Chest pain in asbestos and silica-exposed workers

Our plain-English summary of Chest pain in asbestos and silica-exposed workers, by E.K. Park, P.S. Thomas, D. Wilson, et al (Occupational Medicine, 2011).

The study

• Authors: E.K. Park, P.S. Thomas, D. Wilson, H.J. Choi, A.R. Johnson, D.H. Yates
• Journal: Occupational Medicine
• Published: 2011;61(3):178-83
• Cited by: 8 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: Chest pain may be the first symptom of developing respiratory malignancy, particularly in subjects with asbestos exposure, yet little information exists on this topic.

Aims: To investigate chest pain in a cohort of subjects exposed to asbestos and silica dust applying for compensation.

Methods: Cross-sectional study using a standardized questionnaire. Data collection included: smoking history, Medical Research Council scales of exercise capacity and respiratory symptoms.

Results: We studied 621 subjects. Six disease groups were categorized: asbestosis (n = 27), diffuse pleural thickening (DPT) (132), asbestosis and DPT (14), silicosis (26), pleural plaques only (160) and healthy subjects with a history of dust exposure (256). Crude prevalence rates of chest pain were high, with chest pain approximately twice as common in subjects with asbestos-related disorders and silicosis as in healthy subjects, with an overall frequency of ~40%. However, when other variables were taken into account in a multivariate analysis the differences between groups disappeared. The factor most significantly related to chest pain was age.

Conclusions: Chest pain is apparently common in subjects with asbestos-related disorders and silicosis, but after adjustment for other variables, no increased prevalence was apparent in subjects with pleural disorders. More sophisticated questionnaires and dedicated imaging are required to elucidate this further.

In plain English

This cross-sectional study examined chest pain in people attending the Workers' Compensation (Dust Diseases) Board of New South Wales in Sydney, Australia, from February to November 2006, for compensation assessment or follow-up. Of 621 participants, 615 were analysed and 603 were men. A thoracic physician recorded symptoms using a standardized questionnaire. Before adjustment, chest pain was reported by 22% of apparently healthy subjects with a history of asbestos or silica exposure. The figures were 33% with asbestosis, 46% with silicosis, 42% with diffuse pleural thickening, 50% with asbestosis plus diffuse pleural thickening, and 38% with pleural plaques only. After adjusting for age, sex, smoking and other factors, no disease group had significantly raised odds of chest pain. For pleural plaques the adjusted odds ratio was 0.98 (95% CI 0.97 to 1.02). Breathlessness was the only symptom significantly raised by disease. The authors concluded that chest pain is common and that factors other than asbestos and silica should be excluded before attributing it to work exposure. They noted their chest-pain method was crude, subjects were a selected group, and results apply only to men.

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 study using a standardized, physician-administered questionnaire
• Who was studied: 621 people with occupational dust exposure who agreed to take part while attending the Workers' Compensation (Dust Diseases) Board of New South Wales, Sydney, Australia, from February to November 2006, for compensation assessment or follow-up. 615 were analysed: 603 men and 12 women. Groups were asbestosis (27), silicosis (26), diffuse pleural thickening (132), asbestosis plus diffuse pleural thickening (14), pleural plaques only (160), and apparently healthy subjects with a history of asbestos or silica exposure (256).
• Exposure: Occupational exposure to asbestos and to silica dust. The article does not give fiber types, products or doses, and states that asbestos exposure varied.
• Main results:
  • Crude (unadjusted) prevalence of chest pain in apparently healthy dust-exposed subjects was 22%.
  • Crude chest pain prevalence was 32% overall, 22% healthy, 33% asbestosis, 46% silicosis, 42% diffuse pleural thickening, 50% asbestosis plus diffuse pleural thickening, and 38% pleural plaques. Table 1 gives the group difference as P less than 0.05.
  • Chest pain was present in 43% of subjects with diffuse pleural thickening or asbestosis plus diffuse pleural thickening, compared with 38% of subjects with pleural plaques. This difference was not statistically significant.
  • After adjustment, chest pain was not significantly increased in any disease group compared with apparently healthy subjects. Adjusted odds ratios (95% CI) were: asbestosis 1.23 (0.43–3.55), silicosis 0.96 (0.57–1.56), diffuse pleural thickening 0.98 (0.87–1.01), and asbestosis plus diffuse pleural thickening 0.99 (0.88–1.11).
  • Pleural plaques group (n = 160): adjusted prevalence of chest pain 34%, adjusted odds ratio 0.98 (95% CI 0.97–1.02), compared with apparently healthy subjects.
  • Subjects who smoked 17–24 pack-years had an adjusted odds ratio for chest pain of 1.33 (95% CI 1.05–1.70) compared with never-smokers.
  • Breathlessness was the only symptom significantly raised by disease after adjustment. For example, the adjusted odds ratio for silicosis was 2.94 (95% CI 1.49–5.80).
• The authors' conclusion: The authors concluded that chest pain is common in these workers and needs careful examination to exclude causes other than asbestos and silica before it is attributed to occupational exposure. They called for a specific questionnaire and standardized dedicated imaging.
• Limitations the authors state:
  • The method used to assess chest pain was crude.
  • The chest pain definition was not specific for pleural pain and likely included pain of cardiac and gastrointestinal origin.
  • Subjects were likely a selected group because they were attending compensation screening.
  • Most subjects were male, so the results apply only to men.
  • Asbestos exposure and smoking history varied between subjects.
  • The authors could not adjust for disease severity using CT findings because CT technique was not standardized.
  • Group data may miss individual differences.

Topics

Medical terms in this study, explained in our Lexicon: Asbestos Exposure, Diffuse Pleural Thickening, Silicosis, Pleural Plaques, Multivariate Analysis.

Related studies

• 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)
• Chest pain and ST elevation: not always ST-segment-elevation myocardial infarction — S.A. Pyxaras, G. Lardieri, et al. (2010)
• A 70-year-old woman with dyspnea and chest pain — A. Ganesh, M. Flores, et al. (2014)
• An update on the detoxification processes for silica particles and asbestos fibers: successess and limitations — M. Gulumian (2005)
• Respiratory symptoms and functional status in workers exposed to silica, asbestos, and coal mine dusts — X.R. Wang, D.C. Christiani (2000)

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