Distribution of asbestos bodies in the human lung as determined by bronchoalveolar lavage

Our plain-English summary of Distribution of asbestos bodies in the human lung as determined by bronchoalveolar lavage, by H. Teschler, N. Konietzko, B. Schoenfeld, et al (The American Review of Respiratory Disease, 1993).

The study

• Authors: H. Teschler, N. Konietzko, B. Schoenfeld, C. Ramin, T. Schraps, U. Costabel
• Journal: The American Review of Respiratory Disease
• Published: 1993;147(5):1211-5
• Cited by: 19 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Asbestos-related lung diseases tend to have distinct local distributions, for example, asbestosis first appears and tends to be more severe in the peripheral parts of the lower lung zones. The risk for asbestosis is related to the total asbestos burden of the lung. This suggests that the lower lobes in asbestos-exposed individuals may contain more asbestos than the other lobes. To test whether such topographic differences exist, we compared the number of retrieved asbestos bodies (AB) per ml BAL fluid in three groups of occupationally asbestos-exposed subjects who underwent BAL at different sampling sites. In Group 1 (n = 24) we performed BAL at three sites, namely in a segment of the right upper, right middle, and right lower lobe, to evaluate differences in asbestos body burden from lung apex to basis. There was a distinct increase in BAL asbestos body concentrations from the upper (21.2 +/- 9.1 AB/ml BAL fluid) to the middle (30.4 +/- 12.8 AB/ml BAL fluid) and to the lower lobe (56.0 +/- 20.2 AB/ml BAL fluid), all differences being significant (p < 0.01). In Group 2 (n = 40), we found good interlobar correlations for asbestos body counts between the right middle lobe (21.0 +/- 5.8 AB/ml BAL fluid) and the lingula (22.4 +/- 5.9 AB/ml BAL fluid) (r = 0.941, p < 0.001) and, in Group 3 (n = 15), between the ventral basal segment of the right (41.2 +/- 13.6 AB/ml BAL fluid) and left lung (39.0 +/- 13.6 AB/ml BAL fluid) (r = 0.966, p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

In plain English

This study from Germany used bronchoalveolar lavage (BAL), which rinses part of the lung with saline through a bronchoscope, to test whether asbestos bodies (coated asbestos fibers) are evenly spread through the lungs. It enrolled 87 people occupationally exposed to a mixture of chrysotile and amphibole asbestos for at least 3 years. 79 were analyzed. In 24 patients, all three lobes of the right lung were rinsed. Average counts per ml of fluid were 21.2 in the upper lobe, 30.4 in the middle lobe and 56.0 in the lower lobe, and all differences were statistically significant. All 24 had a higher count in the lower than the middle lobe. Matching sites in the right and left lungs gave closely correlated counts: the right middle lobe and lingula in 40 patients (r = 0.941), and the lower-lobe basal segments in 15 patients (r = 0.966). The authors concluded that lavage at the standard middle-lobe or lingula site may be somewhat misleading for measuring asbestos bodies, and recommended a lower-lobe basal segment. They noted that fluid recovery was lowest from the lower lobe.

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: Clinical comparison study: BAL fluid was taken from two or three different lung sites in the same patients, and asbestos body counts were compared between sites
• Who was studied: 87 occupationally asbestos-exposed subjects (Ruhrlandklinik, Essen, and Ruhr University, Bochum, Germany; dates not given). 52 had BAL for suspected asbestos-related disease and 35 had bronchoscopy to rule out bronchial carcinoma. 79 were analyzed: Group 1, 24 (6 excluded for low fluid recovery); Group 2, 40; Group 3, 15 (2 excluded). Diagnoses included asbestosis, pleural plaques only, bronchogenic carcinoma and mesothelioma.
• Exposure: Occupational exposure to a mixture of chrysotile and amphibole asbestos for at least 3 years, with last exposure 6 or more years before BAL. Mean exposure duration by group was 9.7, 12.1 and 10.4 years.
• Main results:
  • Group 1 (24 patients, right lung): mean asbestos bodies per ml BAL fluid (mean plus or minus standard error) were 21.2 ± 9.1 in the upper lobe, 30.4 ± 12.8 in the middle lobe and 56.0 ± 20.2 in the lower lobe. The differences between all lobes were significant.
  • Group 1: all 24 patients had a higher count in the lower lobe than the middle lobe. 21 of 24 had a higher count in the middle lobe than the upper lobe.
  • Group 1: the mean ratio of asbestos bodies, upper to middle to lower lobe, was 1:1.4:2.7.
  • Group 2 (40 patients): counts in the right middle lobe (21.0 ± 5.8 per ml) and the lingula (22.4 ± 5.9 per ml) were strongly correlated (r = 0.941, p less than 0.001), and mean counts did not differ between the two sites.
  • Group 3 (15 patients): counts in the right (41.2 ± 13.6 per ml) and left (39.0 ± 13.6 per ml) ventral basal segments of the lower lobes were strongly correlated (r = 0.966, p less than 0.001), and mean counts did not differ.
• The authors' conclusion: The authors concluded that asbestos body counts in BAL rise from the top to the base of the lung but agree between matching sites of the right and left lungs. They stated that BAL at the standard right middle lobe or lingula site may be somewhat misleading for measuring asbestos body concentrations, and recommended a basal segment of the lower lobes for this purpose.
• Limitations the authors state:
  • Fluid recovery was lowest from the lower lobe, which the authors said raised the possibility of unequal sampling. They argued against this because total cell counts did not vary and lower recovery would, if anything, reduce counts.
  • Light-microscopy counting of asbestos bodies in BAL fluid captures only a small fraction of the lung's total fiber burden, mainly longer amphibole fibers, to a degree that varies between individuals.

Topics

Medical terms in this study, explained in our Lexicon: Asbestos Bodies, Bronchoalveolar Lavage (BAL), BAL Fluid, Asbestos Body Formation.

Related studies

• Asbestos bodies in bronchoalveolar lavage in relation to asbestos bodies and asbestos fibres in lung parenchyma — A. Karjalainen, R. Piipari, et al. (1996)
• Diagnostic value of asbestos bodies in bronchoalveolar lavage fluid — P. De Vuyst, P. Dumortier, et al. (1987)
• Asbestos bodies in bronchoalveolar lavage fluids of brake lining and asbestos cement workers — P. Dumortier, P. De Vuyst, et al. (1990)
• Erionite bodies and fibres in bronchoalveolar lavage fluid (BALF) of residents from Tuzköy, Cappadocia, Turkey — P. Dumortier, L. Coplü, et al. (2001)
• Asbestos bodies in bronchoalveolar lavage fluid in relation to occupational history — A. Karjalainen, S. Anttila, et al. (1994)
• Fibres and asbestos bodies in bronchoalveolar lavage fluids of asbestos sprayers — T. Tuomi, P. Oksa, et al. (1992)

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