Commentary to the article lung function not affected by asbestos exposure in workers with normal Computed Tomography scan, by Schikowsky, Felten, et al., 2017

Our plain-English summary of Commentary to the article lung function not affected by asbestos exposure in workers with normal Computed Tomography scan, by Schikowsky, Felten, et al., 2017, by X. Baur, B. Terracini, F. Belpoggi, et al (American Journal of Industrial Medicine, 2018).

The study

• Authors: X. Baur, B. Terracini, F. Belpoggi, L.T. Budnik, H.J. Woitowitz, C.L. Soskolne
• Journal: American Journal of Industrial Medicine
• Published: 2018;61(4):351-354
• Type of article: Letter, Comment
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

In plain English

This is a letter to the editor, not a new study. The authors criticized a 2017 cross-sectional study by Schikowsky, Felten and colleagues of 207 selected power plant asbestos workers. That study reported that lung function was not affected by asbestos exposure in workers with normal Computed Tomography scans. The authors argued that the group varied widely in dose and duration of exposure, which they said reduced statistical power. They also objected that cumulative exposure was left out of the regression model after a P-value of 0.09 for its association with airway resistance (Rtot). They raised possible selection bias, because the original database of 8565 people came from self-reports, and a likely healthy worker effect. They cited a meta-analysis by Wilken et al. in which asbestos workers with normal imaging had FVC, FEV1 and FEV1/FVC on average 4.3%, 6.4% and 3.6% below predicted values. They also questioned the focus on body mass index and stated that the original authors had not declared a conflict of interest. The authors concluded that the study does not provide reliable information on this question.

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: Letter to the editor (commentary criticizing a published study); no new data
• Who was studied: No population of its own. The letter discusses the Schikowsky et al. 2017 cross-sectional study of 207 selected asbestos workers from a power plant.
• Exposure: Asbestos exposure at a power plant in the criticized study, as the letter reports it: mean 49 (range 0.1 to 844.9) fiber-years, mean duration 21.4 (1 to 42) years. No fiber type is named.
• Main results:
  • The authors argued that the criticized study's group was not homogeneous, as that study claimed, but heterogeneous in dose and duration of exposure.
  • The authors noted a P-value of 0.09 for cumulative exposure and airway resistance (Rtot) in the criticized study. On that basis cumulative exposure was not included in the regression model.
  • The authors cited a meta-analysis by Wilken et al. In that meta-analysis, asbestos workers with normal radiological findings had FVC, FEV1 and FEV1/FVC on average 4.3%, 6.4% and 3.6% below predicted values for the combined group.
  • The authors raised possible selection bias, because the original database of 8565 individuals was built from self-reports.
  • The authors stated that a significant healthy worker effect must be assumed.
  • The criticized study linked DLCO/VA only to time since end of exposure, not to cumulative exposure or duration. The authors suggested this result may be spurious.
  • The authors questioned the criticized study's emphasis on BMI, stating that the influence of BMI on lung function is limited.
  • The authors stated that the original authors failed to declare a conflict of interest. They said the funding grants came from a large German power plant and from the statutory accident insurance company responsible for power plants.
• The authors' conclusion: The authors concluded that the Schikowsky et al. publication does not provide reliable information on the effect of asbestos exposure on lung function in the absence of radiological abnormalities.

Topics

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

Related studies

• Lung function not affected by asbestos exposure in workers with normal Computed Tomography scan — C. Schikowsky, M.K. Felten, et al. (2017)
• High resolution computed tomography and lung function in asbestos-exposed workers with normal chest radiographs — C.A. Staples, G. Gamsu, et al. (1989)
• Findings from high resolution computed tomography of the lung and pleura of symptom free workers exposed to amosite who had normal chest radiographs and pulmonary function tests — S. Neri, A. Antonelli, et al. (1994)
• Pulmonary function, smoking habits, and high resolution computed tomography (HRCT) early abnormalities of lung and pleural fibrosis in shipyard workers exposed to asbestos — S. Neri, P. Boraschi, et al. (1996)
• Smoking, occupational risk factors, and bronchial tumor location: a possible impact for lung cancer computed tomography scan screening — M. Gonzalez, J.M. Vignaud, et al. (2012)
• Surface of localized pleural plaques quantitated by computed tomography scanning: no relation with cumulative asbestos exposure and no effect on lung function — J. Van Cleemput, H. De Raeve, et al. (2001)

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