Environmental lung disease

Our plain-English summary of Environmental lung disease, by M.X. FitzGerald, C.B. Carrington, E.A. Gaensler (The Medical Clinics of North America, 1973).

The study

• Authors: M.X. FitzGerald, C.B. Carrington, E.A. Gaensler
• Journal: The Medical Clinics of North America
• Published: 1973;57(3):593-622
• Type of article: Review
• Cited by: 22 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. 002388).

Summary of the article

This review, from Boston University and Yale University, surveyed lung diseases caused by inhaled dusts, gases, fumes and infectious agents at work and in the wider environment. It drew on the authors' experience in New England, where over 21 years 277 of 4751 nontuberculous referrals (5.8 per cent) had lung disease mainly of occupational origin. Illustrative cases covered asbestosis, talc, graphite, coal, iron, silo-filler's disease, beryllium, coccidioidomycosis, cutting-oil exposure and mesothelioma. The authors reported that asbestos had caused far more disease in their population than silica, and that 84 per cent of referred asbestos patients had pleural complications, including often bloody, recurrent effusions. They described disease in 'secondary' users of asbestos products and in workers exposed by others' use of asbestos nearby. They cited reports that one in five smoking asbestos insulation workers is likely to die of lung cancer, and that some occupational or paraoccupational asbestos contact was found in 80 per cent of mesotheliomas in British and South African studies. In their patients, profusion of small rounded opacities did not correlate with diffusing capacity (r = 0.04), whereas irregular opacities did (r = -0.55). Open lung biopsy was done in 71 of the 277 patients, with 0.2 per cent mortality in 496 biopsies. The authors stressed detailed occupational histories, standardised radiograph classification, epidemiologic study and prevention.

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 1973 clinical review covered lung diseases caused by workplace and environmental dusts, gases, fumes and infections. It was illustrated with cases from the authors' practice at Boston University. Over 21 years, 277 of 4751 nontuberculous referrals (5.8 per cent) had mainly occupational lung disease. The authors reported that asbestos caused far more disease in their patients than silica. Of their referred asbestos patients, 84 per cent had pleural complications, including pleural effusions that were often bloody. The article does not say how many asbestos patients there were. They increasingly saw disease in "secondary" users of processed asbestos material and in workers exposed by others' nearby asbestos use. Cases included a man who bagged and ground raw asbestos for 31 years and had a massive blood-stained pleural effusion. Another, a construction laborer who did not directly handle asbestos, had pleural mesothelioma associated with indirect exposure. Among patients with irregular x-ray shadows, mostly with asbestosis or talcosis, shadowing correlated with diffusing capacity (r = -0.55), with important individual exceptions. The authors concluded that a major public health problem exists.

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 review article in a symposium issue, illustrated with the authors' own case series and individual case reports
• Who was studied: 277 patients with lung disease mainly of occupational origin, out of 4751 nontuberculous referrals over 21 years to the Thoracic Services of Boston University School of Medicine, in New England
• Exposure: Many environmental agents (silica, asbestos, talc, carbon, metals, biological dusts, toxic chemicals, infections). Asbestos exposure included raw asbestos handling, secondary use of processed asbestos material, and indirect exposure from co-workers.
• Main results:
  • In the paragraph on asbestos, the authors reported pleural complications in 84 per cent of referred patients, meaning their referred asbestos patients. Besides plaques and calcifications, these included pleural effusions that were often bloody. The size of this asbestos group is not given, and the figure is not stated for all 277 occupational cases or all 4751 referrals.
  • The authors increasingly saw asbestos-related disease in "secondary" users of processed or semiprocessed material.
  • In some workers, disease came from other people's asbestos use nearby rather than from their own job.
  • Case report: a 56-year-old man who had bagged and ground raw asbestos for 31 years.
  • In 1969 the same man had a massive, blood-stained right pleural effusion that eventually required surgery (decortication).
  • Case report: a retired laborer and wrecker who did not directly handle asbestos, but whose fellow workers used it extensively, was diagnosed with pleural mesothelioma associated with indirect exposure to asbestos.
  • In patients with irregular (linear) x-ray shadows, mostly those with asbestosis or talcosis and some with graphite pneumoconiosis, the profusion of shadows was significantly correlated with per cent predicted diffusing capacity (r = -0.55, p less than 0.01), with important individual exceptions. This figure was reprinted from an earlier paper by Gaensler and colleagues.
• The authors' conclusion: The authors concluded that environmental lung disease is a major public health problem.
• Limitations the authors state:
  • In their patients with desquamative interstitial pneumonia and excess dust in the lung (including a talc-exposed rubber factory worker), the authors stated it is not certain that the dust and the lung reaction are related.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Talc and vermiculite.

Medical terms in this study, explained in our Lexicon: Talc, Mesothelioma, Insulator, Lung Cancer, Diffusing Capacity (DLCO), Biopsy.

Related studies

• Pathologica, physiological, and radiological correlations in the pneumoconioses — E.A. Gaensler, C.B. Carrington, et al. (1972)
• Occupational respiratory disease in mining — M.H. Ross, J. Murray (2004)
• Environmental fiber-induced pleuro-pulmonary diseases in an Anatolian village: an epidemiologic study — M. Artvinli, Y.I. Baris (1982)
• Crackles (rales) in the interstitial pulmonary diseases — G.R. Epler, C.B. Carrington, et al. (1978)
• Occupational lung diseases and global occupational health on the Net — K. Takahashi, A. Sekikawa, et al. (1998)
• Relative importance of cigarette smoking in occupational lung disease — P.C. Elmes (1981)

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