Pulmonary function in asbestosis: serial tests in a long-term prospective study

Our plain-English summary of Pulmonary function in asbestosis: serial tests in a long-term prospective study, by M.E. Bader, R.A. Bader, A.S. Tierstein, et al (Annals of the New York Academy of Sciences, 1965).

The study

• Authors: M.E. Bader, R.A. Bader, A.S. Tierstein, I.J. Selikoff
• Journal: Annals of the New York Academy of Sciences
• Published: 1965;132(1):391-405
• Cited by: 29 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. 002496).

Abstract

SUMMARY AND CONCLUSIONS

1. In 1954-1955, pulmonary physiological studies in 17 asbestos workers revealed the characteristic pattern of alveolar-capillary block syndrome. These patients were withdrawn from industrial exposure.
2. Of these 17 patients, 13 were available to follow-up study up to 10 years after the initial observation. Eight are now dead -one of cor pulmonale, two of carcinoma of the lung, two of carcinoma of the stomach, one of asbestosis, one of coronary occlusion, and one of mesothelioma. Of the living, six are working, one had surgery for carcinoma of the lung, one had a coronary occlusion and is unable to work.
3. Follow-up measurements were made in 13 patients. These included vital capacity, maximum breathing capacity, arterial oxygen saturation at rest and with exercise, and arterial pCO2 and pH.
4. During the period of the study, vital capacity was found to be reduced significantly in 12 of the 13 patients. There was also a fall in maximum breathing capacity, but in general they remained relatively well preserved. Air velocity indices showed an upward trend in more than half, and in only one was the air velocity index slightly less than one.
5. There was no significant trend in the arterial oxygen saturation at rest or on exercise. Arterial pCO2 and pH remained essentially unchanged.
6. The fall in vital capacity correlated well in about half of the cases with progression of X-ray findings and progression of dyspnea on exertion. In the remainder, vital capacity fell in almost all, without significant progression of radiological features or clinical symptoms.
7. The reduction in vital capacity correlated well with reduction in pulmonary compliance in 30 observations on 21 patients with asbestosis. This would indicate that the reduction in vital capacity is not a consequence of poor patient performance.
8. While diffusing capacity was not measured, the arterial O2 saturation on exercise did not demonstrate changes parallel to the fall in vital capacity observed.
9. It is concluded that of the parameters here studied, vital capacity was the most sensitive index of progression of the disease. Its ease of application, availability, and repeatability all recommend it for use in the frequent assessment of workers exposed to asbestos dust.

PubMed has no abstract for this study. This is the authors' abstract, copied from the article.

In plain English

This study at Mount Sinai Hospital, New York, followed lung function over about ten years in men with asbestosis. In 1954-1955, 17 workers from asbestos factories, exposed to asbestos dust for 4 to 24 years, were tested and then withdrawn from industrial exposure. 13 had follow-up tests. Vital capacity (how much air the lungs can move in one full breath) fell in 12 of the 13, by 9 to 31 percent of the predicted value, with an average fall of 18 percent. The authors said this was more than aging alone would explain. Maximum breathing capacity also fell in 12 but generally stayed relatively well preserved. Blood oxygen saturation at rest or on exercise showed no significant trend. Eight of the 17 men died, including one of asbestosis, two of lung carcinoma and one of pleural mesothelioma. In 21 asbestos workers, vital capacity tracked lung compliance, a test that does not depend on patient effort. The authors concluded that, of the measures they studied, vital capacity was the most sensitive index of disease progression. Diffusing capacity was not measured serially.

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: Prospective follow-up study with serial lung function tests over about ten years, plus separate one-time measurements of lung compliance in a second group
• Who was studied: 17 workers from asbestos factories with pulmonary asbestosis, first studied in 1954-1955 at Mount Sinai Hospital, New York. 13 had follow-up studies up to 1964. A separate group of 21 asbestos workers (cases of asbestosis) had lung compliance measured.
• Exposure: Occupational asbestos dust exposure in asbestos factories for 4 to 24 years, graded 1 to 4 for severity. Fiber type is not stated. The workers were withdrawn from industrial exposure after the initial study.
• Main results:
  • Among the 13 followed patients, vital capacity fell in 12, by 9 to 31 percent of predicted.
  • In one of the 13 followed patients, vital capacity rose 9 percent. The average fall was 18 percent, which the authors described as in excess of what aging alone would be expected to cause.
  • In the original study of 17 patients, nine had a vital capacity above 80 percent of predicted and two had less than 60 percent. At the last follow-up studies, only three were above 80 percent and four were below 60 percent.
  • Maximum breathing capacity fell in 12 of the 13 followed patients, by 6 to 51 percent (average 21 percent), and rose 10 percent in one. In general it remained relatively well preserved.
  • There was no significant trend in arterial oxygen saturation at rest or on exercise in the followed patients. Arterial carbon dioxide tension and pH remained essentially unchanged.
  • In the 4 patients who had residual volume measured serially, the ratio of residual volume to total capacity increased in all four. The authors attributed this mainly to the fall in vital capacity.
  • Comparing the fall in vital capacity with X-ray progression in the 13 followed patients, correlation was good in six, fair in two and poor in five. Poor correlation usually meant vital capacity fell without X-ray progression.
  • In the 21 asbestos workers who had pulmonary compliance measured, there was a linear relation between vital capacity and pulmonary compliance. The authors took this to indicate the vital capacity fall was not due to poor patient performance.
  • Of the original 17 men, eight had died: one of cor pulmonale, two of carcinoma of the lung, two of carcinoma of the stomach, one of asbestosis, one of coronary occlusion and one of pleural mesothelioma.
• The authors' conclusion: The authors concluded that, of the parameters they studied, vital capacity was the most sensitive index of progression of asbestosis. They recommended it for frequent assessment of asbestos-exposed workers because it is easy to apply, available and repeatable.
• Limitations the authors state:
  • Diffusing capacity of the lung was not measured serially, so the authors could not conclude that vital capacity is superior to diffusing capacity as an index of progression.
  • The authors noted that assessing the degree of asbestos dust exposure is difficult for all such studies.

Topics

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

Medical terms in this study, explained in our Lexicon: Cor Pulmonale, Carcinoma, Mesothelioma, Oxygen Saturation, Dyspnea, Diffusing Capacity (DLCO).

Related studies

• The discriminant value of pulmonary function tests in asbestosis — M.L. Thomson, A.M. Pelzer, et al. (1965)
• Relationship between chest X-ray findings and pulmonary function tests in dust workers — Y. Tonori, M. Niitsuya, et al. (2005)
• Is it time to end race and ethnicity adjustment for pediatric pulmonary function tests? — A.L. Non, K. Akong, et al. (2024)
• Assessment of progression of asbestosis in the sheep model by bronchoalveolar lavage and pulmonary function tests — R. Bégin, M. Rola-Pleszczynski, et al. (1983)
• Pulmonary function in long-term asbestos workers in China — X.R. Wang, E. Yano, et al. (2001)
• Evolution of idiopathic pleural effusion: a prospective, long-term follow-up study — J.S. Ferrer, X.G. Muñoz, et al. (1996)

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