Ventilatory failure due to asbestos pleurisy

Our plain-English summary of Ventilatory failure due to asbestos pleurisy, by A. Miller, A.S. Teirstein, I.J. Selikoff (The American Journal of Medicine, 1983).

The study

• Authors: A. Miller, A.S. Teirstein, I.J. Selikoff
• Journal: The American Journal of Medicine
• Published: 1983;75(6):911-9
• Type of article: Case report
• Cited by: 68 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. 000631).

Abstract

Seven patients are described who had a distinctive syndrome of chest wall restriction caused by asbestos-induced pleural fibrosis. All had severe dyspnea and predominant pleural disease on radiographic examination, with pulmonary function findings of reduced vital capacity, total lung capacity (measured in five patients), and maximal voluntary ventilation. Five patients had ventilatory failure with carbon dioxide retention; four of these have died and one is close to death. Examination of the thoracic organs in five patients showed minimal or no parenchymal fibrosis in three and less severe involvement of the parenchyma than of the pleura in the remaining two. Neoplasms were suspected in three patients because of extension of the pleural fibrosis into the lung. Two of these patients had pleural uptake of 67-gallium citrate attributable to the inflammatory reaction. With the increasing duration since onset of exposure in the nine million workers who have been exposed to asbestos, as well as in other exposed persons, it is expected that additional cases of ventilatory failure caused by asbestos-induced pleural fibrosis will be encountered.

In plain English

This article described seven patients at the Mount Sinai Medical Center in New York with severe breathlessness that the authors attributed to asbestos-induced scarring (fibrosis) of the pleura, the lining around the lungs. Most had been insulation workers. Others were exposed aboard ship or in a shipyard. Fiber types were not named. Five met the authors' criteria for ventilatory failure, including a build-up of carbon dioxide in the blood. Four of these five died and one was severely disabled. In these five, vital capacity averaged 33 percent of predicted, with a low of 20 percent (1.03 liters). Five of the seven had little or no X-ray evidence of scarring within the lung tissue. Three were suspected of having mesothelioma or lung cancer, but their pleural disease proved nonmalignant. The authors concluded that extensive asbestos pleural fibrosis may lead to ventilatory failure and death even with little lung-tissue disease. Four had surgery to remove thickened pleura. In the one operated on to improve breathing rather than to rule out cancer, exercise tolerance improved. They called that single case insufficient for generalization.

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 seven patients, which the authors describe as a prospective study begun after their second case
• Who was studied: Seven asbestos-exposed patients with pleural fibrosis, all hospitalized at the Mount Sinai Medical Center in New York City. Five met the authors' criteria for ventilatory failure with carbon dioxide retention. Two were representative cases without carbon dioxide retention.
• Exposure: Occupational asbestos exposure, mainly insulation work. For example, Patient 1 was an insulation worker 1929 to 1946 and 1959 to 1961. Table I also lists exposure aboard ship and in a shipyard for other patients. Fiber types and doses were not given.
• Main results:
  • Of the five patients with respiratory failure and carbon dioxide retention (Patients 1 to 5), four died and one was severely disabled.
  • In these five patients, vital capacity was below 50 percent of predicted in all. It was as low as 20 percent (1.03 liters) and averaged 33 percent of predicted.
  • Maximal voluntary ventilation was reduced in all five patients with ventilatory failure (average 64, lowest 44 percent of predicted), without airway obstruction.
  • Five of the seven patients, including four of the five with ventilatory failure, had little or no radiographic evidence of interstitial fibrosis (scarring within the lung tissue).
  • Three of the seven patients were suspected of having mesothelioma or lung cancer because of mass-like shadows on X-ray. Their pleural disease was nonmalignant, and two of the three showed uptake on gallium scanning.
  • Pleural effusions (fluid around the lungs) were noted in four of the seven patients.
  • Surgery to remove the pleura (decortication) was done in four patients. In the three operated on to rule out cancer, it did not improve their clinical status.
  • In Patient 2, removal of the left pleura to improve lung function was followed by marked improvement in exercise tolerance.
  • Pulmonary compliance was measured in three patients and was markedly reduced in all three.
• The authors' conclusion: The authors concluded that ventilatory failure, cor pulmonale (heart strain from lung disease) and death may result from extensive asbestos-caused pleural fibrosis even when little or no disease of the lung tissue is present.
• Limitations the authors state:
  • In three patients whose lungs showed no palpable fibrosis, the authors could not say whether microscopic interstitial fibrosis was present, because biopsies of normal-appearing lung were not taken.
  • Only one patient had pleurectomy to improve breathing rather than for diagnosis, which the authors said is not enough to generalize from.
  • The authors note that the esophageal pressure recordings used to measure compliance are of questionable usefulness when gross pleural disease is present.
  • Not all tests could be done in all patients. For example, Patient 1 was studied before some techniques were available.

Topics

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

Medical terms in this study, explained in our Lexicon: Pleurisy, Fibrosis, Dyspnea, Total Lung Capacity (TLC), Parenchymal Fibrosis, Parenchyma, Pleura, Neoplasm.

Related studies

• Pathogenesis of pleurisy, pleural fibrosis, and mesothelial proliferation — A. Herbert (1986)
• Respiratory function changes after asbestos pleurisy — P.H. Wright, A. Hanson, et al. (1980)
• Acute pleurisy in asbestos exposed persons — G.K. Sluis-Cremer, I. Webster (1972)
• Benign asbestos pleurisy in the rabbit. A model for the study of pathogenesis — B.L. Shore, C.C. Daughaday, et al. (1983)
• Cause of Asbestos-Induced Pleurisy Forgotten — E. Böhm (2019)
• An outbreak of pleural mesothelioma and chronic fibrosing pleurisy in the village of Karain/Urgüp in Anatolia — Y.I. Baris, A.A. Sahin, et al. (1978)

Browse more research in The American Journal of Medicine, or return to medical research.