Progressive apical pleural fibrosis: a 'constrictive' ventilatory defect

Our plain-English summary of Progressive apical pleural fibrosis: a 'constrictive' ventilatory defect, by R.M. Oliver, E. Neville (British Journal of Diseases of the Chest, 1988).

The study

• Authors: R.M. Oliver, E. Neville
• Journal: British Journal of Diseases of the Chest
• Published: 1988;82(4):439-43
• Type of article: Case report
• Cited by: 12 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. 000926).

Abstract

We report two patients with bilateral apical pleural fibrosis which may be a form of benign asbestos-related pleurisy, one of these being steroid responsive. The pulmonary function defect of reduced lung volumes with raised gas transfer coefficient is characteristic and is best described as 'constrictive'.

In plain English

This article reported two patients seen at St Mary's Hospital, Portsmouth, with progressive scarring (fibrosis) of the pleura at the tops of both lungs. Both had been exposed to asbestos. One was a 56-year-old electronics engineer who thought the exposure was small. The other was a 35-year-old heating engineer with extensive exposure. Imaging showed no underlying lung abnormality, and tests for tuberculosis in sputum and laryngeal swabs were negative. In both patients, lung volumes fell progressively. In the first patient, a pleural biopsy showed extensive fibrosis with chronic inflammatory cells. Steroids were followed by improved breathing tests, and stopping them in May 1983 led to a dramatic deterioration that reversed when they were restarted. In the second patient, prednisolone 20 mg daily brought no improvement. In both, the gas transfer coefficient (Kco) was above predicted, at 116% and 133%. The authors called the cause uncertain and judged mesothelioma improbable given the length of follow-up. They thought benign asbestos-related pleurisy in an unusual distribution likely, and proposed the term 'constrictive' for this lung function pattern. These are two individual cases, not a rate.

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 report (two patients)
• Who was studied: Two male engineers at the Department of Respiratory Medicine, St Mary's Hospital, Portsmouth: a 56-year-old electronics engineer who presented in 1976 and a 35-year-old heating engineer who presented in 1979
• Exposure: Occupational asbestos exposure, fiber type not stated. Case 1 (electronics engineer) thought the exposure was small but some contact was inevitable. Case 2 (heating engineer) had extensive exposure.
• Main results:
  • Case 1: chest radiograph showed bilateral apical pleural thickening, and tomograms showed no underlying lung pathology
  • Case 1: an open pleural biopsy in 1979 showed extensive pleural fibrosis with chronic inflammatory cells
  • Case 1: at presentation, FEV1 was 2.8 litres (predicted 3.4) and FVC was 3.0 litres (predicted 4.5). Diffusing capacity was 60% of predicted.
  • Case 1: oral steroids were followed by objective improvement in spirometry. Withdrawal in May 1983 led to dramatic deterioration, and restarting prednisolone returned the patient to the previous state. Symptoms and spirometry then stayed static on a small maintenance dose.
  • Case 2: radiographs showed bilateral apical pleural thickening with no apparent underlying lung abnormality. The Heaf test was grade 4 positive and HLA-B27 was positive, but sputum and laryngeal cultures for tuberculosis were negative. The patient had been in contact with tuberculosis in 1975.
  • Case 2: at presentation, FEV1 was 2.3 litres (predicted 3.8) and FVC was 2.7 litres (predicted 4.7). Diffusing capacity was 89% of predicted. Exercise tolerance and spirometry declined progressively by 1983.
  • Case 2: prednisolone 20 mg daily from October 1983 gave no symptomatic or objective improvement and was stopped
  • Later lung function (Table 1), Case 1: FVC 47%, FEV1 55%, total lung capacity 58%, diffusing capacity 69% and Kco 116% of predicted
  • Later lung function (Table 1), Case 2: FVC 38%, FEV1 43%, total lung capacity 46%, diffusing capacity 54% and Kco 133% of predicted
  • In both patients, the authors described an elevated Kco together with a restrictive ventilatory deficit as a characteristic finding
• The authors' conclusion: The authors concluded that the cause was uncertain. They considered mesothelioma improbable given the length of follow-up, and thought the patients likely had benign asbestos-related pleurisy in an unusual distribution. They proposed the term 'constrictive' for reduced lung volumes with an elevated transfer coefficient (Kco), and stated that steroids seemed causally related to the improvement in Case 1.
• Limitations the authors state:
  • The authors stated that the cause of the apical pleural fibrosis was uncertain
  • The authors stated that mesothelioma had to be considered, though they judged it improbable given the length of follow-up
  • The authors found the steroid response in Case 1 difficult to explain

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, Bilateral, Pleurisy.

Related studies

• 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)
• Ventilatory insufficiency due to asbestos-related diffuse pleural fibrosis successfully treated with noninvasive home mechanical ventilation — X. Muñoz, A. Roger, et al. (2001)
• Risk and significance of chest radiograph and pulmonary function abnormalities in an elderly cohort of former nuclear weapons workers — M.A. Mikulski, P.G. Hartley, et al. (2011)
• The validity of static lung compliance in asbestos-induced diseases — J. Schneider, R. Arhelger, et al. (2012)
• Restrictive lung function and asbestos-induced pleural fibrosis. A quantitative approach — D.A. Schwartz, J.R. Galvin, et al. (1993)

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