The diagnosis of asbestosis

Our plain-English summary of The diagnosis of asbestosis, by R.N. Jones (The American Review of Respiratory Disease, 1991).

The study

• Author: R.N. Jones
• Journal: The American Review of Respiratory Disease
• Published: 1991;144(3 Pt 1):477-8
• Type of article: Comment, Editorial
• Cited by: 9 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. 004159).

Summary of the article

In this editorial, the author commented on a report by Gaensler and coworkers in the same issue and reviewed how asbestosis is diagnosed. He described the diagnosis as inferential, resting on two main criteria. The first is an occupational exposure history showing substantial present risk of lung fibrosis, taking account of exposure intensity, duration and latency. The second is evidence, usually clinical and radiologic, that diffuse interstitial pulmonary fibrosis (DIPF) has developed. Drawing on the principle of prior probability, he proposed a third criterion: there should be no good reason to attribute the findings to another condition, such as connective tissue disease, chronic sarcoidosis, certain chemotherapy agents, amiodarone or lung radiotherapy. He noted that tissue examination can establish exposure through asbestos bodies, quantify fiber burdens and confirm DIPF. In the Gaensler pathology series, 9 of 176 asbestos-exposed persons (5.1%) lacked histologic asbestos bodies. Compared with 9 asbestosis cases matched for age and smoking, seven had shipyard exposures, against one in the asbestosis group. Asbestos product factory, insulator and pipe coverer trades accounted for eight of the nine asbestosis cases. Years of exposure and latency differed little between the groups. The author concluded that both intensity and duration of exposure must be considered and that yes/no exposure categories are inadequate for asbestosis. When the exposure or response criteria are deficient, or a confounder is present, asbestosis becomes a strictly pathologic diagnosis.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.

In plain English

This was an editorial by the author, commenting on a pathology report by Gaensler and coworkers in the same journal issue. It presented no new data of its own. The author argued that diagnosing asbestosis is inferential and rests on two main criteria. First, past asbestos exposure must have placed the person at substantial risk of lung fibrosis. Second, lung fibrosis must in fact have developed. The author added a third criterion: there should be no good reason to believe the findings are as likely caused by some other condition. Describing the Gaensler report, the author noted that it found nine cases among lung tissue from 176 asbestos-exposed persons in which asbestos bodies could not be shown. The trades in those cases differed from those of nine matched cases with asbestosis. The author argued that both the intensity and the duration of exposure must be taken into account. The author also said that the available considerations give only rough guidelines for what counts as an adequate exposure history.

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 (commentary on another study, Gaensler and coworkers)
• Who was studied: No study population of its own; the editorial discussed a pathology case series reported by Gaensler and coworkers
• Exposure: Asbestos exposure in general, described in terms of cumulative exposure (intensity and duration) and trade or job
• Main results:
  • The author stated that a sound diagnosis of asbestosis has two main criteria: exposure placing the person at substantial risk of lung fibrosis, and evidence that fibrosis has developed
  • The author proposed a third criterion: no good reason to believe the findings are as likely due to another condition
  • Describing the Gaensler report (not this article's own data): among lung tissue from 176 asbestos-exposed persons, nine cases had no asbestos bodies shown by ordinary histologic techniques
  • Describing the Gaensler report: asbestos product factory work, insulator and pipe coverer trades accounted for eight of the nine asbestosis cases but were absent from the exposed group without asbestosis
  • The author argued that both intensity and duration of exposure must be considered in the study or clinical diagnosis of asbestosis
• The authors' conclusion: The author concluded that a weak exposure history, insufficient evidence of fibrosis, or a potential confounder precludes a sound clinical diagnosis, and that asbestosis then becomes a strictly pathologic diagnosis
• Limitations the authors state:
  • The author stated that the considerations offered give only rough guidelines for deciding what constitutes an adequate exposure history

Topics

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

Medical terms in this study, explained in our Lexicon: Occupational Exposure History, Fibrosis, Latency, Interstitial, Pulmonary Fibrosis, Chemotherapy, Asbestos Bodies, Fiber Burden.

Related studies

• Differential diagnosis in the pathology of asbestosis — J. Gough (1965)
• Asbestos bodies or fibers and the diagnosis of asbestosis — M.L. Warnock, G. Wolery (1987)
• The clinical diagnosis of asbestosis in this century requires more than a chest radiograph — R.M. Ross (2003)
• Diagnosis of asbestosis by a time expanded wave form analysis, auscultation and high resolution computed tomography: a comparative study — N. al Jarad, B. Strickland, et al. (1993)
• Asbestos bodies and the diagnosis of asbestosis in chrysotile workers — J. Holden, A. Churg (1986)
• Mineralogical analysis of bronchoalveolar lavage fluid as an aid to diagnosis of "imported" pleural asbestosis — P. De Vuyst, M. Mairesse, et al. (1983)

Browse more research in The American Review of Respiratory Disease, or return to medical research.