Pleural disease during treatment with bromocriptine in patients previously exposed to asbestos

Our plain-English summary of Pleural disease during treatment with bromocriptine in patients previously exposed to asbestos, by G. Hillerdal, J. Lee, A. Blomkvist, et al (The European Respiratory Journal, 1997).

The study

• Authors: G. Hillerdal, J. Lee, A. Blomkvist, A. Rask-Andersen, M. Uddenfeldt, H. Koyi, E. Rasmussen
• Journal: The European Respiratory Journal
• Published: 1997;10(12):2711-5
• Type of article: Case report
• Cited by: 11 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Bromocriptine, which is used in the treatment of Parkinson's disease, can cause adverse pleuropulmonary reactions. Exposure to asbestos can result in similar lesions. Fifteen patients with former exposure to asbestos, who developed pleural fibrosis after treatment with bromocriptine, were observed independently in Sweden (11 patients) and Australia (four patients). The patients complained of malaise, often associated with weight loss, dyspnoea, and a disturbing cough. Laboratory values included increased erythrocyte sedimentation rate and a low haemoglobin level. Lung function tests showed a restrictive lung function defect. Chest radiographs showed bilateral pleural fibrosis, with small amounts of fluid in some cases. Soon after bromocriptine was withdrawn, the patients improved clinically, and the laboratory values returned to normal. However, in most cases, pleural fibrosis and a restrictive lung function defect persisted to some extent. In conclusion, in patients who develop pleuropulmonary fibrosis whilst being treated with bromocriptine, former exposure to asbestos should be investigated. Conversely, when pleural changes develop in a patient on bromocriptine and with prior exposure to asbestos, the possible causative role of the drug should be discussed. Special follow-up may be indicated when bromocriptine is planned in a patient with previous asbestos exposure, and if symptoms or signs of pleural fibrosis develop, bromocriptine withdrawal should be considered.

In plain English

This article was a case series. It described 15 patients who had been exposed to asbestos in the past and who developed pleural fibrosis (scarring of the lining around the lungs) while taking bromocriptine, a drug used for Parkinson's disease. Eleven were seen in Sweden and four in Australia between 1986 and 1997, without systematic recruitment. Past jobs included building work, building painting and chemical factory work. The article did not name fiber types. Chest X-rays showed diffuse thickening of the pleura on both sides in all patients, and six had pleural fluid at some stage. Of 11 patients with data, 10 had a raised sedimentation rate, a blood marker of inflammation, and haemoglobin was low in all cases. In 12 patients, forced vital capacity averaged 62% of predicted. After bromocriptine was stopped, cough and malaise disappeared within days. Lung function improved only slightly or remained unchanged, and a restrictive defect often persisted. The authors suggested that asbestos and bromocriptine may act together, and they stated that their study does not provide epidemiological proof of this.

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 (report of 15 patients seen by the authors; no systematic recruitment and no epidemiological comparison)
• Who was studied: 15 patients referred to or evaluated by one of the authors between 1986 and 1997 because of a restrictive lung function defect caused by pleural and/or pleural-parenchymal lesions. All had past asbestos exposure and were being treated with bromocriptine. Eleven were seen in Sweden and four in the Sydney region of Australia.
• Exposure: Past asbestos exposure, together with bromocriptine treatment. Occupations in the table include building worker, building painter, chemical factory, electrician, retail hardware store, farmer, and work in an asbestos mine. Fiber types are not stated. Bromocriptine doses in the table range from 5 to 30 mg per day.
• Main results:
  • An increased erythrocyte sedimentation rate was found in 10 of the 11 patients for whom data were available, and a low haemoglobin level was seen in all cases
  • Chest radiographs showed diffuse bilateral pleural thickening in all 15 patients
  • Six patients had pleural fluid at some stage of the disease
  • Rounded atelectasis was seen in 5 of the 15 patients
  • In the 12 patients with dynamic spirometry, forced vital capacity was low: mean 62% of predicted (plus or minus 3, standard error), range 50 to 81% predicted
  • In the 8 patients with static spirometry, total lung capacity averaged 66% of predicted (range 58 to 73%), a restrictive pattern
  • Pleural biopsies in 5 patients all showed extensive nonspecific fibrosis
  • After bromocriptine was withdrawn, symptoms such as cough and malaise disappeared after a few days
  • After withdrawal, lung function improved only slightly or remained unchanged, and a restrictive lung function defect often remained due to pleural fibrosis
  • In case No. 14, forced vital capacity was 5.0 L (96% predicted) before bromocriptine, fell to 3.0 L (62% predicted) during treatment, and returned to 3.5 L (71% predicted) after the drug was stopped
• The authors' conclusion: The authors suggested that there may be a synergistic effect between past asbestos exposure and bromocriptine. In their words, the risk of adverse respiratory effects from bromocriptine may be enhanced in people previously exposed to asbestos.
• Limitations the authors state:
  • The authors stated that the study does not provide epidemiological proof that asbestos potentiates the adverse effects of bromocriptine
  • Patients were not recruited systematically, and no epidemiological study was done among bromocriptine users or asbestos-exposed cohorts
  • Lung function tests could not be performed in five patients because of severe Parkinson's disease symptoms

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: Fibrosis, Restrictive Lung Disease, Chest X-Ray, Bilateral, Asbestos Exposure.

Related studies

• Pleural effusion during bromocriptine exposure in two patients with pre-existing asbestos pleural plaques: a relationship? — C. Knoop, M. Mairesse, et al. (1997)
• Pleuropulmonary fibrosis after long-term treatment with the dopamine agonist pergolide for Parkinson Disease — R. Tintner, P. Manian, et al. (2005)
• Rounded atelectasis and respiratory compromise secondary to pergolide use — C.I. Bloom, G.E. Wilson (2009)
• Asbestos, ergot drugs and the pleura — P. Camus, G. Hillerdal, et al. (1998)
• The relationship between HLA-A, B, DQ, and DR antigens and asbestos-induced lung disease — J.F. Shih, G.W. Hunninghake, et al. (1993)
• Non-malignant asbestos pleural disease — G. Hillerdal (1981)

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