Parenchymal and airway diseases caused by asbestos

Our plain-English summary of Parenchymal and airway diseases caused by asbestos, by A.L. Antonescu-Turcu, R.M. Schapira (Current Opinion in Pulmonary Medicine, 2010).

The study

• Authors: A.L. Antonescu-Turcu, R.M. Schapira
• Journal: Current Opinion in Pulmonary Medicine
• Published: 2010;16(2):155-61
• Type of article: Review
• Cited by: 10 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Purpose Of Review: The extensive industrial use of asbestos for many decades has been linked to development of benign and malignant pleuropulmonary disease. This review summarizes newer evidence and ongoing controversies that exist in the literature regarding asbestos-related parenchymal and airway diseases.

Recent Findings: Asbestosis represents a significant respiratory problem despite the improvement in the workplace hygiene and a decrease in use of asbestos. The management of asbestosis remains challenging as currently there is no specific treatment. The role of asbestos exposure alone as a cause of chronic airway obstruction remains uncertain. The relationship between lung cancer and asbestos exposure alone and in combination with smoking has also been investigated. The benefit of screening for asbestos-related pleuropulmonary disease remains uncertain as does the use of computed tomography scanning for the purpose of screening.

Summary: Future studies will help clarify the clinical issues and shape screening strategies for asbestos-exposed individuals.

In plain English

This article was a review, not a new study. The authors summarized published evidence and ongoing debates about asbestos-related diseases of the lung tissue (parenchyma) and airways, mainly asbestosis, airway obstruction and lung cancer. They described several earlier studies. A Finnish study screened heavily exposed workers with high-resolution CT and found interstitial fibrosis in 13.7% of 627 workers. A Dutch cohort of 58 279 men found that asbestos exposure was associated with a relative risk of lung cancer of 3.5 (95% CI 1.7–7.2). In a North Carolina cohort of 5770 chrysotile-exposed workers, lung cancer risk rose by 10% per 100 fiber-year/ml. The Great Britain Asbestos Survey of 98 117 workers found an increased risk of death from all causes (SMR 141, 95% CI 139–143). The authors wrote that the role of asbestos alone in chronic airway obstruction remains uncertain. They also wrote that the data do not support CT screening for lung cancer in asbestos-exposed workers. The authors concluded that asbestos remains a significant cause of illness and death in exposed workers.

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 literature
• Who was studied: No study population of its own. The review drew on published studies of asbestos-exposed workers in countries including Croatia, Finland, China, the United States, France, the Netherlands, Canada and Great Britain.
• Exposure: Asbestos, chiefly occupational exposure. The article describes the fibers as serpentine (chrysotile) and amphibole (crocidolite, amosite, tremolite, anthophyllite and actinolite). It also discusses the combined effect of asbestos and smoking.
• Main results:
  • Finnish study (Vierikko et al.) of heavily exposed asbestos workers screened with high-resolution CT: interstitial fibrosis was found in 13.7% of the 627 workers.
  • Study by Silva et al. of asbestos-exposed workers: 81% (42/52) showed radiographic progression at 3–5 years, but the proposed semiquantitative scoring schemes did not detect this progression.
  • Study by Ohar et al. of 3383 individuals: an obstructive defect was the most common lung function abnormality (25.4%). Most individuals (42%) had normal lung function.
  • The review authors' assessment of airway disease: the role of asbestos exposure alone in chronic airway obstruction remains uncertain. In never smokers an association has been described, but its clinical significance seems small.
  • Netherlands prospective cohort of 58 279 men (van Loon et al.): 524 lung cancer cases developed over 4.3 years of follow-up. Asbestos exposure was associated with a relative risk of lung cancer of 3.5 (95% CI 1.7–7.2), and lifetime occupational asbestos exposure accounted for 11.6% of lung cancer cases in the cohort.
  • North Carolina cohort of 5770 workers exposed to chrysotile (Loomis et al.): mortality from all cancers and from lung cancer was higher than expected compared with the national population, and lung cancer risk increased by 10% per 100 fiber-year/ml.
  • French screening study of 972 highly exposed individuals (Clin et al.): 24 lung cancers were diagnosed over 2 years. With a greater than 2 mm cutoff, sensitivity was 33% for plain chest radiograph and 83% for CT scan, and specificity was 95% and 78% respectively.
  • Canadian annual low-dose CT screening of 516 asbestos workers (Roberts et al.): the lung cancer rate was 1.1%. The review authors wrote that the data do not support lung cancer screening by CT scan in asbestos-exposed workers.
  • Great Britain Asbestos Survey of 98 117 asbestos workers, followed to the end of 2005 (Harding et al.): there was an increased risk of death from all causes (SMR 141, 95% CI 139–143), as well as from lung cancer, mesothelioma and asbestosis.
• The authors' conclusion: The authors concluded that asbestos remains a significant cause of illness and death in exposed workers. They expect future studies to clarify the impact of improved work practices and possible changes in disease burden.
• Limitations the authors state:
  • The authors noted that studies linking asbestos with airway obstruction are limited by two factors: the presence of asbestosis and smoking history.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Asbestosis.

Medical terms in this study, explained in our Lexicon: Asbestos Exposure, Lung Cancer.

Related studies

• Cigarette smoke makes airway and early parenchymal asbestos-induced lung disease worse in the guinea pig — V. Tron, J.L. Wright, et al. (1987)
• Chest pain in asbestos-exposed individuals with benign pleural and parenchymal disease — S. Mukherjee, N. de Klerk, et al. (2000)
• Correlation of lung function with ultra-low-dose CT-detected lung parenchymal abnormalities: a cohort study of 1344 asbestos exposed individuals — F. Brims, E.J. Harris, et al. (2022)
• The relative importance of clinical, radiological and pulmonary function variables in evaluating asbestosis and chronic obstructive airway disease in asbestos workers — G.M. Regan, B. Tagg, et al. (1971)
• Crackles (rales) in the interstitial pulmonary diseases — G.R. Epler, C.B. Carrington, et al. (1978)
• Asbestos-related diseases in construction carpenters — M. García-Closas, D.C. Christiani (1995)

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