Smoking, morbidity, and pulmonary function in a group of ex-asbestos workers: a pilot study

Our plain-English summary of Smoking, morbidity, and pulmonary function in a group of ex-asbestos workers: a pilot study, by E.D. Richter, H. Tuch, O. Sarel, et al (American Journal of Industrial Medicine, 1986).

The study

• Authors: E.D. Richter, H. Tuch, O. Sarel, Z. Shabbat, D. Weiler
• Journal: American Journal of Industrial Medicine
• Published: 1986;10(5-6):515-23
• Cited by: 2 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. 001151).

Abstract

Thirty-three of 184 formerly exposed asbestos textile workers were interviewed to evaluate knowledge, attitudes, and practices concerning smoking and asbestos. Twenty-three subjects in this group also underwent physical examination to determine smoking-symptom/sign-pulmonary function interrelationships. Approximately half of the exworkers smoked, and the majority who had stopped did so mostly because of illness rather than because of knowledge concerning smoking-asbestos hazards. All workers welcomed the offer of smoking cessation programs. Smokers and exsmokers, but not nonsmokers, were at risk for obstructive-type impairments, but all three groups contained subjects with impairments interpretable as restrictive. The presence of shortness of breath, cough, râles, or decreased breathing sounds alone or in any combination greatly increased the odds that either obstructive- or possible restrictive- or mixed-type impairments would be found on spirometry. Mass screening techniques required about one hour of person time per examinee to assess health status, provide educational material on smoking, and counsel workers on referral arrangements. The findings suggest that smoking alerts, smoking cessation clinics, and medical follow-up are needed, feasible, and acceptable in Israel.

In plain English

This pilot study looked at people who had worked at an asbestos-textile brake lining factory in Bnei Brak, Israel. Of 184 employees, 60 were traced; 7 had died and 9 refused. Students interviewed 33 in 1982-1983 about smoking and asbestos. In April 1984, 23 were examined and given breathing tests (spirometry). No chest X-rays were taken. Sixteen of the 33 (49%) knew that asbestos and smoking together raise lung cancer risk, and only 12 of 32 (38%) knew about their compensation rights. All workers welcomed counselling on quitting smoking. Among workers of known smoking status, obstructive-type impairments appeared only in smokers and ex-smokers. Possibly restrictive-type impairments appeared in all three groups, though they were borderline in nonsmokers. Having any symptom or sign was associated with impaired breathing tests: 13 of 17 people with one had impairment, versus 0 of 5 without. Screening took about one hour of person-time per examinee. The authors concluded that smoking alerts, cessation clinics and medical follow-up are needed, feasible and acceptable in Israel. They noted the small group, the lack of X-rays and the lack of Israeli comparison data.

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: Pilot survey (interviews plus physical and spirometry examinations) of former asbestos workers; cross-sectional, with no unexposed comparison group
• Who was studied: Former employees of an asbestos-textile brake lining factory in Bnei Brak, Israel. Of 184 employees, 60 were traced, of whom 7 had died and 9 refused. Thirty-three of the remaining 44 were interviewed at home (1982-1983), and 23 were examined in April 1984. The original cohort began work in 1952-1955 (44 employees) or 1956-1959 (140 employees).
• Exposure: Work in asbestos textile and brake lining manufacture; the fiber type is not named. Earlier measurements in the factory (Shabbat, 1974-1975) ranged from less than 1 million to 20 million fibers/m3. Workers reported that earlier dust levels impaired visibility. Length of exposure among those examined was 5 to 13 years.
• Main results:
  • Of the 33 interviewed workers, 16 (49%) knew that asbestos and smoking together increase lung cancer risk.
  • Only 7 of 27 workers (printed as 27%) knew that dust brought home was a hazard, and only 12 of 32 (38%) knew their compensation rights.
  • All workers welcomed counselling on the asbestos-smoking interaction and the benefits of quitting. Ex-smokers were unanimous that they had lacked knowledge of the special dangers of the combination.
  • Among the 23 examined, râles and decreased breath sounds (and, in one case each, ronchi and clubbing) were found only in smokers and ex-smokers, not in nonsmokers.
  • Observed/expected ratios for forced vital capacity (FVC) were 0.68 in smokers (n=7), 0.78 in ex-smokers (n=8) and 0.97 in nonsmokers (n=7). For FEV1 the ratios were 0.64, 0.76 and 0.94 respectively.
  • Among workers of known smoking status, obstructive-type impairments were found only in smokers and ex-smokers; none of the 7 nonsmokers had one. Table VI also records obstructive impairment in the one worker whose smoking status was unknown. Possibly restrictive-type impairments were seen in all three groups, although they were borderline in nonsmokers. Overall, 13 of 22 tested had some impairment (borderline cases counted as positive).
  • Having any one symptom or sign was associated with a greater likelihood of impaired pulmonary function. Impairment was found in 13 of 17 with a symptom or sign versus 0 of 5 without (odds ratio printed as greater than 16, p less than .05). For dyspnea alone (OR 2.3) and cough alone (OR 4.5), the table marks p as greater than .05.
  • None of the workers under care or evaluation for cardiorespiratory problems had ever been told their problems might be linked to past asbestos exposure.
  • About one hour of person-time per examinee was needed to interview, examine and provide information on smoking and asbestos.
• The authors' conclusion: The authors concluded that smoking alerts, smoking cessation clinics and medical follow-up are needed, feasible and acceptable for former asbestos workers in Israel. They also suggested that mass screening methods, augmented by X-ray, could be used to follow these workers at low cost.
• Limitations the authors state:
  • Budget restrictions prevented chest X-rays and the examination of additional workers.
  • The study population was small.
  • Total lung capacity was not measured, which limited confidence in identifying restrictive and mixed patterns.
  • There were no Israeli population-based reference or baseline data for unexposed smokers, ex-smokers and nonsmokers.
  • Borderline spirometry results were counted as positive impairments.

Topics

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

Related studies

• Effects of asbestos and smoking on the levels and rates of change of lung function in a crocidolite exposed cohort in Western Australia — H.S. Alfonso, L. Fritschi, et al. (2004)
• The relation among pulmonary function, chest roentgenographic abnormalities, and smoking status in an asbestos-exposed cohort — L. Rosenstock, S. Barnhart, et al. (1988)
• A pilot study of telephone-based smoking cessation intervention in asbestos workers — O.Y. Osinubi, J. Moline, et al. (2003)
• Spirometric impairments in long-term insulators. Relationships to duration of exposure, smoking, and radiographic abnormalities — A. Miller, R. Lilis, et al. (1994)
• Comparative quantitative evaluation of pleural fibrosis and its effects on pulmonary function in two large asbestos-exposed occupational groups--insulators and sheet metal workers — R. Lilis, A. Miller, et al. (1992)
• Pulmonary function in asbestos cement workers: a dose-response study — M. Finkelstein (1986)

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