Diagnosis of asbestos-related disease

Our plain-English summary of Diagnosis of asbestos-related disease, by H. Weill (Chest, 1987).

The study

• Author: H. Weill
• Journal: Chest
• Published: 1987;91(6):802-3
• Type of article: Editorial
• Cited by: 12 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. 001006).

Summary of the article

In this editorial, the author argued that public policy on asbestos-related diseases should rest on sound scientific and medical knowledge, both for estimating risks and for compensating workers injured by past workplace exposure. He noted that a joint ACCP/ATS committee had recently published a consensus statement on diagnosing nonmalignant asbestos-related diseases. He highlighted several of its points, stating that the comments were his own. He wrote that asbestosis means diffuse lung fibrosis and not pleural abnormalities. Its diagnosis usually depends mainly on a compatible chest radiograph together with a history of nontrivial exposure, and a pathologic diagnosis requires both asbestos bodies and fibrosis. He described the ILO classification as descriptive and designed for epidemiologic research, with the greatest interobserver disagreement at the lower categories (0/1 to 1/1). He argued that no single category could serve as the diagnostic threshold for all readers, and that a 1/1 reading illustrates a film compatible with asbestosis, as might a 1/0 film. He stated that lung function changes and crackles are supportive but nonspecific, and that clinically significant chronic airways obstruction is not an expected consequence of asbestos exposure in the absence of far more important causes such as smoking. Plaques do not affect lung function. He concluded that both over- and underdiagnosis are harmful and that credible diagnostic standards are needed and achievable.

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 was an editorial, not a research study. The author commented on the diagnosis of nonmalignant asbestos-related diseases, highlighting points from a joint ACCP/ATS committee statement, and said the comments were the author's own, not necessarily the committee's. The author stated that asbestosis means diffuse lung fibrosis from asbestos and should not be used for pleural abnormalities. A pathologic diagnosis of asbestosis, the author wrote, needs both asbestos bodies and fibrosis. On chest X-ray readings under the International Labour Office classification, the author said no single category marks the lower limit 'diagnostic' of asbestosis for all qualified readers. Category 1/1, or for some readers 1/0, could be compatible with asbestosis. Lung function findings and crackles were described as supportive but too nonspecific on their own. The author stated that plaques do not affect lung function and that it was still unclear whether benign pleural abnormalities add tumor risk beyond exposure. The author concluded that diagnostic standards are needed and achievable, and that both over- and underdiagnosis can be harmful.

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: editorial/commentary highlighting points from an ACCP/ATS consensus statement; no new data
• Who was studied: No study population; the editorial discusses diagnosis in former workers seeking compensation for nonmalignant asbestos-related disease
• Exposure: asbestos in general; no fiber types, products or doses specified
• Main results:
  • The author's view: asbestosis means diffuse lung fibrosis due to asbestos, and the term is not correct for pleural abnormalities
  • The author's view: a pathologic diagnosis of asbestosis requires both asbestos bodies and fibrosis; neither alone is sufficient
  • The author's view: no single ILO profusion category is the 'diagnostic' lower limit of asbestosis for all qualified readers
  • The author's view: a reading of 1/1 illustrates a film compatible with asbestosis, and a 1/0 film might be too, depending on the reader
  • The author's view: abnormal lung function patterns and inspiratory crackles support the diagnosis but are too nonspecific to be helpful alone
  • The author's view: clinically significant chronic airways obstruction is not an expected result of asbestos exposure without other causes such as smoking
  • The author's view: plaques do not affect lung function, and diffuse pleural thickening reduces lung volumes only when very extensive
  • The author's view: it is still unclear whether benign pleural abnormalities are a risk factor, beyond exposure, for asbestos-related tumors
  • The author's view: mesothelial tumors in exposed people are very likely caused by asbestos, whereas lung cancer even in exposed people is more likely due to smoking
• The authors' conclusion: The author concluded that diagnostic standards for asbestos-related diseases are needed and achievable, and that both over- and underdiagnosis can be detrimental

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: Fibrosis, Chest X-Ray, Asbestos Bodies, ILO Classification, Asbestos Exposure.

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 — American Thoracic Society (2004)
• Conventional and high resolution computed tomography in the diagnosis of asbestos-related diseases — D.A. Lynch, G. Gamsu, et al. (1989)
• Computed tomography in the diagnosis of asbestos-related thoracic disease — G. Gamsu, D.R. Aberle, et al. (1989)
• Incremental value of oblique chest radiographs in the diagnosis of asbestos-induced pleural disease — E.L. Baker, R. Greene (1982)
• Asbestos: when the dust settles an imaging review of asbestos-related disease — H.D. Roach, G.J. Davies, et al. (2002)

Browse more research in Chest, or return to medical research.