Pulmonary Asbestosis: Its Clinical, Radiological, And Pathological Features, And Associated Risk Of Tuberculosis Infection

Our plain-English summary of Pulmonary Asbestosis: Its Clinical, Radiological, And Pathological Features, And Associated Risk Of Tuberculosis Infection, by P. Ellman (1933).

The study

• Author: P. Ellman
• Published: Journal Of Industrial Hygiene 15(4):165-183, July (1933)
• Type of article: Journal article
• Our copy: from Johns-Manville's own medical library, J-M no. 003046. The article is still under copyright, so we describe it here rather than post it.

In plain English

This 1933 article by a London chest physician described pulmonary asbestosis in the author's own patients and its tuberculosis risk. It presented case reports of six asbestos factory workers (five women, one man) and a dog kept in an asbestos factory. The author wrote that symptoms usually appeared about 5 to 15 years after exposure. The author described roughly four X-ray stages. These ran from basal linear striation and haze, through fine punctate stippling at the bases and pleural involvement, to a fine diffuse mottling spreading upward from the lung bases, unlike the coarse nodular mottling of silicosis. Asbestosis bodies persisted in sputum for years. In one worker exposed for only 10 weeks, they were found 5 years later. Of 17 of the author's own definite cases, six had tuberculosis, four of them active. In one woman, tuberculosis developed on top of pure asbestosis. The author concluded that pulmonary asbestosis, once established, is progressive with a bad prognosis. The author also held that its tuberculosis risk must be reckoned with, though whether it was lower than, equal to or greater than in silicosis was not yet known.

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: Clinical description with a case series (case reports of six patients and a dog), based on the author's own clinical experience
• Who was studied: Six asbestos factory workers seen by the author, Physician in Charge of the Tuberculosis and Chest Clinic, County Borough of East Ham, London. They were women aged 22, 35, 26, 31 and 34 and a man aged 43. The article also described a dog (Case 7) kept in an asbestos factory.
• Exposure: Work in asbestos factories: mattress making with asbestos cloth and fibre (Case 1, 4 years), work as a teaser and carder (Case 3, 6 years) and work as a card-room superintendent (Case 6). Fiber types are not named; the article refers only to asbestos dust and fibres.
• Main results:
  • In the author's experience, workers may be fairly free of symptoms for several years, usually 5 to 15. In one or two cases symptoms followed exposure of 1 to 3 years or less.
  • The author described roughly four radiological stages. The first stage showed restricted diaphragm movement, basal linear striation and a fine haze at the bases. In the second stage the opacity became more obvious and fine punctate stippling could be detected at the bases. The third stage showed pleural involvement.
  • In the fourth stage, a fine diffuse punctate mottling spread from the lower zone to the middle and even upper zones. The author contrasted it with the coarse nodular mottling of silicosis.
  • Asbestosis bodies persisted in sputum for years. In one case exposed to the dust for only 10 weeks, the bodies were present in the sputum 5 years later.
  • According to the author, asbestosis bodies in sputum indicate only exposure to asbestos dust and cannot alone justify a diagnosis of pulmonary asbestosis.
  • Among 17 of the author's own definite cases of asbestosis, most of whom were not at work, six had tuberculosis, four of them active.
  • In Case 5 (woman aged 34), X-rays nearly 2 years apart showed tuberculous infiltration with cavitation developing on what had been pure asbestosis.
  • In Case 4 (woman aged 31), post-mortem examination showed pulmonary asbestosis complicated by advanced tuberculosis.
  • In the dog (Case 7), the lungs showed chronic diffuse interstitial fibrosis. Asbestos fibres were seen in large numbers, but no asbestosis bodies were found.
• The authors' conclusion: The author concluded that pulmonary asbestosis, once established, is a progressive disease with a bad prognosis. The author judged the time between exposure and death to be about half that in silicosis. The author held that the tuberculosis risk in asbestosis must be reckoned with, although time had yet to show whether it was less than, equal to, or perhaps greater than that in silicosis.
• Limitations the authors state:
  • The author described their own experience of tuberculosis in asbestosis as limited.
  • Whether the tuberculosis risk in asbestosis is lower than, equal to or greater than in silicosis was not yet known.

Topics

Medical terms in this study, explained in our Lexicon: Asbestosis, Silicosis, Sputum, Prognosis.

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