Roentgenographic manifestations and pulmonary function effects of asbestos-induced pleural thickening

Our plain-English summary of Roentgenographic manifestations and pulmonary function effects of asbestos-induced pleural thickening, by L. Rosenstock (Toxicology and Industrial Health, 1991).

The study

• Author: L. Rosenstock
• Journal: Toxicology and Industrial Health
• Published: 1991;7(1-2):81-7
• Type of article: Review
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Pleural thickening is the most common roentgenographic manifestation of past asbestos exposure. In addition to pleural thickening serving as a specific market of exposure, discrete (plaques) and diffuse pleural fibrosis are important abnormalities because they have been found to be associated with increased risk for other asbestos-related sequelae and to themselves have an adverse effect on pulmonary function. We review here the results of an evaluation of a cohort of asbestos-exposed workers, plumbers and pipefitters, who were consecutively enrolled in a large cross-sectional prevalence study. Among the 681 male participants, pleural abnormalities were associated with decreased values of forced vital capacity, an effect independent of ILO profusion grade. The risk for pleural disease was unexplained by smoking status. Diffuse pleural thickening was more common and was associated with greater decrements in function than was discrete thickening.

In plain English

This single-author article was a short review of asbestos-related pleural thickening, scarring of the lining around the lungs, of two types: discrete (plaques) and diffuse. Its results section restated earlier findings from the author's group's cross-sectional survey of 681 male plumbers and pipefitters in construction and shipbuilding and repair. In that group, 132 (19%) had parenchymal fibrosis and 200 pleural thickening. Among men with pleural findings, isolated diffuse thickening outnumbered plaques (52% vs 37%). Pleural abnormalities affected 12 (5%) of men with under 10 years in the trade and 71 (56%) of those with 30 or more. At each X-ray profusion grade, even grades not usually counted as lung fibrosis, the group with pleural thickening had lower mean percent-predicted forced vital capacity, a breathing test measure. Diffuse thickening on both sides went with a greater decrease than discrete thickening. Allowing for age, smoking was not related to pleural thickening. The author noted that lung fibrosis invisible on X-ray could explain some of this effect. The author concluded that pleural abnormalities are associated with abnormal lung function.

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: Narrative review that restates results of the author's group's previously reported cross-sectional prevalence survey
• Who was studied: 681 male plumbers and pipefitters, mean age 42 years, mean 17 years in the trade, in construction (75%) and shipbuilding and repair (25%)
• Exposure: Asbestos exposure in the plumbing and pipefitting trades; many were exposed only while working in the building trades. No fiber types were named.
• Main results:
  • Of the 681 men, 132 (19%) had parenchymal fibrosis and 200 had evidence of pleural thickening
  • Among men with pleural findings, isolated diffuse pleural thickening was more common than plaques (52% vs 37%)
  • Pleural abnormalities increased with time in the trade: 12 (5%) of men with less than 10 years, and 71 (56%) of men with 30 or more years
  • Mean percent predicted forced vital capacity (FVC) declined in a linear fashion as X-ray evidence of interstitial fibrosis increased (ILO profusion grades 0/- to 1/2)
  • At any given ILO profusion grade, the group with pleural thickening had a lower mean percent predicted FVC, including at grades usually considered not to represent evidence of interstitial fibrosis
  • Bilateral diffuse pleural thickening (63 men) was associated with a greater decrease in FVC than bilateral discrete thickening (48 men) at any given ILO profusion grade
  • After controlling for age, cigarette smoking was found to have no relation to the risk of pleural thickening
• The authors' conclusion: The author concluded that pleural abnormalities are common and relatively specific markers of past asbestos exposure, may carry a greater risk of other asbestos-related conditions, and are themselves associated with abnormal lung function
• Limitations the authors state:
  • The findings do not show how pleural fibrosis reduces lung function; in at least some men, interstitial fibrosis not visible on X-ray could explain the findings

Topics

The National Library of Medicine indexes this study under subjects our site covers: Pleural plaques and thickening.

Medical terms in this study, explained in our Lexicon: Pleural Thickening, Asbestos Exposure, Fibrosis, Pipefitter, Diffuse Pleural Thickening.

Related studies

• The relation among pulmonary function, chest roentgenographic abnormalities, and smoking status in an asbestos-exposed cohort — L. Rosenstock, S. Barnhart, et al. (1988)
• Bilateral pleural thickening: a manifestation of asbestos dust exposure — E.N. Sargent, J. Gordonson, et al. (1978)
• Cardiorespiratory responses to incremental exercise in patients with asbestos-related pleural thickening and normal or slightly abnormal lung function — A. Miller, A. Bhuptani, et al. (1993)
• Diffuse pleural thickening in asbestos workers: disability and lung function abnormalities — C.R. McGavin, G. Sheers (1984)
• Risk and significance of chest radiograph and pulmonary function abnormalities in an elderly cohort of former nuclear weapons workers — M.A. Mikulski, P.G. Hartley, et al. (2011)
• The presentation and natural history of asbestos-induced diffuse pleural thickening — V. Jeebun, S.C. Stenton (2012)

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