Pulmonary fibrosis following household exposure to asbestos dust?

Our plain-English summary of Pulmonary fibrosis following household exposure to asbestos dust?, by J. Schneider, B. Brückel, L. Fink, et al (Journal of Occupational Medicine and Toxicology, 2014).

The study

• Authors: J. Schneider, B. Brückel, L. Fink, H.J. Woitowitz
• Journal: Journal of Occupational Medicine and Toxicology
• Published: 2014;9(1):39
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

An 81-year-old woman was dying from histologically confirmed pulmonary fibrosis without having had any asbestos exposure in the workplace. The lung dust fibre analysis showed significantly increased "asbestos bodies" (AB) (2,640 AB per gram of wet lung tissue) and asbestos fibre concentrations (8,600,000 amphibole fibres of all lengths and 540,000 amphibole fibres with a length ≥5 μm per gram of dry lung tissue). Asbestos exposure was revealed to have occurred during household contact after 27 years of washing her husband's industrial clothing that had been contaminated by asbestos at his workplace in an asbestos textile factory. Household asbestos dust exposure as a risk or co-factor in the aetiology of the fatal pulmonary fibrosis is discussed.

In plain English

This case report described an 81-year-old housewife who died of pulmonary fibrosis (scarring of the lung tissue), confirmed under the microscope. She had no asbestos exposure at work. For over 27 years she shook out, brushed out and washed, daily, the work clothing of her husband, a mechanical engineer in an asbestos textile factory in the 1960s. Chest X-rays showed small, irregular opacities in all lung fields and diffuse pleural thickening without pleural plaques. She died of right heart failure with cor pulmonale and bronchopneumonia, and autopsy found extensive pulmonary fibrosis. Her lung tissue contained 2,640 asbestos bodies per gram of wet tissue. Electron microscopy found 8.6 million amphibole fibres of all lengths and 540,000 fibres 5 micrometres or longer per gram of dry tissue, all classified as crocidolite. The authors noted that these counts exceeded the upper limit for the normal population but fell within the lower range reported for asbestosis. They also noted that the tissue findings fit either asbestosis or idiopathic fibrosis. They concluded that this was a case of asbestosis following household asbestos exposure.

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 (one patient)
• Who was studied: One 81-year-old housewife with no workplace asbestos exposure. She had earlier worked at a post office counter. The article does not state the country.
• Exposure: Household (para-occupational) exposure: daily shaking out, brushing out and washing for over 27 years of the asbestos-contaminated work clothing of her husband. He was a mechanical engineer at the mill, spinnery and carding facility of an asbestos textile factory in the 1960s. She also visited the factory about once a month. The fibres found in her lungs were classified as exclusively crocidolite.
• Main results:
  • Chest X-rays showed small, irregular opacities (s/t) in all lung fields with ILO profusion 1/1, and diffuse pleural thickening (ILO 1a) without pleural plaques.
  • She died of right heart failure with cor pulmonale and bronchopneumonia. At autopsy, extensive pulmonary fibrosis was diagnosed as the underlying disease.
  • Under the microscope, the lung showed diffuse interstitial fibrosis with honeycombing, in a pattern mimicking usual interstitial pneumonia (UIP). The fibrosis was graded 3 to 4 on a simplified CAP-NIOSH scheme.
  • Her lung tissue contained 2,640 asbestos bodies per gram of wet lung tissue.
  • Electron microscopy found 8.6 million amphibole fibres of all lengths and 0.54 million (540,000) fibres 5 micrometres or longer per gram of dry tissue, all classified as crocidolite.
  • The authors reported that these crocidolite counts exceeded the upper limit for the normal population (95th percentile, 140,000 amphibole fibres per gram of dry tissue, measured by the same method). They also exceeded the levels said to identify people likely to have had workplace exposure: 1,000,000 amphibole fibres 1 micrometre or longer, and 100,000 fibres 5 micrometres or longer.
  • The uncoated fibre counts and the 2,640 asbestos bodies fell within the lower range recorded in cases of histologically confirmed asbestosis.
• The authors' conclusion: The authors concluded that this was a case of asbestosis following household asbestos exposure. They based this on the asbestos bodies seen in tissue sections and on a fibre burden above the lower 95th percentile of the range reported for asbestosis. The article's title is phrased as a question, and its abstract describes household exposure as a 'risk or co-factor' that is discussed.
• Limitations the authors state:
  • The authors stated that the tissue diagnosis was consistent with either asbestosis or end-stage idiopathic interstitial fibrosis.
  • The authors noted that the asbestos burden in her lungs was only slightly elevated. This contrasts with studies of asbestosis patients, whose lung burdens are 100 to 1,000 times greater than background.
  • The authors noted that the link between the lung's mineral fibre content and the severity of fibrosis is imperfect.

Topics

Medical terms in this study, explained in our Lexicon: Pulmonary Fibrosis, Asbestos Exposure, Asbestos Bodies, Amphibole Group.

Related studies

• Lung dust content in idiopathic pulmonary fibrosis: a study with scanning electron microscopy and energy dispersive x ray analysis — E. Monsó, J.M. Tura, et al. (1991)
• Antifibrotic treatment response and prognostic predictors in patients with idiopathic pulmonary fibrosis and exposed to occupational dust — V. Casillo, S. Cerri, et al. (2019)
• Relationships of Lower Lung Fibrosis, Pleural Disease, and Lung Mass with Occupational, Household, Neighborhood, and Slate Roof-Dense Area Residential Asbestos Exposure — D. Kang, Y.Y. Kim, et al. (2018)
• Pleural mesothelioma and household asbestos exposure — J. Schneider, K. Straif, et al. (1996)
• Evaluation of the fate and pathological response in the lung and pleura of brake dust alone and in combination with added chrysotile compared to crocidolite asbestos following short-term inhalation exposure — D.M. Bernstein, R.A. Rogers, et al. (2015)
• Evaluation of the deposition, translocation and pathological response of brake dust with and without added chrysotile in comparison to crocidolite asbestos following short-term inhalation: interim results — D.M. Bernstein, R. Rogers, et al. (2014)

Browse more research in Journal of Occupational Medicine and Toxicology, or return to medical research.