Chest pain in asbestos-exposed individuals with benign pleural and parenchymal disease

Our plain-English summary of Chest pain in asbestos-exposed individuals with benign pleural and parenchymal disease, by S. Mukherjee, N. de Klerk, L.J. Palmer, et al (American Journal of Respiratory and Critical Care Medicine, 2000).

The study

• Authors: S. Mukherjee, N. de Klerk, L.J. Palmer, N.J. Olsen, S.C. Pang, A. William Musk
• Journal: American Journal of Respiratory and Critical Care Medicine
• Published: 2000;162(5):1807-11
• Cited by: 28 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Many asbestos-exposed individuals complain of chest pain for which there is no clear explanation. To determine whether chest pain is associated with the presence of benign pleural or parenchymal disease on chest radiograph, we studied 1,280 subjects undergoing surveillance because of prior asbestos exposure at Wittenoom, Western Australia. All subjects completed the Rose questionnaire on chest pain and this revealed 556 subjects (43%) who experienced some chest pain. A posterior-anterior chest radiograph was performed at the same clinic visit and was subsequently graded independently by two experienced readers for diffuse parenchymal disease and pleural disease. Logistic regression models adjusted for sex, age, and cumulative asbestos exposure indicated that the presence of chest pain was significantly associated with the presence of both benign pleural disease and diffuse parenchymal disease. Further analysis after stratification of chest pain into nonanginal and anginal pain showed that there was a significant association between anginal pain and the presence of pleural and parenchymal asbestos-induced radiologic abnormalities and an association of nonanginal pain with parenchymal disease. We conclude that radiographic evidence of either parenchymal or pleural disease in subjects exposed to asbestos is significantly related to the presence of chest pain, particularly anginal pain.

In plain English

This study asked whether chest pain in people exposed to crocidolite at Wittenoom, Western Australia, was linked to benign changes on chest X-ray. Between September 1994 and June 1995, 1,280 former asbestos company workers and former Wittenoom residents taking part in a vitamin A cancer-prevention program completed the Rose chest pain questionnaire and had a chest X-ray the same day. Two readers graded the X-rays for pleural disease (thickening of the lining around the lungs) and parenchymal disease (changes in the lung tissue). Overall, 556 people (43%) reported some chest pain, and 157 had pain classed as angina. In statistical models that included age, parenchymal disease agreed by both readers was linked to any chest pain (odds ratio 2.16, 95% CI 1.29–3.61), to anginal pain and to nonanginal pain. Pleural disease was linked to any pain (1.53, 1.02–2.29) and to anginal pain (2.03, 1.20–3.43), but not significantly to nonanginal pain. The authors concluded the results fit the idea that these changes can lead to angina-like pain. They also noted other possible explanations, such as smoking, confusing pain with breathlessness, or anxiety.

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 analysis: a chest pain questionnaire and a chest radiograph taken on the same day, with logistic regression
• Who was studied: 1,280 people (931 males, 349 females; mean age 54.5 years, range 11 to 85). They were former employees of the Australian Blue Asbestos Company and former residents of Wittenoom, Western Australia, all in a vitamin A cancer-prevention program. They were studied between September 1994 and June 1995.
• Exposure: Crocidolite at Wittenoom, either at work (former company employees) or not at work (former town residents). Cumulative exposure, in fibers per ml-years, was calculated from work and residence histories and measured fiber concentrations.
• Main results:
  • 556 of the 1,280 subjects (43%) reported pain, discomfort, pressure or heaviness in the chest. Of these, 157 were classed as mild or severe angina (724 no pain, 399 nonanginal pain, 115 mild angina, 42 severe angina).
  • Former workers, more heavily exposed subjects and older subjects had more severe pain. The geometric mean cumulative exposure was 2.3 f/ml-yr in the no-pain group, 2.8 in nonanginal pain, 4.6 in mild angina and 9.5 in severe angina.
  • On readings agreed by both readers, 1,117 subjects had no signs, 42 had parenchymal disease, 86 had pleural disease and 35 had both. The readers agreed on 74% of pleural readings and 81% of parenchymal readings.
  • Odds of any chest pain compared with no pain: parenchymal disease odds ratio 2.16 (95% CI 1.29–3.61, p 0.003); pleural disease odds ratio 1.53 (95% CI 1.02–2.29, p 0.04).
  • Odds of anginal pain compared with no pain: parenchymal disease odds ratio 2.22 (95% CI 1.16–4.24, p 0.02); pleural disease odds ratio 2.03 (95% CI 1.20–3.43, p 0.008).
  • Odds of nonanginal pain compared with no pain: parenchymal disease odds ratio 2.10 (95% CI 1.18–3.75, p 0.011); pleural disease odds ratio 1.29 (95% CI 0.80–2.06, p 0.294), not statistically significant.
  • The associations were similar for men and women, ex-workers and residents, and smokers and nonsmokers.
• The authors' conclusion: The authors concluded that, based on the Rose questionnaire, their results are consistent with the hypothesis that benign pleural and parenchymal abnormalities caused by asbestos exposure can lead to chest pain with the characteristics of angina.
• Limitations the authors state:
  • The Rose questionnaire is likely more accurate at telling anginal from nonanginal pain in men than in women.
  • A common factor, such as smoking, might explain an association between coronary disease and the asbestos-related changes.
  • Subjects may have confused the sensation of pain with breathlessness (dyspnea).
  • Subjects knew the risks of their past exposure, and anxiety in the more heavily exposed may have led them to report more pain.

Mines named here

Asbestos mines this study is about. Each mine's page says who ran it, when it worked, and what it produced.

• Wittenoom, Western Australia

All asbestos mines

Topics

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

Medical terms in this study, explained in our Lexicon: Chest X-Ray, Asbestos Exposure, Wittenoom.

Related studies

• A retrospective study of chest pain in benign asbestos pleural disease — R.K. Allen, T. Cramond, et al. (2011)
• Chest pain in asbestos and silica-exposed workers — E.K. Park, P.S. Thomas, et al. (2011)
• Risk and significance of chest radiograph and pulmonary function abnormalities in an elderly cohort of former nuclear weapons workers — M.A. Mikulski, P.G. Hartley, et al. (2011)
• A 70-year-old woman with dyspnea and chest pain — A. Ganesh, M. Flores, et al. (2014)
• Asbestos exposure and benign asbestos diseases in 772 formerly exposed workers: dose-response relationships — G. Mastrangelo, M.N. Ballarin, et al. (2009)
• Chest pain and ST elevation: not always ST-segment-elevation myocardial infarction — S.A. Pyxaras, G. Lardieri, et al. (2010)

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