New developments in asbestos-induced pleural disease

Our plain-English summary of New developments in asbestos-induced pleural disease, by D.A. Schwartz (Chest, 1991).

The study

• Author: D.A. Schwartz
• Journal: Chest
• Published: 1991;99(1):191-8
• Type of article: Review
• Cited by: 57 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. 000490).

In plain English

This was a single-author review of published research on non-cancerous asbestos-related pleural disease. It focused on pleural plaques and diffuse pleural thickening, together called pleural fibrosis. It reported that across 16 general-population autopsy studies, pleural plaques were found in 857 of 7,085 autopsies (12.2 percent, range 0.5 to 39.3 percent), and that standard chest x-rays identified 50 to 80 percent of plaques present. It discussed theories of how fibers reach the pleura. It also questioned the 1980 International Labour Organization (ILO) x-ray classification, citing a study in which trained readers disagreed on the type of pleural abnormality 19 to 28 percent of the time between readers and 17 to 27 percent when the same reader read them again. In an earlier study by the author's group of 1,211 sheet metal workers, both circumscribed plaques and diffuse pleural thickening were independently associated with lower forced vital capacity (FVC), and the effect of diffuse thickening was about twice as large. The author concluded that pleural fibrosis is the most common asbestos-induced abnormality, is underdiagnosed, is linked to restricted lung function, and needs further study.

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: Narrative review of published studies on non-malignant asbestos-induced pleural disease, including summaries of the author's group's own earlier studies
• Who was studied: Published studies of asbestos-exposed workers, household and environmentally exposed people, autopsy series and animal experiments. Also an earlier study by the author's group of 1,211 sheet metal workers.
• Exposure: Asbestos exposure in general, mainly occupational (sheet metal work in the author's group's study), plus household contact and endemic environmental exposure to asbestiform minerals. The review notes that pleural fibrosis depends on cumulative dose and time since first exposure.
• Main results:
  • Across 16 autopsy studies of the general population, pleural plaques were found in 857 of 7,085 routine autopsies (12.2 percent; range 0.5 to 39.3 percent).
  • According to the review, autopsy and CT studies indicate that the standard chest x-ray identifies between 50 and 80 percent of pleural plaques actually present.
  • The review reports that 20 to 60 percent of workers exposed to high asbestos concentrations had x-ray evidence of pleural fibrosis in earlier studies.
  • The review reports that household or endemic environmental exposure produced a prevalence of pleural fibrosis of 2 to 17 percent.
  • In a cited study (Bourbeau and Ernst), ILO-trained readers disagreed on the type of pleural abnormality (circumscribed plaque vs diffuse pleural thickening). The same reader disagreed with themselves 17 to 27 percent of the time, and different readers disagreed with each other 19 to 28 percent of the time.
  • In the author's group's earlier study of 1,211 sheet metal workers, 334 had pleural fibrosis: 260 (78 percent) had circumscribed plaques and 74 (22 percent) had diffuse pleural thickening.
  • In the sheet metal workers, after adjusting for age, years in the trade, pack-years of smoking and ILO profusion category, both circumscribed plaques (p=0.02) and diffuse pleural thickening (p=0.005) were independently associated with reductions in FVC. The effect of diffuse thickening was approximately twice that of plaques.
  • In the author's group's study of nonsmoking asbestos workers with normal-looking lungs on chest x-ray (24 workers, per the figure legends), pleural plaques and diffuse pleural thickening were associated with lymphocytic alveolitis (lung inflammation). In a multivariate analysis, neither the alveolitis nor fibrosis seen on high-resolution CT changed the relation between pleural fibrosis and restrictive lung function.
• The authors' conclusion: The author concluded that previous studies indicate pleural fibrosis is the most common asbestos-induced abnormality and is being underdiagnosed. The author also concluded it is associated with restrictive lung function that appears independent of parenchymal fibrosis, and that further studies are needed, including on the accuracy of the ILO criteria.

Topics

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

Related studies

• Are lung and pleural benign asbestos induced diseases a preliminary step in the pathogenic process of mesothelioma and lung cancer development? — M. Goldberg (2005)
• The relationship between HLA-A, B, DQ, and DR antigens and asbestos-induced lung disease — J.F. Shih, G.W. Hunninghake, et al. (1993)
• Rounded atelectasis and its association with asbestos-induced pleural disease — R.A. Mintzer, R.M. Gore, et al. (1981)
• The association of asbestos-induced pleural disease and rounded atelectasis — R.A. Mintzer, D.W. Cugell (1982)
• Environmental fiber-induced pleuro-pulmonary diseases in an Anatolian village: an epidemiologic study — M. Artvinli, Y.I. Baris (1982)
• Incremental value of oblique chest radiographs in the diagnosis of asbestos-induced pleural disease — E.L. Baker, R. Greene (1982)

Browse more research in Chest, or return to medical research.