Pleural and parenchymal fibrosis mainly affecting the upper lung lobes in persons exposed to asbestos

Our plain-English summary of Pleural and parenchymal fibrosis mainly affecting the upper lung lobes in persons exposed to asbestos, by G. Hillerdal (Respiratory Medicine, 1990).

The study

• Author: G. Hillerdal
• Journal: Respiratory Medicine
• Published: 1990;84(2):129-34
• Cited by: 20 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. 003828).

Abstract

From the County of Uppsala, Sweden, more than 1600 persons with pleural plaques and/or asbestos-related pleural thickening have been seen at the Uppsala University Hospital during a period of about 15 years. During the observation time, 40 patients developed lesions mainly affecting the upper lobes of the lung. They were all men, 41 to 78-years-old, and all had been occupationally exposed to asbestos. The mean latency time from the first exposure was 34 years. The mean width of the apical pleural thickening was 21 mm. In 21 patients the lesions were on the right side, in 15 they were bilateral, and in only four patients was the left side alone affected. Biopsies from the pleura were available in twelve patients and from the lung parenchyma in eight. The biopsies of the lungs all showed varying degrees of asbestosis and of the pleura nonspecific pleuritis. The lesions tended to progress and in all cases except one they were part of a diffuse pleural and parenchymal fibrosis involving the rest of the lung. Consequently, the pulmonary function was impaired, with the vital capacity reduced to an average of 62% and total lung capacity to 68% of the predicted value. In many patients there was contraction of the upper lobe and deviation of the trachea towards the same side. Upper lobe changes are a relatively rare complication of exposure to asbestos but are important to recognise. Other possible causes of upper lobe changes such as tuberculosis must always be excluded before the diagnosis is made.

In plain English

This article followed up 40 men from the County of Uppsala, Sweden. They came from about 1600 patients with asbestos-related X-ray changes at Uppsala University Hospital. All had been exposed to asbestos at work, mostly in construction, and none reported heavy daily exposure. During follow-up they developed pleural thickening greatest at the lung's top (apex). The changes were right-sided in 21 men, left-sided in four and on both sides in 15. Mean maximum thickness was 21 mm. The lesions progressed in every man followed for more than five years. In the 21 men tested, vital capacity averaged 62% and total lung capacity 68% of predicted. Lung biopsies from nine men showed asbestosis, and pleural biopsies from twelve showed nonspecific chronic pleuritis. Tuberculosis cultures, from bronchial secretions in eight men and gastric lavage in another 15, were all negative. Ten men died, four of asbestosis and three of lung carcinoma. The author concluded that these upper-lobe changes are a fairly rare effect of asbestos that should be recognised to avoid confusion with tuberculosis. The author noted that the diagnosis rests on excluding other causes.

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: Case series: follow-up of 16 patients the author reported in 1982, plus 24 new patients, drawn from a regional series of patients with asbestos-related chest changes
• Who was studied: 40 men, from about 1600 patients from the County of Uppsala, Sweden, who had asbestos-related pleural and/or parenchymal changes and were followed at Uppsala University Hospital from the early 1970s. Patient investigation ended in 1986 and follow-up ran to June 1989. The 40 had no apical lesions at the start but developed them during observation. Mean age at the first apical sign was 60 years.
• Exposure: Occupational asbestos exposure, graded 1 (intermittent), 2 (daily but moderate) or 3 (heavy daily). Most men worked in the construction trades (18 builders, three plumbers, others repairmen, electricians and so on). Two traded or transported asbestos and one was a goldsmith. Fiber types were not stated. Mean length of exposure was 25 years.
• Main results:
  • Of the 40 men, 29 (73%) reported Grade 1 (intermittent) exposure and 11 reported Grade 2. None reported Grade 3 (heavy daily) exposure.
  • Mean latency from first asbestos exposure to the apical changes was 32 years, ranging from 5 to 51 years.
  • Apical changes were on the right side alone in 21 men, the left side alone in four, and both sides in 15.
  • Mean maximum width of the apical thickening on the last available chest X-ray was 21 mm (1 SD = 9 mm), with a range of 7 to 40 mm.
  • The apical lesions progressed in all patients observed for more than 5 years.
  • All but one man had diffuse pleural thickening on both sides. The remaining man had pleural plaques.
  • In the 21 men with lung function tests, vital capacity averaged 62% of predicted (1 SD = 12%). Total lung capacity averaged 68% of predicted (1 SD = 12%), with a range of 50 to 93%.
  • Lung function showed no significant correlation with the thickness of the apical changes. It also showed no correlation with the degree or years of asbestos exposure.
  • Lung biopsies from nine men showed classical asbestosis, ranging from slight to severe. Pleural biopsies from 12 men all showed unspecific cell-poor chronic pleuritis.
  • Cultures for tubercle bacilli were made on bronchial secretions in eight men and on gastric lavage in another 15.
  • The tuberculosis cultures that were done were all negative.
  • Tuberculosis chemotherapy given to five men did not affect the progression of their disease.
  • Ten men died during the observation period: four of asbestosis confirmed at autopsy, and three of carcinoma of the lung.
• The authors' conclusion: The author concluded that upper-lobe changes are a fairly rare manifestation of asbestos exposure. The author wrote that awareness of them matters to avoid confusion with tuberculosis and for compensation purposes.
• Limitations the authors state:
  • The author noted that the diagnosis rests on excluding other causes and on a history of asbestos exposure.

Topics

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

Medical terms in this study, explained in our Lexicon: Parenchymal Fibrosis, Pleural Plaques, Pleural Thickening, Latency, Bilateral, Pleura, Parenchyma, Total Lung Capacity (TLC).

Related studies

• Massive bilateral upper lobe fibrosis secondary to asbestos exposure — R.A. Green, D.G. Dimcheff (1974)
• The human evidence: parenchymal and pleural changes — G. Hillerdal (1994)
• Determinants of restrictive lung function in asbestos-induced pleural fibrosis — D.A. Schwartz, J.R. Galvin, et al. (1990)
• Asbestos-induced pleural fibrosis and impaired lung function — D.A. Schwartz, L.J. Fuortes, et al. (1990)
• Diffusing capacity and forced vital capacity in 5,003 asbestos-exposed workers: relationships to interstitial fibrosis (ILO profusion score) and pleural thickening — A. Miller, R. Warshaw, et al. (2013)
• Do asbestos-related pleural plaques on HRCT scans cause restrictive impairment in the absence of pulmonary fibrosis? — B. Clin, C. Paris, et al. (2011)

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