The past and present of pneumoconioses

Our plain-English summary of The past and present of pneumoconioses, by P. De Vuyst, P. Camus (Current Opinion in Pulmonary Medicine, 2000).

The study

• Authors: P. De Vuyst, P. Camus
• Journal: Current Opinion in Pulmonary Medicine
• Published: 2000;6(2):151-6
• Type of article: Review
• Cited by: 29 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Pneumoconioses are still a common cause of chronic lung disease. In industrialized countries, improvements in working conditions and dust control measures have led to a decrease in the incidence of severe forms of silicosis, coal worker pneumoconiosis, and parenchymal asbestosis. However, the diversity of settings in which silica and asbestos are used fuels a continued input of cases, and the burden of cases related to remote exposures is still considerable. Overall, the clinical picture of the classic pneumoconioses and their complications has not changed substantially. However, their limits and links have expanded toward systemic and connective tissue disease, idiopathic pulmonary fibrosis, and antineutrophil cytoplasmic autoantibody-positive vasculitides. Immunologically mediated occupational lung diseases have emerged, such as berylliosis and hard-metal disease. Advances in imaging, mineralogic analysis of bronchoalveolar lavage fluid, and immunologic techniques have been instrumental in describing new patterns of disease and are helpful in litigious or difficult cases.

In plain English

This article was a narrative review of how pneumoconioses (lung diseases caused by inhaled dusts) had changed in recent years, mainly in industrialized countries. It reported no new study, though it illustrated some points with individual patient cases. Citing earlier work, the authors wrote that most currently compensated cases of "asbestosis" in a broad sense, including pleural disease, were benign pleural lesions such as plaques and thickening with little effect on lung function, and that true asbestosis was diminishing markedly. They wrote that stable death rates from asbestos-related diseases probably reflected rising pleural mesothelioma and lung cancer alongside falling parenchymal asbestosis. They noted that since the asbestos ban, electricians, plumbers, insulators and demolition workers outnumbered primary asbestos workers. These workers were more likely to be independent and less well protected. They noted that environmental tremolite exposure had been described in Turkey. They described reported cases of rapidly progressive pleural thickening or effusion in asbestos-exposed patients taking bromocriptine, and said epidemiologic proof was still needed. The authors concluded that the clinical picture of classic pneumoconioses had not changed substantially, although their links to other diseases had expanded.

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, with individual patient cases as illustrations
• Who was studied: No study population of its own. The authors reviewed published literature on pneumoconioses, mainly in industrialized countries, and illustrated points with individual patient cases.
• Exposure: Mineral and other dusts: silica, coal mine dust and asbestos (including environmental tremolite in Turkey), plus beryllium, hard metals, man-made mineral fibers and various chemicals
• Main results:
  • Citing earlier work, the authors wrote that of currently compensated cases of "asbestosis" in general (not only parenchymal asbestosis), the vast majority are benign pleural lesions (plaques and thickening) with little effect on lung function
  • Because true asbestosis is becoming rare, the authors wrote that interstitial fibrosis in a person with low past asbestos exposure or low fiber counts in lavage fluid raises the possibility of coincidental idiopathic pulmonary fibrosis
  • The authors wrote that stable death rates from asbestos-related diseases probably reflect rising pleural mesothelioma and lung cancer while parenchymal asbestosis decreases
  • Since the asbestos ban, electricians, plumbers, insulators and demolition workers outnumber primary asbestos workers. The authors described these workers as more likely to be independent and less well protected by industrial hygiene regulations
  • Environmental asbestos exposure in the form of tremolite has been described in Turkey, with very high lung fiber burdens in some cases
  • Cases were reported of patients with previous asbestos exposure who developed rapidly progressive pleural thickening or effusion while taking bromocriptine. The authors said epidemiologic proof is needed to establish that asbestos and ergot drugs act together
  • Widespread use of high-resolution CT has increased detection of early subclinical abnormalities
• The authors' conclusion: The authors concluded that the clinical picture of the classic pneumoconioses and their complications has not changed substantially, though their links to other diseases have expanded

Topics

Medical terms in this study, explained in our Lexicon: Dust Control, Silicosis, Pneumoconiosis, Idiopathic, Pulmonary Fibrosis, Occupational Lung Disease, Bronchoalveolar Lavage (BAL).

Related studies

• Role of oxidants in interstitial lung diseases: pneumoconioses, constrictive bronchiolitis, and chronic tropical pulmonary eosinophilia — W.N. Rom (2011)
• The second diagnosis: the role of the pathologist in identifying pneumoconioses in lungs excised for tumor — E.J. Mark (1981)
• Pathologica, physiological, and radiological correlations in the pneumoconioses — E.A. Gaensler, C.B. Carrington, et al. (1972)
• Between- and within-reader variability in the assessment of pleural abnormality using the ILO 1980 international classification of pneumoconioses — J. Bourbeau, P. Ernst (1988)
• The classic pneumoconioses: new epidemiological and laboratory observations — A.S. Laney, D.N. Weissman (2012)
• Railways and asbestos in Japan (1928-1987)--epidemiology of pleural plaques, malignancies and pneumoconioses- — Y. Hosoda, Y. Hiraga, et al. (2008)

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