The role of environmental and occupational exposures in Turkish immigrants with fibre-related disease

Our plain-English summary of The role of environmental and occupational exposures in Turkish immigrants with fibre-related disease, by P. Dumortier, A. Göcmen, K. Laurent, et al (The European Respiratory Journal, 2001).

The study

• Authors: P. Dumortier, A. Göcmen, K. Laurent, A. Manço, P. De Vuyst
• Journal: The European Respiratory Journal
• Published: 2001;17(5):922-7
• Cited by: 14 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Environmental exposure to tremolite and erionite causes endemic diseases of the lung and pleura in Turkey. This study aimed to evaluate the impact of these exposures and further occupational exposures on fibre-related diseases in Turkish immigrants living in Belgium. The study included 51 males and 17 females that emigrated < 1-38 yrs ago. Most of them (n=46) had nonmalignant pleural lesions, one had asbestosis and one had mesothelioma. Environmental asbestos exposure was likely for the majority of patients (60%), but there were also reports of possible occupational asbestos (n = 14) and erionite (n = 2) exposure. Tremolite was the main fibre type in bronchoalveolar lavage fluid (BALF). Elevated concentrations of amosite or crocidolite were detected in only two patients. The delay elapsed since the end of the environmental exposure had no influence on the asbestos body or the tremolite fibre concentrations in the BALF of Turkish immigrants. Most fibre-related diseases in Turkish immigrants are probably due to environmental rather than occupational exposure. Precise information about geographical origin and occupation should be obtained when investigating these patients. Mineralogical analysis of bronchoalveolar lavage fluid gives valuable information on the type and intensity of exposure, especially in patients with both environmental and occupational exposure.

In plain English

This study examined 68 Turkish immigrants in Belgium (51 men, 17 women). Their bronchoalveolar lavage fluid, which is fluid washed from the lungs, had been sent to the authors' laboratory for fibre analysis on clinical grounds since 1979. The authors grouped them by likely exposure: 30 with very likely environmental exposure in Turkey, 11 with mixed environmental and work exposure, 3 with work exposure only, 2 with erionite exposure, 9 unlikely and 13 unknown. Non-malignant pleural lesions were the most common finding, seen in 86% of the environmental group and 100% of the mixed group. There was one mesothelioma and one case of lung fibrosis, both in the environmental group. Tremolite was the main fibre found. Amosite or crocidolite above 300 fibres per mL appeared in 2 of 13 patients with possible work exposure and in none of 25 with unlikely work exposure. Time since exposure ended showed no influence on asbestos body or tremolite levels. The authors concluded that tremolite seems to be the main cause of these diseases. They noted that work exposure was judged only from reported jobs, and that disease rates could not be calculated.

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: Case series of mineralogical analyses of bronchoalveolar lavage fluid referred to the authors' laboratory, compared with previously studied residents of Turkey
• Who was studied: All 68 Turkish immigrants living in Belgium (51 males, 17 females; mean age 51) identified from more than 5,000 subjects whose lavage fluid was analysed since 1979; they had emigrated less than 1 to 38 years earlier
• Exposure: Environmental (domestic) tremolite asbestos exposure in rural Turkey, including whitewashing, plus possible later occupational asbestos exposure and erionite exposure. Patients were classified into six groups: 30 very likely environmental, 9 unlikely, 11 mixed environmental and occupational, 3 only occupational, 2 erionite in Tuzkoy, 13 unknown.
• Main results:
  • Nonmalignant pleural lesions were seen in 86% of subjects with environmental asbestos exposure only, 100% of those with mixed exposure, and 22% of those with unlikely exposure
  • One case of mesothelioma and one case of lung fibrosis occurred, both among subjects with environmental exposure
  • In asbestos body core analysis (293 bodies from 25 patients), tremolite was the core in 95% of bodies from those with environmental exposure and 69% from those with mixed exposure
  • Of 40 cases with electron microscopy fibre counting, tremolite was identified in 75%
  • Tremolite was present in 32 of 36 (89%) immigrants from endemic areas and 3 of 8 (38%) from outside endemic areas
  • Among those with possible occupational exposure (about 20% of cases, all males), commercial amphiboles were detected in 43%. More than 300 amosite-crocidolite fibres per mL were found in 2 of 13 patients with possible occupational exposure, and in none of those without suspicion of occupational exposure.
  • Comparing immigrants with residents of Turkey showed no influence of duration of exposure (p=0.27) or delay since end of exposure (p=0.75) on asbestos body and tremolite fibre concentrations
  • Lung cancer was reported in 5 patients. The authors considered that one case, a 59-year-old female never-smoker with pleural plaques and pulmonary adenocarcinoma, can be reliably linked with environmental tremolite exposure.
• The authors' conclusion: The authors concluded that tremolite seems to be the main cause of the fibre-related diseases in these immigrants, and that the role of environmental exposure must be borne in mind when investigating Turkish immigrants
• Limitations the authors state:
  • Occupational exposure was assessed only from the occupations patients reported, without considering duration or intensity
  • Chrysotile fibres were not taken into account in interpreting the lavage results
  • The study included only cases with known or suspected asbestos-related abnormalities, so prevalence or incidence among all Turkish immigrants cannot be calculated

Topics

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

Medical terms in this study, explained in our Lexicon: Occupational Exposure, Environmental Exposure, Tremolite, erionite, Endemic, Pleura, Mesothelioma, Asbestos Exposure.

Related studies

• Erionite bodies and fibres in bronchoalveolar lavage fluid (BALF) of residents from Tuzköy, Cappadocia, Turkey — P. Dumortier, L. Coplü, et al. (2001)
• Lung diseases due to environmental exposures to erionite and asbestos in Turkey — S. Emri, A. Demir, et al. (2002)
• Prospective clinical and radiologic study of zeolite-exposed Turkish immigrants in Sweden — M. Ozesmi, G. Hillerdal, et al. (1990)
• Biological effects of naturally occurring and man-made fibres: in vitro cytotoxicity and mutagenesis in mammalian cells — R. Okayasu, L. Wu, et al. (1999)
• Assessment of environmental asbestos exposure in Turkey by bronchoalveolar lavage — P. Dumortier, L. Coplü, et al. (1998)
• Erionite exposure in North Dakota and Turkish villages with mesothelioma — M. Carbone, Y.I. Baris, et al. (2011)

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