Common problems in asbestos-related pulmonary diseases

Our plain-English summary of Common problems in asbestos-related pulmonary diseases, by A.H. Rubin (American Journal of Industrial Medicine, 1986).

The study

• Author: A.H. Rubin
• Journal: American Journal of Industrial Medicine
• Published: 1986;10(5-6):555-62
• 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. 000431).

Abstract

Exposure to asbestos is an important public health hazard in all industrialized societies. Although the pulmonary manifestations of prolonged asbestos fiber exposure are well known, there is considerable disagreement over specific clinical features and employment policies. Three of these controversies are the following: a) Can lung cancer be ascribed to asbestos exposure in subjects who lack evidence of asbestosis? b) Is there any clinical significance to benign asbestos pleural changes? c) Is it advisable to change jobs when evidence of asbestosis or benign pleural changes develop? The purpose of this presentation is to help develop a suitable public policy for Israel. Such a policy would have clinical importance as well as economic, legal, and social consequences for the individual and society as a whole.

In plain English

This article was a narrative review, not a new study. The author examined published research on three disputed questions about asbestos-related lung disease, to help develop public policy for Israel. On lung cancer without asbestosis, the author reported a widespread belief, based on epidemiological studies, that there was a causal link. The author also reported disagreement over the size of the risk, and the view of Parkes that the evidence was insufficient. No pathology method could split a smoker's lung cancer between asbestos and smoking. On benign pleural changes, the author described a study by Baker and colleagues. In it, forced vital capacity was 99.5% of predicted in asbestos workers with pleural abnormalities and 103.2% in those with normal-appearing pleura. The author judged this difference too small to be clinically important. The author reported a medical consensus that pleural plaques and diffuse pleural thickening do not become malignant, while noting that diffuse thickening can cause severe disability. The author concluded that workers with diffuse pleural thickening and normal lung function should be considered individually. Those with restrictive impairment and pleural abnormalities should be removed from further asbestos exposure.

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 (presentation) of published literature on three controversies in asbestos-related lung disease; no original data
• Who was studied: No study population of its own; the article reviewed published studies of asbestos-exposed workers and the general population, with a view to policy in Israel
• Exposure: Asbestos exposure in general (fiber types not specified in the body of the article), including its combination with cigarette smoking
• Main results:
  • On lung cancer without asbestosis, the author reported a widespread belief from epidemiological studies that asbestos exposure without asbestosis causes lung cancer, with disagreement about the size of the increased risk
  • The author cited Parkes's view that the evidence was insufficient to conclude that asbestos causes lung cancer in the absence of asbestosis
  • In asbestos workers who smoke, the author stated that no pathologic method could assign the lung disease to asbestos or to smoking
  • Baker et al. reported forced vital capacity of 99.5% of predicted in asbestos workers with pleural abnormalities versus 103.2% in those with normal-appearing pleura. The author judged this statistically significant difference (p less than 0.05) too small to be clinically important
  • The author reported a consensus of medical opinion that pleural plaques and diffuse pleural thickening do not become malignant or progress to malignant mesothelioma
  • Citing other studies, the author noted that diffuse pleural thickening can cause severe disability
• The authors' conclusion: The author concluded that employees with diffuse pleural thickening and normal lung function should be considered individually. Those with restrictive ventilatory impairment and pleural abnormalities should be removed from further asbestos exposure.
• Limitations the authors state:
  • The author noted that post-mortem examinations are seldom performed in Israel for religious reasons, which limits diagnostic confirmation
  • The author noted that the risk from current lower-level workplace exposure is unresolved and rests on extrapolation from high-level exposure

Topics

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

Related studies

• Advances in asbestos disease research. Common practical problems: panel discussion — G.L. Baum, S. Gitter, et al. (1986)
• Thoracic surgical problems in asbestos-related disorders — E.A. Gaensler, T.C. McLoud, et al. (1985)
• Effect of smoking on attack rates of pulmonary and pleural lesions related to exposure to asbestos dust — G.H. McMillan, R.J. Pethybridge, et al. (1980)
• Relative release of interleukin-1 beta and interleukin-1 receptor antagonist by alveolar macrophages. A study in asbestos-induced lung disease, sarcoidosis, and idiopathic pulmonary fibrosis — J.N. Kline, D.A. Schwartz, et al. (1993)
• Asbestos-related diseases of lung and pleura: clinical picture and illustrative cases — B. Varkey, U.N. Kumar (1978)
• Prevalence of Asbestos-Related Disease Among Workers in Sri Lanka — B.A. Wickramatillake, M.A. Fernando, et al. (2019)

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