"Not your grandfather's pleural disease": rapid progression, ventilatory impairment, and chronic pleuritic pain from Libby vermiculite/amphibole

Our plain-English summary of "Not your grandfather's pleural disease": rapid progression, ventilatory impairment, and chronic pleuritic pain from Libby vermiculite/amphibole, by A. Miller (American Journal of Industrial Medicine, 2014).

The study

• Author: A. Miller
• Journal: American Journal of Industrial Medicine
• Published: 2014;57(11):1195-6
• Type of article: Comment
• Cited by: 5 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Summary of the article

In this commentary, the author discussed a report by Black and colleagues, published in the same journal issue, on pleural disease in people exposed to Libby vermiculite/amphibole. He summarized established knowledge of benign asbestos-related pleural disease, including acute exudative pleural effusion, plaques and diffuse pleural thickening. He also noted problems with the ILO X-ray classification, including discrepancies between X-ray and CT findings. He reviewed earlier Libby studies, including a reported latency of 8.6 years for pleural thickening, progression in 64 of 84 patients, and accelerated yearly loss of lung function in 94 of 123 patients (vital capacity 3.2%, total lung capacity 2.3%, diffusing capacity 3.3%). He described the disease shown in Black and colleagues' five illustrative cases as remarkably thin, smooth and non-dense, and often missed on X-ray and even on CT. It was unassociated with pleural effusion and more likely to be accompanied by progressive dyspnea, restrictive ventilatory impairment and difficult-to-treat pleuritic pain. He stated that the reason for this behavior was not known and noted the possible role of autoimmunity discussed by those authors. He concluded that their message was to make the medical community and government agencies aware of this devastating progressive asbestos-related disease.

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 short commentary presented no new data. It introduced a report by Black and colleagues, in the same journal issue, on pleural disease from amphibole asbestos in vermiculite mined at Libby. According to the author, Black and colleagues used five illustrative cases to describe a pleural disease that was remarkably thin, smooth and non-dense, often missed on chest X-ray, and not associated with pleural effusion. The author wrote that, unlike the familiar diffuse pleural thickening that is obvious on X-ray, this disease was much more likely to come with progressive breathlessness, restrictive ventilatory impairment and pleuritic pain that was difficult to treat. The author also cited an earlier report (Whitehouse, 2004) in which 94 of 123 pulmonary-practice patients showed accelerated loss of lung function. The author stated that why the pleura responds this way to Libby amphibole is not known. The author noted that Black and colleagues planned a future report on the disease's frequency. The author concluded that their message was to make doctors and government agencies aware of what the author called a devastating progressive asbestos-related 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: Commentary (editorial introducing another article in the same issue); no original data
• Who was studied: No population was studied by the author. The commentary discusses a report by Black et al. (2014) in the same issue, which presented five illustrative cases of people exposed to Libby amphibole.
• Exposure: Amphibole asbestos in vermiculite mined at Libby. The commentary cites Meeker et al. (2003) as describing these amphiboles as winchite, richterite and tremolite.
• Main results:
  • The commentary describes the pleural disease reported by Black et al. (not by this author) as remarkably thin, smooth and non-dense, and often not seen on X-ray.
  • The commentary states that, as reported by Black et al., this disease was unassociated with pleural effusion. Compared with the familiar, radiologically obvious diffuse pleural thickening, it was much more likely to be accompanied by progressive dyspnea, restrictive ventilatory impairment and difficult-to-treat pleuritic pain.
  • The commentary cites an earlier study (Whitehouse, 2004), not this article. In that study, 94 of 123 patients seen in a pulmonary practice showed accelerated loss of lung function. The yearly losses were 3.2% for vital capacity, 2.3% for total lung capacity and 3.3% for diffusing capacity.
  • The commentary notes that Black et al. planned a future report on the frequency, progression, pathology and exposure characteristics of their cohort.
• The authors' conclusion: The author stated that why the pleura reacts this way to Libby amphibole is not known. The author concluded that the message of Black and colleagues was to make the medical community and government agencies aware of what the author called a devastating progressive asbestos-related disease.

Topics

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

Medical terms in this study, explained in our Lexicon: Pleuritic Chest Pain, Libby Vermiculite, Amphibole Group, Asbestos-Related Pleural Disease, Pleural Effusion, Diffuse Pleural Thickening, Latency, Pleural Thickening.

Related studies

• Rapid progression of pleural disease due to exposure to Libby amphibole: "Not your grandfather's asbestos related disease" — B. Black, J. Szeinuk, et al. (2014)
• Libby Amphibole Disease: Pulmonary Function and CT Abnormalities in Vermiculite Miners — A. Miller, J. Szeinuk, et al. (2018)
• Chronic pleuritic pain in four patients with asbestos induced pleural fibrosis — A. Miller (1990)
• Workers with Libby amphibole exposure: retrospective identification and progression of radiographic changes — T.C. Larson, C.A. Meyer, et al. (2010)
• Pulmonary abnormalities as a result of exposure to Libby amphibole during childhood and adolescence-The Pre-Adult Latency Study (PALS) — J. Szeinuk, C.W. Noonan, et al. (2017)
• Lung cancer screening in patients with Libby amphibole disease: High yield despite predominantly environmental and household exposure — G. Loewen, B. Black, et al. (2019)

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