Ventilatory insufficiency due to asbestos-related diffuse pleural fibrosis successfully treated with noninvasive home mechanical ventilation

Our plain-English summary of Ventilatory insufficiency due to asbestos-related diffuse pleural fibrosis successfully treated with noninvasive home mechanical ventilation, by X. Muñoz, A. Roger, E. Pallisa, et al (Respiration; International Review of Thoracic Diseases, 2001).

The study

• Authors: X. Muñoz, A. Roger, E. Pallisa, S. Martí, J. Ferrer
• Journal: Respiration; International Review of Thoracic Diseases
• Published: 2001;68(5):533-6
• Type of article: Case report
• Cited by: 6 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

A 54-year-old man with diffuse pleural fibrosis due to previous asbestos exposure developed hypercapnic respiratory failure. Noninvasive mechanical ventilation (NIMV) was started at the hospital and maintained at the patient's home, achieving reversal of the respiratory failure. During a 2-year follow-up, NIMV has been well tolerated by the patient and no relapse in ventilatory failure has occurred. Home NIMV can be considered as an alternative to pleural decortication in asbestos-related diffuse pleural fibrosis with ventilatory insufficiency.

Copyright 2001 S. Karger AG, Basel

In plain English

This case report from Barcelona, Spain, described one 54-year-old man with diffuse pleural fibrosis (widespread thickening of the lining around the lung). The authors related it to his asbestos exposure, which lasted 1 year when he was 23. The article did not name a fiber type or job. He was admitted with hypercapnic respiratory failure (carbon dioxide building up in the blood) and right heart failure. CT showed calcified right-sided pleural thickening 3.3 cm thick, with no emphysema or interstitial lung disease. Bronchodilator treatment did not help. Breathing support through a nasal mask (noninvasive mechanical ventilation) was started. By discharge 7 days later, his room-air oxygen level had risen from 35 to 66 mm Hg and carbon dioxide had fallen from 69 to 46 mm Hg. Over 2 years of follow-up, no relapses of respiratory failure were detected. His blood gases worsened during a 1-month break from ventilation and returned to normal after it resumed. The authors proposed this treatment as an effective and safe alternative to pleurectomy (pleural surgery). They noted he also had chronic bronchitis and a possible obstructive component.

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 report (one patient)
• Who was studied: One 54-year-old man, an ex-smoker of 35 pack-years, admitted to the Respiratory Department of Hospital General Vall d'Hebron, Barcelona, Spain
• Exposure: Asbestos exposure described as significant, lasting 1 year at age 23. No fiber type, product or job is given.
• Main results:
  • The authors judged that the patient met the diagnostic criteria for diffuse pleural fibrosis related to his previous asbestos exposure
  • CT showed diffuse calcified pleural thickening on the right side, 14 cm in craniocaudal extent, 3.3 cm thick and 14 cm wide
  • No emphysema or interstitial lung disease was seen on CT
  • On admission, room-air blood gases were PO2 35 mm Hg, PCO2 69 mm Hg, pH 7.37
  • Lung function on admission: FVC 1,160 ml (26%), FEV1 820 ml (25%)
  • Bronchodilator therapy did not improve the patient; hypercapnia and right heart failure persisted
  • After noninvasive ventilation by nasal mask, the patient was discharged 7 days later with room-air PO2 66 mm Hg, PCO2 46 mm Hg, pH 7.40
  • Use of noninvasive ventilation for 10 hours a day, including sleep, was recommended after discharge
  • During 2 years of outpatient follow-up, no relapses of respiratory failure or cor pulmonale were detected
  • When ventilation was stopped for 1 month, blood gases worsened, and they normalized after it was resumed
  • Pulmonary function tests did not change during follow-up
• The authors' conclusion: The authors proposed noninvasive mechanical ventilation as an effective and safe alternative to pleurectomy in patients with ventilatory failure due to asbestos-related diffuse pleural fibrosis
• Limitations the authors state:
  • The patient had chronic bronchitis, and a slight increase in residual volume suggested a possible additional obstructive component. The authors added that clinically evident obstruction was not demonstrated.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Pleural plaques and thickening.

Medical terms in this study, explained in our Lexicon: Fibrosis, Asbestos Exposure.

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