Quantifying asbestos in lung tissue: what debate?

Our plain-English summary of Quantifying asbestos in lung tissue: what debate?, by B. Nemery, V. Nuyts, K. Nackaerts (The European Respiratory Journal, 2017).

The study

• Authors: B. Nemery, V. Nuyts, K. Nackaerts
• Journal: The European Respiratory Journal
• Published: 2017;49(6)
• Type of article: Editorial, Comment
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher

In plain English

This article was an editorial, not an original study. The authors commented on a study by Feder and colleagues on the 'chrysotile debate': whether chrysotile ('white asbestos') is cleared from the lungs faster, and so is less harmful, than amphiboles such as crocidolite. Feder and colleagues used the German Mesothelioma Register to examine 12 patients whose asbestos bodies were counted during life and again at autopsy at least 4 years later (median 8 years). Fibre concentration did not decrease over time. Electron microscopy in six patients found mainly crocidolite in two and mainly chrysotile in four. The editorial authors noted that the study was very small, with fibre analysis in only half the patients, and included only people with asbestos-related disease and high fibre burdens. They also cited their own earlier lavage study: of 578 patients, 10 had two counts; three were zero both times, and in the other seven first and second values did not differ significantly. The editorial authors called it reasonable for Feder and colleagues to conclude that chrysotile fibres that escape early clearance persist for many years in the lung.

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: Editorial commenting on another study (Feder et al., Eur Respir J 2017). It reports no new data of its own.
• Who was studied: The editorial has no study population of its own. The study it discusses (Feder et al.) used the German Mesothelioma Register, which held almost 24000 patients whose lung asbestos burden was measured between 1987 and 2015. Feder et al. selected 12 patients with more than 500 asbestos bodies per gram of wet lung tissue. Each was counted twice: first during life, in surgical lung tissue (10 patients) or bronchoalveolar lavage (2 patients), then again at autopsy at least 4 years later (median 8 years). All 12 died from an asbestos-related disease.
• Exposure: Asbestos fibres retained in lung tissue, comparing how long chrysotile persists in the lung with amphiboles (crocidolite, amosite, tremolite).
• Main results:
  • In the Feder et al. study, as reported by the editorial, the concentration of asbestos fibres in lung tissue did not decrease with time. Asbestos body counts were, if anything, higher at autopsy than at surgery, which could be explained by fewer sampling errors at autopsy.
  • In the Feder et al. study, electron microscopy with energy dispersive X-ray analysis was done in six subjects. The fibres were predominantly crocidolite in two patients and predominantly chrysotile in four patients.
  • In the editorial authors' own earlier retrospective study of asbestos bodies in bronchoalveolar lavage, 10 of 578 patients had two counts. The median interval between samples was 2.4 years (range 44 days to 10 years), and the median difference between the second and first counts was 0 (range -28.3 to +31.1 asbestos bodies per mL).
  • In that earlier lavage study, 3 of the 10 subjects had zero values both times. In the other 7, first and second values did not differ significantly (median 7.1 versus 6.7 asbestos bodies per mL).
• The authors' conclusion: The editorial authors judged it reasonable for Feder and colleagues to conclude that chrysotile fibres that escape early clearance from the lungs persist for many years.
• Limitations the authors state:
  • The editorial authors stated that the Feder et al. study had very few subjects: 12 patients, with electron microscopy fibre analysis in only half. They said this may raise questions about how far the findings apply more generally.
  • The editorial authors stated that the Feder et al. study included only patients with overt asbestos-related disease and high lung-fibre burdens, several years after exposure ended.

Related studies

• Misleading "New Insights into the Chrysotile Debate" — H.J. Woitowitz, X. Baur (2018)
• Twenty-five years of fiber analysis: what have we learned? — V.L. Roggli, R.T. Vollmer (2008)
• Man-made respirable-sized organic fibers: what do we know about their toxicological profiles? — D.B. Warheit, K.L. Reed, et al. (2001)
• Measuring EMPs in the lung what can be measured in the lung: Asbestiform minerals and cleavage fragments — V.L. Roggli (2018)
• What is a significant lung asbestos fibre result? — S.K. Suvarna, C. Layton (2006)
• Quantifying the mediating effects of smoking and occupational exposures in the relation between education and lung cancer: the ICARE study — G. Menvielle, J.E. Franck, et al. (2016)

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