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

The study

• Author: D.D. Smith
• Journal: American Journal of Respiratory and Critical Care Medicine
• Published: 2005;171(6):665-6; author reply 666-7
• 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, Dorsett D. Smith (University of Washington, Seattle) argued that the American Thoracic Society's 2004 official statement on the diagnosis and initial management of nonmalignant asbestos-related diseases contained statements not supported by the literature, many of them conflicting or inaccurate. He quoted passages on subjective symptoms and exposure histories, on pleural plaques as indicators of increased risk of future asbestosis, on asbestos and airway obstruction, and on the chest film as adequate for diagnosis. He argued that patient histories and subjective symptoms are unreliable, particularly in legal proceedings; that pleural plaques are evidence of exposure and do not indicate a greatly increased risk of asbestos-related disease compared with equally exposed workers without visible plaques; that the implication that asbestos contributes to clinically significant COPD is not supportable; and that the role of ILO B-reader chest X-ray interpretation had come into question. He disclosed that he had been an expert witness for the defense in asbestos litigation. In a reply that also answered a letter from Lawrence Martin, the ATS committee said the passages made reasonable distinctions and stood by its text on plaques. It noted that the statement described the asbestos effect on airways as possibly clinically significant in the presence of low lung function. It pointed out that the B-reader program belongs to NIOSH, not the ILO, and said the guidelines were intended for clinical diagnosis and patient care.

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 letter to the editor, followed by a reply from the guideline committee, presented no new data. The author wrote that a 2004 American Thoracic Society statement on nonmalignant asbestos-related disease contained statements not supported by the literature, many conflicting or inaccurate. The author argued that patient histories and symptoms are unreliable, particularly in legal proceedings. In the author's view, pleural plaques are evidence of exposure and do not indicate a greatly increased risk of asbestos-related disease relative to equally exposed workers without radiologically visible plaques. The author also called a clinically significant asbestos contribution to COPD not supportable and said ILO B-reader interpretation had come into question. The author disclosed serving as a defense expert witness in asbestos litigation. The committee replied that the passages make reasonable distinctions and that it stood by its statements on plaques. On airway obstruction, it said its statement holds that asbestos exposure might be clinically significant with low lung function. It noted that the B-Reader Program belongs to NIOSH, not the ILO, and that the guidelines were not formulated for uses outside clinical diagnosis.

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) criticizing a 2004 American Thoracic Society statement, with a reply from the ATS committee that wrote the statement; not a research study
• Main results:
  • The author's overall claim: the ATS statement contains statements not supported by the literature
  • The author argued that patient histories and subjective symptoms are unreliable, particularly in legal proceedings
  • The author argued that pleural plaques are evidence of exposure and do not indicate a greatly increased risk for asbestos-related disease in workers with plaques, compared with workers who had equal exposure and no radiologically visible plaques
  • The author argued that the implication that asbestos contributes to clinically significant COPD is not supportable
  • The author stated that the role of ILO B-reader chest X-ray interpretation had recently come into question
  • The author disclosed having been an expert witness for the defense in asbestos litigation
  • The committee replied that the passages the author called contradictory make reasonable distinctions
  • On pleural plaques, the committee stood by its statement and the evidence it cited
  • On the contribution of asbestos exposure to airway obstruction, the committee said its statement holds that asbestos exposure might be clinically significant in the presence of low lung function
  • The committee noted that the B-Reader Program belongs to NIOSH and is not an ILO activity
  • The committee said it did not formulate the guidelines for applications outside clinical diagnosis
• The authors' conclusion: The author concluded that many of the ATS statement's passages are conflicting or inaccurate

Topics

The National Library of Medicine indexes this study under subjects our site covers: Asbestosis.

Medical terms in this study, explained in our Lexicon: Pleural Plaques, Chest X-Ray, COPD, B-Reader, Expert Witness, NIOSH.

Related studies

• Diagnosis and initial management of nonmalignant diseases related to asbestos — A.J. Ghio, V.L. Roggli (2005)
• 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. Weill, H. Weill (2005)
• Nonmalignant respiratory disease mortality among woodworkers participating in the American Cancer Society Cancer Prevention Study-II (CPS-II) — P.A. Demers, S.D. Stellman, et al. (1998)
• Dose-response associations of silica with nonmalignant respiratory disease and lung cancer mortality in the diatomaceous earth industry — H. Checkoway, N.J. Heyer, et al. (1997)
• Re: "Dose-response associations of silica with nonmalignant respiratory disease and lung cancer mortality in the diatomaceous earth industry" — G.W. Gibbs (1998)

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