The relationship between respiratory impairment and asbestos-related pleural abnormality in an active work force

Our plain-English summary of The relationship between respiratory impairment and asbestos-related pleural abnormality in an active work force, by J.E. Cotes, B. King (The American Review of Respiratory Disease, 1991).

The study

• Authors: J.E. Cotes, B. King
• Journal: The American Review of Respiratory Disease
• Published: 1991;143(5 Pt 1):1197
• Type of article: Letter, Comment
• Read it: PubMed · Publisher
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 004150).

In plain English

This item was not a research study but an exchange of letters to the editor about an earlier study by Bourbeau and colleagues of 110 construction insulators. That study had concluded that asbestos-related pleural abnormality was associated with impaired lung function. No new data were presented. In the first letter, Cotes and King noted that the study counted thickening along the side chest wall, without blunting of the costophrenic angle, as pleural abnormality. They said the 1980 International Labour Office (ILO) classification treats this as a distinct abnormality. They wrote that they and others had found it associated with restricted lung expansion, and argued that the study had not excluded diffuse pleural thickening as the sole explanation. They wrote that, up until then, isolated discrete plaques appeared not to have been incriminated as a cause of asbestos-related respiratory impairment. In reply, Pierre Ernst confirmed the study had not separated the two. The reply argued that trained readers cannot reliably tell them apart on chest X-rays and that such thickening most likely represents merged plaques. It called the ILO distinction inappropriate.

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: Letter to the editor commenting on a published study, with a reply from that study's authors; no new data
• Who was studied: No population was studied in these letters. They discuss an earlier study by Bourbeau and colleagues of 110 construction insulators.
• Exposure: Not studied in these letters. The discussion concerns how asbestos-related pleural abnormality is classified on chest X-rays.
• Main results:
  • Cotes and King stated that, under the 1980 ILO classification, isolated thickening of the chest wall is a distinct abnormality.
  • Cotes and King wrote that they and others had found such chest wall thickening associated with restrictions to lung expansion. This refers to the letter writers' earlier work, not new data.
  • Cotes and King argued that the Bourbeau study had not excluded diffuse pleural thickening as the sole explanation for its findings.
  • Cotes and King wrote that, up until then, isolated discrete plaques appeared not to have been incriminated as a cause of asbestos-related respiratory impairment.
  • The reply confirmed that the study did not separate isolated pleural plaques from diffuse thickening along the lateral chest wall.
  • The reply argued that trained readers cannot repeatably tell discrete plaques from diffuse thickening that does not affect the costophrenic angle.
  • The reply argued that diffuse thickening without costophrenic angle blunting most likely represents confluent (merged) pleural plaques.
  • The reply stated that the study's primary message concerned diffuse pleural thickening identified by costophrenic angle blunting. It said the small deficits linked to changes along the lateral chest wall may have come from discrete or confluent plaques, or from diffuse thickening without blunting.
• The authors' conclusion: Cotes and King warned that discrete plaques could be wrongly incriminated because of a terminology ambiguity. The reply's authors concluded that the three possible causes cannot be told apart on a posterior-anterior chest X-ray. They considered the ILO distinction inappropriate and hoped it would be changed in the next revision.

Topics

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

Related studies

• The relationship between respiratory impairment and asbestos-related pleural abnormality in an active work force — J. Bourbeau, P. Ernst, et al. (1990)
• Lung function impairment as a guide to exercise limitation in work-related lung disorders — J.E. Cotes, J. Zejda, et al. (1988)
• Relationships (I) of International Classification of High-resolution Computed Tomography for Occupational and Environmental Respiratory Diseases with the ILO International Classification of Radiographs of Pneumoconioses for parenchymal abnormalities — T. Tamura, N. Suganuma, et al. (2015)
• Spirometric impairments in long-term insulators. Relationships to duration of exposure, smoking, and radiographic abnormalities — A. Miller, R. Lilis, et al. (1994)
• Pleural abnormality as a cause of impairment and disability — P. Ernst, J. Bourbeau, et al. (1991)
• Work-related respiratory disease in the United Kingdom, 1989-1992: report on the SWORD project — S.K. Meredith, J.C. McDonald (1994)

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