Recommendations for the Diagnosis and Management of Asbestos-Related Pleural and Pulmonary Disease

Our plain-English summary of Recommendations for the Diagnosis and Management of Asbestos-Related Pleural and Pulmonary Disease, by C. Diego Roza, M.J. Cruz Carmona, R. Fernández Álvarez, et al (Archivos de Bronconeumología, 2017).

The study

• Authors: C. Diego Roza, M.J. Cruz Carmona, R. Fernández Álvarez, J. Ferrer Sancho, B. Marín Martínez, C. Martínez González, J.A. Rodríguez Portal, F. Romero Valero, V. Villena Garrido
• Journal: Archivos de Bronconeumología
• Published: 2017;53(8):437-442
• Type of article: Guideline
• Language: Spanish
• Cited by: 11 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Asbestos is the term used for a set of mineral silicates that tend to break up into fibers. Its use has been associated with numerous diseases affecting the lung and pleura in particular, all of which are characterized by their long period of latency. Asbestos, moreover, has been recognized by the WHO as a Group IA carcinogen since 1987 and its use was banned in Spain in 2002. The publication in 2013 of the 3rd edition of the specific asbestos health monitoring protocol, together with the development of new diagnostic techniques, prompted the SEPAR EROM group to sponsor publication of guidelines, which review the clinical, radiological and functional aspects of the different asbestos-related diseases. Recommendations have also been made for the diagnosis and follow-up of exposed patients. These recommendations were drawn up in accordance with the GRADE classification system.

Copyright © 2017 SEPAR. Publicado por Elsevier España, S.L.U. All rights reserved.

In plain English

This article is a clinical guideline, not a study of patients. The EROM group of SEPAR (the Spanish Society of Pulmonology and Thoracic Surgery) reviewed asbestos-related diseases and made recommendations, graded with the GRADE system, for diagnosing and following up exposed patients in Spain. It recommended a complete work history, the chest X-ray as the basic imaging tool, lung function testing, and confirmation of suspected mesothelioma by tissue, preferably surgical biopsy. It stated that pleural plaques are considered not to impair lung function. It advised against routine mesothelin testing in exposed people and said biomarkers and periodic CT scans are not currently indicated for early detection of mesothelioma. For patients without symptoms, suggested check-ups were every 3 years with no disease, every 1 to 3 years for pleural plaques, and yearly for diffuse pleural thickening or asbestosis. The authors noted scarce scientific evidence that surveillance programmes improve outcomes. They called lung cancer screening of asbestos-exposed workers an urgent issue needing a large randomized study.

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 practice guideline (special article) by the SEPAR EROM group, reviewing asbestos-related diseases and giving recommendations graded with the GRADE system; no new patient data
• Who was studied: No study population; the recommendations address patients with past asbestos exposure seen under Spain's health surveillance protocol
• Exposure: Asbestos in general (serpentine chrysotile and the amphiboles), with occupational, domestic and environmental exposure considered in the work history
• Main results:
  • A complete occupational history should be taken (graded as a consistent recommendation, high quality of evidence).
  • The chest X-ray is the basic tool for identifying asbestos-related diseases.
  • When mesothelioma is suspected, diagnosis should be confirmed by pathology on pleural tissue, preferably obtained by surgical biopsy (consistent recommendation, high quality of evidence).
  • Lung function testing is mandatory in the diagnosis and follow-up of asbestos-related disease. Pleural plaques are considered not to cause impaired lung function; when impairment appears, it is attributed to other causes.
  • Values above 1,000 asbestos bodies per gram of dry lung tissue, or one asbestos body per millilitre of bronchoalveolar lavage, indicate exposure. The article reports that previously published Spanish reference values confirmed the international 1,000 threshold is applicable in Spain.
  • Routine measurement of soluble mesothelin in exposed populations is not recommended as an early diagnosis method (consistent recommendation, high quality of evidence).
  • At the first visit the guideline calls for occupational history, smoking cessation advice or treatment for active smokers, chest X-ray and full lung function tests. High-resolution CT is advised if the X-ray or lung function tests are abnormal (low quality of evidence).
  • Suggested follow-up for patients without symptoms (low quality of evidence) depends on the finding: no disease, spirometry and chest X-ray every 3 years; pleural plaques, every 1 to 3 years; diffuse pleural thickening and asbestosis, yearly with chest X-ray and full lung function tests; rounded atelectasis with typical signs, CT every 6 months for 2 years.
  • Biomarkers and periodic CT scans are not currently indicated for early detection of mesothelioma.
  • In patients with a known history of exposure, the resulting diseases may be attributed to that exposure without other considerations (moderate quality of evidence).
• The authors' conclusion: The authors set out recommendations for diagnosis and follow-up of exposed patients. They considered lung cancer screening among asbestos-exposed workers an urgent issue requiring a large randomized study before strong evidence-based recommendations can be made.
• Limitations the authors state:
  • The authors state there is scarce scientific evidence that screening and surveillance programmes for exposed workers are an effective strategy for improving outcomes.
  • Using CT for diagnosis when chest X-ray and lung function are normal and there are no symptoms is described as questionable and not supported by scientific evidence.

Topics

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

Medical terms in this study, explained in our Lexicon: Silicate, Pleura, Latency.

Related studies

• Diagnosis and initial management of nonmalignant diseases related to asbestos — American Thoracic Society (2004)
• Diagnosis and initial management of nonmalignant diseases related to asbestos — D. Weill, H. Weill (2005)
• Diagnosis and initial management of nonmalignant diseases related to asbestos — A.J. Ghio, V.L. Roggli (2005)
• Diagnosis and initial management of nonmalignant diseases related to asbestos — D.D. Smith (2005)
• Conventional and high resolution computed tomography in the diagnosis of asbestos-related diseases — D.A. Lynch, G. Gamsu, et al. (1989)
• Use of asbestos building materials in Malaysia: legislative measures, the management, and recommendations for a ban on use — I. Safitri Zen, R. Ahamad, et al. (2013)

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