Respiratory distress after talc inhalation

Our plain-English summary of Respiratory distress after talc inhalation, by S.R. Gould, D.E. Barnardo (British Journal of Diseases of the Chest, 1972).

The study

• Authors: S.R. Gould, D.E. Barnardo
• Journal: British Journal of Diseases of the Chest
• Published: 1972;66(3):230-3
• Cited by: 10 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. 002424).

In plain English

This was a case report from The London Hospital. A previously healthy girl aged 7 years and 2 months inhaled powdered talc that was blown into her face as a playground prank. She seemed unaffected for 60 minutes, then began to cough and wheeze and turned blue (cyanosed). Within 48 hours she developed a fever and pus-containing sputum. Despite physiotherapy and antibiotics, her left lung was later found to have collapsed completely. It re-expanded considerably over 6 months, but she had repeated wheezing attacks and occasionally coughed up blood. One year after the accident, tests showed bronchiectasis (permanently widened airways) throughout the left lung. Her vital capacity was 775 ml, 48% of the predicted value, and she had airway obstruction that improved after a bronchodilator. Skin tests to allergens, and patch and scratch tests to talc, were negative. The authors counted 5 deaths among 21 published cases of acute respiratory distress after talcum powder inhalation. The authors suggested that talc may have contributed to her asthma, and warned that the symptom-free period after inhalation should not reassure doctors.

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 of one patient, with the authors' summary of previously reported cases of talc inhalation
• Who was studied: One previously healthy girl aged 7 years and 2 months, referred to The London Hospital, London, one year after the accident. She had no personal history of allergy, but her father had died in status asthmaticus at age 27. The date of the accident is not given; the article was received for publication in October 1971.
• Exposure: A single accidental inhalation of powdered talc (talcum powder) blown into the child's face. No dose was measured. The article describes talc as hydrous magnesium silicate and does not mention asbestos.
• Main results:
  • The patient had no symptoms for 60 minutes, then began to cough and wheeze and became cyanosed.
  • Within 48 hours she developed fever with purulent sputum. Despite physiotherapy and antibiotics, she was later found to have complete collapse of the left lung.
  • Over the following 6 months considerable re-expansion of the lung occurred, but she had recurrent attacks of wheezing and occasional haemoptysis (coughing up blood). The extent of re-expansion was not quantified.
  • One year after the accident, bronchography showed bronchiectasis of the whole left lung.
  • Lung function tests showed a reduced vital capacity of 775 ml (48% of predicted value) with airways obstruction. After a bronchodilator aerosol, FEV1 increased by 27% and peak flow by 28%.
  • Skin tests to a wide range of allergens were negative, as were patch and scratch tests to suspensions of calcium carbonate and talc. There was no eosinophilia.
  • The authors found 21 reported cases in the literature, and described them as cases of acute respiratory distress following inhalation of talcum powder.
  • Among these 21 reported cases, the authors counted 5 deaths, a mortality of 24%. Most of those affected had been well under 2 years of age.
• The authors' conclusion: The authors suggested, while noting there was no objective evidence of skin sensitivity to talc, that talc exposure may have been a contributory cause of the girl's asthma, since it developed immediately after the exposure. They considered the lung collapse probably caused by excess mucus produced in response to the irritating talc, and saw no need to propose an allergic mechanism. They stressed that the quiet period between inhalation and respiratory distress should not give doctors a false sense of security.
• Limitations the authors state:
  • The authors noted there was no objective evidence of skin sensitivity to talc in this patient.
  • The authors noted that the post-mortem findings from earlier cases came from a limited number of observations.
  • The authors noted that the 21 reported cases of acute respiratory distress after talcum powder inhalation may underestimate how often such cases occur.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Talc and vermiculite.

Medical terms in this study, explained in our Lexicon: Talc.

Related studies

• Respiratory effects from industrial talc exposure among former mining workers — R.C. Loyola, A.P. Carneiro, et al. (2010)
• Massive pulmonary fibrosis from the inhalation of talc — A.C. Hunt (1956)
• Talc deposition and effects after 20 days of repeated inhalation exposure of rats and mice to talc — J.A. Pickrell, M.B. Snipes, et al. (1989)
• Inhalation Toxicity of Talc — N.F. Johnson (2021)
• Re: Brent L. Finley, Stacey M. Benson & Gary M. Marsh (2017): Cosmetic talc as a risk factor for pleural mesothelioma: a weight of evidence evaluation of the epidemiology, Inhalation Toxicology, DOI: 10.1080/08958378.2017.1336187 — M.M. Finkelstein (2017)
• Mortality from lung cancer and respiratory disease among pottery workers exposed to silica and talc — T.L. Thomas, P.A. Stewart (1987)

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