Clinical findings among asbestos workers in U.S.: influence of cigarette smoking

Our plain-English summary of Clinical findings among asbestos workers in U.S.: influence of cigarette smoking, by Y. Lerman, I.J. Selikoff, R. Lilis, et al (American Journal of Industrial Medicine, 1986).

The study

• Authors: Y. Lerman, I.J. Selikoff, R. Lilis, H. Seidman, S.K. Gelb
• Journal: American Journal of Industrial Medicine
• Published: 1986;10(5-6):449-58
• Cited by: 8 articles, as counted by NIH iCite
• Read it: PubMed · Publisher
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 001152).

Abstract

All members of a large union were invited to participate in a study of potentially adverse effects of asbestos exposure. Clinical findings among 1,117 workers (90% of those eligible for examination) are presented in this study. Cough was much less common among those without a history of cigarette smoking, although duration from onset of employment did not appreciably affect the prevalence of cough among the smokers. Rhonchi present among nonsmokers were limited in extent, but were marked and diffuse among cigarette smokers. Although dyspnea was as prevalent among nonsmokers as in smokers forty years and more after onset of exposure, it was relatively uncommon and found only among smokers when examined shortly after onset of exposure. Cigarette smoking had less influence on the prevalence of râles among asbestos workers; both smokers and nonsmokers showed this finding when examined 30 years and more after onset of asbestos exposure. Analysis of powerhouse work experience and mask use as possible confounders indicated no difference in prevalence of these characteristics between the smokers and nonsmokers.

In plain English

This study reported examination findings from 1963 among 1,117 men, almost 90% of the 1,249 eligible members of the New York-New Jersey asbestos insulation workers' union locals. The authors compared 894 men with a history of cigarette smoking with 223 nonsmokers, grouped by years since they began insulation work. Cough was reported by 422 smokers (47.2%) and 24 nonsmokers (10%). The authors wrote that smoking was largely the determinant of cough. Rhonchi, a chest sound heard with a stethoscope, were found in 141 smokers (15.8%) and 7 nonsmokers (3.3%), and were limited in extent among nonsmokers. Shortness of breath on exertion was rare in the first ten years and grew more common with time. It was less common among nonsmokers in the first 40 years, but the smoker-nonsmoker comparison did not reach statistical significance. Râles, crackling chest sounds, also increased with time, and smoking had less influence on them. The authors noted possible hidden biases and that there were no dust measurements to estimate dose.

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 clinical examination of members of an asbestos insulation workers' union, carried out in 1963
• Who was studied: 1,117 of 1,249 eligible men (89.4%) who had been members of the New York-New Jersey metropolitan locals (Locals 12 and 32) of the International Association of Heat and Frost Insulation and Asbestos Workers at any time from January 1, 1943, through December 31, 1962, examined in 1963. 894 had a history of cigarette smoking (current or ex-smokers) and 223 had never smoked cigarettes regularly.
• Exposure: Asbestos exposure from insulation work, measured as years from onset of employment (including prior nonunion or apprentice work). Cigarette smoking history was the factor compared. Fiber types were not named.
• Main results:
  • Cough was reported by 422 of 894 smokers (47.2%) and by 24 of 223 nonsmokers (10%).
  • Among smokers, years from onset of employment did not appreciably affect how common cough was.
  • Rhonchi were heard in 141 of 894 smokers (15.8%) and in 7 of 223 nonsmokers (3.3%).
  • Rhonchi in nonsmokers were limited in extent. In 35 of the 141 smokers with rhonchi, they were diffuse and marked.
  • Among 353 men with less than ten years from onset of exposure, exertional dyspnea was recorded in only 5. Three of these 5 had had possible household contact exposure in childhood.
  • The proportion of men with exertional dyspnea steadily increased from 10 to 14 years after onset of insulation work onward.
  • With less than 30 years from onset of exposure, 4 of 153 nonsmokers and 43 of 656 smokers reported exertional dyspnea.
  • In the first 40 years from onset, exertional dyspnea was considerably less common among nonsmokers. The authors said this difference was less well seen after 40 years or more.
  • In the table comparing smokers and nonsmokers by years from exposure, differences in the presence of dyspnea did not reach statistical significance.
  • Râles were present in 5 of 355 men with less than ten years from onset of exposure and rose steadily with time, reaching 73 of 117 men at 40 or more years. The authors called râles a common finding in asbestosis but not a very early sign.
  • Smoking appeared to have less influence on râles than on rhonchi. The authors saw no striking difference between smokers and nonsmokers after the first 30 years; before that, râles were somewhat more common among smokers.
  • Smokers did somewhat, but not significantly, more powerhouse work. Neither group used masks very often: 264 of 894 smokers (29.5%) and 70 of 223 nonsmokers (31.4%) reported some mask use.
• The authors' conclusion: The authors stated that smoking was largely the determinant of cough among these asbestos workers.
• Limitations the authors state:
  • Hidden biases may have remained despite grouping by years from onset, for example differences between age and years in the trade.
  • Work histories differed by era. Only 5.8% of men who began after World War II had shipyard experience, compared with 71.9% of those who began during or before the war, which could have affected outcomes.
  • Dose of asbestos could not readily be included because there were no dust measurements in those years.
  • Other possible confounders include survivor effects, competing risks over time, and changes in smoking habits.
  • Râles are not specific to asbestosis.
  • Data on changes in cough over time among nonsmokers were limited.

Topics

Medical terms in this study, explained in our Lexicon: Asbestos Exposure, Dyspnea.

Related studies

• Asbestosis: interstitial pulmonary fibrosis and pleural fibrosis in a cohort of asbestos insulation workers: influence of cigarette smoking — R. Lilis, I.J. Selikoff, et al. (1986)
• Influence of cigarette smoking on bronchoalveolar lavage cellularity in asbestos-induced lung disease — D.A. Schwartz, J.R. Galvin, et al. (1992)
• Asbestos exposure, cigarette smoking and death rates — E.C. Hammond, I.J. Selikoff, et al. (1979)
• Pleural plaques and cigarette smoking in asbestos workers — W. Weiss, R. Levin, et al. (1981)
• Influence of age at death on accuracy of death certificate disease diagnosis: findings in 475 consecutive deaths of mesothelioma among asbestos insulation workers and asbestos factory workers — I.J. Selikoff (1992)
• Effects of tobacco smoking on findings in chest computed tomography among asbestos-exposed workers — T. Vehmas, L. Kivisaari, et al. (2003)

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