Hyperventilation in men claiming compensation for benign asbestos-related diseases

Our plain-English summary of Hyperventilation in men claiming compensation for benign asbestos-related diseases, by G.K. Crompton (The Journal of the Royal College of Physicians of Edinburgh, 2010).

The study

• Author: G.K. Crompton
• Journal: The Journal of the Royal College of Physicians of Edinburgh
• Published: 2010;40(4):297-300
• Read it: PubMed · Publisher

Abstract

The observation that hyperventilation was common in men involved in civil court actions compared with my non-medico-legal practice stimulated me to carefully assess 100 consecutively seen men with non-malignant asbestos-related disease(s). A diagnosis of hyperventilation was made in 33 and probable hyperventilation in 12. The development of anxiety symptoms in these men could, in part at least, be prevented or greatly decreased if more emphasis was placed on the education of ex-asbestos workers by solicitors and organisations responsible for the initiation of civil actions.

In plain English

This paper, by a retired consultant physician in Edinburgh, reviewed the author's own notes and expert reports on 100 men seen consecutively between March 2003 and April 2009 for civil court actions over asbestos-related conditions. The men, aged 54 to 87, had pleural plaques, diffuse pleural thickening and/or asbestosis. Men who had, or were thought to have, malignant disease were excluded. More than 90% of the reports were commissioned by solicitors for the defenders. Using a set of symptom criteria and direct questioning, the author diagnosed hyperventilation in 33 men and probable hyperventilation in 12 (45% in total). The combined share varied by group: 14 of 49 men (28.6%) with pleural plaques and asbestosis, 5 of 5 with pleural thickening and asbestosis, and 9 of 16 with pleural plaques alone. In five men referred for metabolic exercise testing, the diagnosis was confirmed. The author reported that the majority of men believed their condition would considerably shorten their lives. The author concluded that hyperventilation is common in these men and is usually triggered by anxiety, and that better education by solicitors and organisations starting civil actions could reduce it. The author acknowledged possible over-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: Retrospective review of the author's own expert medico-legal reports and records on consecutively seen patients (case series)
• Who was studied: 100 men seen consecutively between March 2003 and April 2009 by the author as a medical expert in civil actions, aged 54 to 87, with pleural plaques and/or diffuse pleural thickening and/or asbestosis. Men with, or thought to have, malignant disease were excluded, as were desktop (records-only) reports. More than 90% of the reports were commissioned by solicitors for the defenders.
• Exposure: Past industrial asbestos exposure leading to non-malignant asbestos-related disease, together with involvement in civil actions. No fiber types, jobs or doses were reported.
• Main results:
  • Among the 100 men, hyperventilation was diagnosed in 33 and probable hyperventilation in 12 (45% combined).
  • Diagnostic groups: pleural plaques alone (16), pleural plaques and asbestosis (49), pleural plaques and diffuse pleural thickening (6), all three conditions (8), diffuse pleural thickening alone (16), diffuse pleural thickening and asbestosis (5). There was no asbestosis without pleural disease.
  • The lowest proportion with hyperventilation or probable hyperventilation was in the 49 men with pleural plaques and asbestosis (28.6%, 14 men). The author took this to suggest that disease severity was unlikely to be the main cause.
  • All 5 men with pleural thickening and asbestosis had hyperventilation or probable hyperventilation (Table 2).
  • Of the 16 men with pleural plaques alone, 9 developed hyperventilation (5 hyperventilation, 4 possible hyperventilation). Two of these 9 had no other medical conditions.
  • In five men referred for metabolic exercise testing, the author's diagnosis of hyperventilation was confirmed.
  • The author reported common misconceptions among the men, including that the majority believed their asbestos condition would considerably shorten their lives.
• The authors' conclusion: The author concluded that hyperventilation is common in men with non-malignant asbestos-related diseases involved in civil actions and is often overlooked. Its onset is usually triggered by anxiety, often brought on by a lack of information. The author also concluded that anxiety symptoms could be partly prevented or greatly decreased by more emphasis on educating ex-asbestos workers, by the solicitors and organisations responsible for starting civil actions.
• Limitations the authors state:
  • The author acknowledged that the hyperventilation diagnoses might have been incorrect (over-diagnosis), which is hard to check because follow-up is rarely available.
  • The author did not record whether other physicians had diagnosed hyperventilation before the author's examination.
  • The author noted that respiratory disability is extremely difficult to estimate when organic and non-organic causes are combined.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Asbestosis, Pleural plaques and thickening.

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