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 D. Weill, H. Weill (American Journal of Respiratory and Critical Care Medicine, 2005).

The study

• Authors: D. Weill, H. Weill
• Journal: American Journal of Respiratory and Critical Care Medicine
• Published: 2005;171(5):527-8; author reply 528-30
• Type of article: Comment, Letter
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Summary of the article

In this letter, Weill and Weill argued that the 2004 American Thoracic Society (ATS) Statement on the diagnosis and initial management of nonmalignant asbestos-related diseases did not fully consider alternative views and the available literature. They addressed two issues. On pleural plaques, they said the Statement relied on two studies with known weaknesses. It omitted a prospective study of asbestos cement workers in which plaques without asbestosis were not associated with increased lung cancer risk, and a meta-analysis by Weiss reaching a similar view. They added that it did not address whether asbestosis is required to attribute lung cancer to asbestos. On airway disease, they said the cited studies lacked dose-response data and did not control for smoking, radiographic abnormalities and age, and that the Statement was internally inconsistent. They agreed that asbestos can cause small airway abnormalities but said these changes lack proven clinical importance. The authors disclosed consulting and testifying in occupational lung disease litigation. In reply, the Committee said the Statement updated clinical diagnostic criteria and was not a comprehensive review or a review of cancer causation. It said Weiss's 1993 review did not address the question the Statement considered, and that a review of 10 studies and later studies supported plaques as a risk marker. It said it had described the airway effect as "relatively small" and invited a point-by-point rebuttal. The reply also answered a separate letter by Ghio and Roggli on smoking and small opacities.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.

In plain English

This is a letter to the editor, not a research study, and reports no new data. The authors argued that the American Thoracic Society's 2004 Statement on nonmalignant asbestos-related diseases did not, in their opinion, fully consider alternative views and the literature. On pleural plaques and cancer risk, they said the Statement cited two studies and omitted other evidence. This included a study of asbestos cement workers where plaques without asbestosis were not associated with increased lung cancer risk. They also faulted the Statement for not reviewing whether asbestosis is required to attribute lung cancer to asbestos. They agreed that asbestos can cause small airway abnormalities. But they argued that, excluding nonsmoking patients with radiographic asbestos-related lung disease and defining COPD as a reduced FEV1/FVC ratio, there is no evidence linking clinically significant airway obstruction to asbestos exposure alone. The authors concluded that the process had not produced a useful and credible summary. In a printed reply, the Committee said the Statement was not meant as a comprehensive review and cited studies supporting pleural plaques as a marker of lung cancer risk.

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 (correspondence) critiquing a published American Thoracic Society Statement, followed by the Committee's reply; no original data
• Who was studied: No study population; the letter discusses the 2004 American Thoracic Society Statement on diagnosis and initial management of nonmalignant diseases related to asbestos
• Exposure: Asbestos exposure in general (no fiber types specified), in relation to pleural plaques, lung cancer, asbestosis and chronic airway obstruction
• Main results:
  • The authors argued that, on pleural plaques as a marker of increased malignancy risk, the Statement cited only two studies, and that weaknesses of those studies had been pointed out elsewhere
  • The authors cited a longitudinal study of asbestos cement workers (their reference 5) in which pleural plaques without asbestosis were not associated with increased lung cancer risk, and said this was not included in the Statement
  • The authors argued that the Statement failed to review whether asbestosis is required to attribute lung cancer to asbestos exposure
  • The authors argued that when nonsmoking patients with radiographic evidence of asbestos-related lung disease are excluded and the GOLD initiative's definition of COPD (reduced FEV1/FVC ratio) is used, there is no evidence of an association between clinically significant airway obstruction and asbestos exposure alone
  • The authors agreed that asbestos inhalation can cause small airway abnormalities, detected both histologically and physiologically
  • In its reply, the Committee said the Statement was not intended as a comprehensive literature review but as an update of clinical diagnostic criteria
  • In its reply, the Committee defended the position that pleural plaques are an independent marker of risk for lung cancer. It said the 1997 Hillerdal and Henderson review examined 10 studies and reached a different conclusion than Weiss, and that this conclusion was later confirmed by other studies
• The authors' conclusion: The authors concluded that the process leading to the Statement failed to result in a useful and credible summary of current knowledge on causal aspects of asbestos-related health effects

Topics

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

Medical terms in this study, explained in our Lexicon: Pleural Plaques, Asbestos-Cement, Lung Cancer, Meta-Analysis, Dose-response relationship, Occupational Lung Disease, Causation.

Related studies

• Diagnosis and initial management of nonmalignant diseases related to asbestos — American Thoracic Society (2004)
• 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)
• Diagnosis of asbestos-related disease — H. Weill (1987)
• 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)

Browse more research in American Journal of Respiratory and Critical Care Medicine, or return to medical research.