Interstitial pulmonary fibrosis environmental or idiopathic?

Our plain-English summary of Interstitial pulmonary fibrosis environmental or idiopathic?, by G.L. Snider (Hospital Practice, 1985).

The study

• Author: G.L. Snider
• Journal: Hospital Practice
• Published: 1985;20(6):94C-94H, 94M-94P, 94T-94U passim
• Cited by: 1 article, 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. 001237).

In plain English

This 1985 article was a clinical review of chronic interstitial pulmonary fibrosis, built around the case of one patient. It was not a study of a group of people. The author used four disorders as examples: hypersensitivity pneumonia, sarcoidosis, idiopathic interstitial pulmonary fibrosis, and inorganic dust diseases such as asbestosis and silicosis. The patient was a 64-year-old man who had smoked two packs of cigarettes a day from age 20 and had been exposed to asbestos in construction work. His chest x-ray showed diffuse infiltration of both lungs. His lung volumes were 55% to 60% of predicted values, and a muscle biopsy was consistent with polymyositis. He had spent most of his working life remodeling old buildings, where the author wrote little asbestos is likely to be found, so asbestos seemed unlikely to be a significant factor. The author added that his lung disease responded to corticosteroids, which asbestosis does not, but lung function improved only modestly. In the review, the author wrote that pleural plaques suggest asbestosis and that ferruginous bodies indicate exposure but do not prove disease.

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 for physicians, built around a single case report
• Who was studied: One patient: a 64-year-old man with a 20-year history of knee joint pain, seen by the author's team (author at Boston University); no group of subjects was studied
• Exposure: Chronic asbestos exposure over many years in the construction industry, including asbestos used to insulate the beams of high-rise buildings; fiber type not stated. He had also smoked an average of two packs of cigarettes a day from age 20.
• Main results:
  • In the patient, the chest x-ray showed diffuse bilateral parenchymal pulmonary infiltration
  • In the patient, total lung capacity, vital capacity, residual volume and functional residual capacity were all 55% to 60% of predicted values
  • In the patient, the carbon monoxide diffusing capacity was 41% of the predicted value
  • In the patient, a deltoid muscle biopsy was consistent with polymyositis, which the author describes as associated with interstitial pulmonary fibrosis
  • The patient had spent most of his working life remodeling old buildings, where the author wrote little asbestos is likely to be found. On the basis of this history, asbestos seemed unlikely to be a significant factor in his lung disease.
  • The author took the response of the patient's lung disease to corticosteroids as suggesting that this judgment was correct, stating that pulmonary asbestosis does not respond to corticosteroid therapy
  • In the patient, prednisone (60 mg per day) brought rapid improvement in joints and muscles, but follow-up studies showed only modest improvement in pulmonary function
  • Review statement by the author (not a finding of this case): fine 'Velcro' crackles are heard in 60% to 90% of patients with idiopathic interstitial pulmonary fibrosis or asbestosis
  • Review statement by the author: pleural plaques, and especially pleural calcification, are suggestive of asbestosis
  • Review statement by the author: ferruginous bodies of asbestosis seen in sputum or lung biopsy indicate exposure but do not prove that the patient has dust-related disease
  • Review statement by the author: asbestos mining is a relatively low-risk occupation, while secondary processes and tertiary uses carry exposure, including for workers such as pipe fitters near insulators who never work directly with asbestos
  • Review statement by the author: in asbestosis, death occurs primarily from mesothelioma and from lung cancer, the latter with greatly increased incidence in cigarette smokers
• The authors' conclusion: The author concluded that an environmental history is the key to diagnosing inorganic and organic dust diseases. In this patient, serologic tests, muscle biopsy and electromyography established polymyositis and made invasive studies unnecessary.

Topics

Medical terms in this study, explained in our Lexicon: Interstitial, Pulmonary Fibrosis, Idiopathic.

Related studies

• Relative release of interleukin-1 beta and interleukin-1 receptor antagonist by alveolar macrophages. A study in asbestos-induced lung disease, sarcoidosis, and idiopathic pulmonary fibrosis — J.N. Kline, D.A. Schwartz, et al. (1993)
• Idiopathic pulmonary fibrosis in asbestos-exposed workers — E.A. Gaensler, P.J. Jederlinic, et al. (1991)
• Lung dust content in idiopathic pulmonary fibrosis: a study with scanning electron microscopy and energy dispersive x ray analysis — E. Monsó, J.M. Tura, et al. (1991)
• A role for the receptor for advanced glycation end products in idiopathic pulmonary fibrosis — J.M. Englert, L.E. Hanford, et al. (2008)
• Agreement between chest radiography and high-resolution computed tomography in diagnosing dust-related interstitial lung fibrosis — R.R. Tiwari (2015)
• Inhibition of lung injury, inflammation, and interstitial pulmonary fibrosis by polyethylene glycol-conjugated catalase in a rapid inhalation model of asbestosis — B.T. Mossman, J.P. Marsh, et al. (1990)

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