers can also elicit pleural injury indirectly via the release of growth factors and inflammatory cytokines from within the lung. Although progress has been made in the understanding of the mechanisms of asbestos pleural injury, many important questions remain unanswered. The role of genetic factors and possible environmental cofactors (eg, simian virus 40) in the pathogenesis of benign asbestos pleural diseases requires further research.

In plain English

This article was a narrative review. It reported no new data of its own. The authors described four benign (non-cancerous) asbestos pleural diseases: pleural plaques, benign asbestos-related pleural effusion, diffuse pleural thickening, and rounded atelectasis. They then discussed advances in imaging and debates about how asbestos injures the pleura, the lining of the lungs and chest wall. Drawing on earlier published work, they wrote that pleural plaques typically develop 20 to 30 years after exposure, are found in as many as 50% of asbestos-exposed workers, and that most studies found no significant association between plaques and lung function abnormalities. Benign effusions could occur within 10 years of exposure. Diffuse pleural thickening could lead to restrictive lung function impairment, especially when the costophrenic angle (the lower corner of the chest cavity) was obliterated. They described growing evidence that CT appearances can predict lung function impairment. They also wrote that asbestos fibers may harm the pleura directly, or indirectly through substances released from the lung. The authors concluded that many questions remain unanswered, and that genetic factors and possible cofactors such as simian virus 40 need further research.

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 review of published literature (no original data)
• Who was studied: No study population of its own. The review covered published human, animal and cell studies on four benign asbestos pleural diseases.
• Exposure: Asbestos in general. This covers chrysotile (serpentine) and the amphiboles crocidolite, amosite, anthophyllite, tremolite and actinolite. The review names mainly occupational exposure (mining, milling, shipping, construction, insulation) and some environmental exposure (parts of Turkey, northwest Greece, Finland).
• Main results:
  • Based on earlier studies, the review stated that pleural plaques typically develop 20 to 30 years after exposure.
  • Based on earlier studies, the review stated that pleural plaques are found in as many as 50% of asbestos-exposed workers.
  • The review reported that the majority of earlier studies showed no significant association between pleural plaques and lung function abnormalities.
  • The review stated that benign asbestos-related pleural effusions can occur within 10 years of exposure.
  • The review stated that diffuse pleural thickening may lead to restrictive lung function impairment, especially when the costophrenic angle is obliterated.
  • The review stated that rounded atelectasis is typically without symptoms.
  • The review described increasing evidence that CT appearances can predict lung function impairment.
  • The review described asbestos fibers harming pleural cells directly. It also described them acting indirectly through growth factors and inflammatory substances released from the lung.
  • The review noted that a role for simian virus 40 in benign asbestos pleural disease had not been investigated.
• The authors' conclusion: The authors concluded that many questions remain unanswered. They called for further research into the role of genetic factors and possible environmental cofactors such as simian virus 40 in benign asbestos pleural diseases.

Topics

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

Medical terms in this study, explained in our Lexicon: Asbestos-Related Pleural Disease, Pleural Plaques, Pleural Effusion, Diffuse Pleural Thickening, Rounded Atelectasis, Pulmonary Function Test (PFT), Inflammation, Mesothelial Cells.

Related studies

• The additional risk of malignant mesothelioma in former workers and residents of Wittenoom with benign pleural disease or asbestosis — A. Reid, N. de Klerk, et al. (2005)
• Chest pain in asbestos-exposed individuals with benign pleural and parenchymal disease — S. Mukherjee, N. de Klerk, et al. (2000)
• A retrospective study of chest pain in benign asbestos pleural disease — R.K. Allen, T. Cramond, et al. (2011)
• Asbestos-related benign pleural disease — C. Peacock, S.J. Copley, et al. (2000)
• Clinical value of fluorodeoxyglucose-positron emission tomography/computed tomography in differentiation of malignant mesothelioma from asbestos-related benign pleural disease: an observational pilot study — H. Yildirim, M. Metintas, et al. (2009)
• Asbestos exposure and benign asbestos diseases in 772 formerly exposed workers: dose-response relationships — G. Mastrangelo, M.N. Ballarin, et al. (2009)

Browse more research in Current Opinion in Pulmonary Medicine, or return to medical research.