Diagnosis and initial management of nonmalignant diseases related to asbestos

Our plain-English summary of Diagnosis and initial management of nonmalignant diseases related to asbestos, by American Thoracic Society (American Journal of Respiratory and Critical Care Medicine, 2004).

The study

• Author: American Thoracic Society
• Journal: American Journal of Respiratory and Critical Care Medicine
• Published: 2004;170(6):691-715
• Type of article: Guideline
• Cited by: 307 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

In plain English

This is an official American Thoracic Society statement, not a new study. A committee convened in 2001 updated the society's 1986 criteria, and the statement was adopted on December 12, 2003. It covers asbestosis, pleural thickening (plaques or diffuse fibrosis), benign pleural effusion and airflow obstruction. It sets three criteria for diagnosis: a structural change consistent with asbestos shown by imaging or histology, evidence that asbestos was the cause, and exclusion of other plausible causes. Impairment testing is not required for diagnosis but is part of a complete evaluation. The guidelines are meant for clinical use, not for research, screening or litigation. The statement treats pleural plaques as markers of exposure and of elevated cancer risk. It says a diagnosis implies a lifelong elevated cancer risk, though most patients do not develop cancer. For exposed people without disease, 10 or more years after first exposure, it suggests chest films and lung function tests every 3 to 5 years. It does not recommend periodic surveillance for lung cancer or mesothelioma. The authors concluded the guidelines should provide a reliable basis for clinical diagnosis for some years to come.

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: Official consensus statement (clinical diagnostic guideline) of the American Thoracic Society, updating its 1986 criteria. It is not an original study.
• Who was studied: No study population. The statement was written by an ad hoc committee of 11 physicians from the ATS Scientific Assembly on Environmental and Occupational Health. It is intended for diagnosing individual patients with past asbestos exposure in a clinical setting.
• Exposure: Asbestos in general: chrysotile and the amphiboles crocidolite, amosite, anthophyllite, actinolite and tremolite. The statement says all forms may cause the nonmalignant diseases described.
• Main results:
  • General diagnostic criteria: evidence of structural pathology by imaging or histology, evidence of causation by asbestos, and exclusion of alternative plausible causes.
  • Functional assessment is not required for diagnosis but is part of a complete evaluation (Table 1).
  • The guidelines are designed for clinical use, not for research, surveillance, screening, litigation or adjudication.
  • A diagnosis of nonmalignant asbestos-related disease implies a lifelong elevated cancer risk, although the majority of such patients do not develop cancer.
  • Pleural plaques are to be interpreted as a marker of exposure and of elevated malignancy risk.
  • People with past exposure but no manifest disease, 10 or more years after initial exposure, may be monitored with chest films and pulmonary function studies every 3 to 5 years.
  • Periodic surveillance for lung cancer or mesothelioma is not recommended; screening for colon cancer is considered reasonable.
  • After a diagnosis of asbestosis, the recommended management includes informing the patient of a work-related illness, reporting it as required by law, informing the patient of compensation options, smoking cessation and immunization.
• The authors' conclusion: The authors concluded that the diagnosis still rests on the 1986 criteria (a compatible structural lesion, evidence of exposure, exclusion of other conditions), that the criteria are compatible with the Helsinki criteria, and that the guidelines should provide a reliable basis for clinical diagnosis for some years to come.
• Limitations the authors state:
  • The guidelines deliberately favor specificity over sensitivity.
  • Disease may be present at a subclinical level not yet detectable by histology, imaging or function tests.
  • The specific guidelines may or may not apply to other asbestiform minerals, such as the tremolite-like mineral in Libby, Montana vermiculite.
  • The supporting guidelines are expected to change in future.

Topics

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

Related studies

• Diagnosis and initial management of nonmalignant diseases related to asbestos — D. Weill, H. Weill (2005)
• Diagnosis and initial management of nonmalignant diseases related to asbestos — D.D. Smith (2005)
• Diagnosis and initial management of nonmalignant diseases related to asbestos — A.J. Ghio, V.L. Roggli (2005)
• The diagnosis of nonmalignant diseases related to asbestos — A. Franzblau, R. Lilis (1987)
• Recommendations for the Diagnosis and Management of Asbestos-Related Pleural and Pulmonary Disease — C. Diego Roza, M.J. Cruz Carmona, et al. (2017)
• Stigma-related experiences in non-communicable respiratory diseases: A systematic review — S. Rose, C. Paul, et al. (2017)

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