Effect of tobacco smoking on the presence of asbestosis at postmortem and on the reading of irregular opacities on roentgenograms in asbestos-exposed workers

Our plain-English summary of Effect of tobacco smoking on the presence of asbestosis at postmortem and on the reading of irregular opacities on roentgenograms in asbestos-exposed workers, by A. Kraut, J. Godbold, R. Lilis (The American Review of Respiratory Disease, 1989).

The study

• Authors: A. Kraut, J. Godbold, R. Lilis
• Journal: The American Review of Respiratory Disease
• Published: 1989;139(6):1567-9
• Type of article: Letter
• Cited by: 2 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 nos. 000094, 000112).

In plain English

This is a letter to the editor, not a new study. The authors criticised a published autopsy and X-ray study of asbestos miners by Hnizdo and Sluis-Cremer. They noted that the X-ray and autopsy findings came from different groups of miners. They also noted that the comparison miners died younger: 24.9% of controls versus 6.0% of cases died before age 40. Using the published figures, they reanalysed the data with miners who had slight asbestosis as controls. The link between cigarette smoking and moderate or marked asbestosis was positive but not statistically significant. Pipe smoking was significantly associated with it. The authors said these results needed adjustment for asbestos exposure and were limited by small numbers. They estimated that the original study had 32% power to detect a 50% increase in asbestosis prevalence if truly associated with cigarette smoking, falling to 25% after excluding ischemic heart disease deaths. The authors did not accept the original study's conclusion that smoking causes X-ray changes that can be misread as asbestosis. A reply from the original authors follows the letter but is cut off.

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 criticising a published autopsy and X-ray study, including the letter authors' own reanalysis of its published figures
• Who was studied: Asbestos miners in Hnizdo and Sluis-Cremer's published study: autopsied miners with asbestosis (cases) and without asbestosis (controls), with X-ray findings coming from a different group of miners
• Exposure: Asbestos exposure in mining (fiber type not stated in the letter), together with cigarette smoking (current and former) and pipe smoking
• Main results:
  • In the original study, the comparison miners (controls) died younger than the cases: 24.9% of controls versus 6.0% of cases died before age 40, and 48.5% versus 18.8% died before age 50
  • In the letter authors' reanalysis, with miners who had slight asbestosis as controls, the odds ratio for moderate or marked asbestosis was 3.6 (95% CI 0.8 to 17.2) for all current smokers and 1.7 (95% CI 0.3 to 10.8) for ex-smokers. These associations were positive but not statistically significant.
  • In the same reanalysis, pipe smoking was significantly associated with moderate or marked asbestosis: odds ratio 7.6 (95% CI 1.2 to 48.0)
  • The letter authors estimated that the original autopsy study had 32% power to detect a 50% increase in the prevalence of asbestosis if it were truly associated with cigarette smoking. Power fell to 25% when miners who died of ischemic heart disease were removed.
  • The letter authors suggested that misclassification of smoking status could explain why the original study found no dose-response relationship, because smoking information was available only from 1960
• The authors' conclusion: The authors did not accept the original study's conclusion that smoking produces lung changes visible on X-rays that can be wrongly read as irregular opacities caused by asbestosis. They said that only pathologic studies with accurate smoking and exposure histories and chest X-rays could answer the question.
• Limitations the authors state:
  • The letter authors' reanalysis was not adjusted for asbestos exposure, which would require access to the raw data
  • Small numbers of individuals in some smoking categories limited the reanalysis

Topics

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

Related studies

• Effect of tobacco smoking on the presence of asbestosis at postmortem and on the reading of irregular opacities on roentgenograms in asbestos-exposed workers — E. Hnizdo, G.K. Sluis-Cremer (1988)
• Cigarette smoking and small irregular opacities — W. Weiss (1991)
• Factors influencing the reading of small irregular opacities in a radiological survey of asbestos miners in South Africa — G.K. Sluis-Cremer, P.A. Hessel, et al. (1989)
• Smoking and roentgenographic opacities in US Navy asbestos workers — A.M. Ducatman, B.F. Withers, et al. (1990)
• Irregular opacities in the lung, occupational asthma, and airways dysfunction in aluminum workers — K.H. Kilburn, R.H. Warshaw (1992)
• Effects of tobacco smoking on findings in chest computed tomography among asbestos-exposed workers — T. Vehmas, L. Kivisaari, et al. (2003)

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