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Changing patterns in asbestos-induced lung disease Ohar J; Sterling DA; Bleecker E; Donohue JChest 2004[Feb]; 125 (2): 744-53STUDY OBJECTIVES: To determine patterns in asbestos-induced lung diseases found in older, less exposed workers. DESIGN: Review of a database evaluating lung function, smoking status, form of asbestos-induced lung disease, and radiograph abnormalities. SETTING: Outpatient clinic. PARTICIPANTS: A total of 3383 asbestos-exposed workers referred for independent medical evaluation, including control subjects who lacked asbestos-specific radiograph abnormalities (n = 243), subjects with low International Labor Organization (ILO) scores (n = 2,685), high ILO scores (n = 312), bronchogenic cancer (n = 63), and mesothelioma (n = 80). Of these, 3,327 workers have specific smoking status information and 3,312 workers have lung volume measures. INTERVENTIONS: Chest radiographs were interpreted by a certified B-reader, and abnormalities were quantified according to the ILO scoring system. Spirometry and lung volume measurement were performed. Subjects completed a self-administered questionnaire that was reviewed at the time of examination. Control subjects were screened on two separate occasions at least 10 years apart to exclude subclinical or slowly progressive asbestos-induced lung disease. MEASUREMENTS AND RESULTS: The mean age of the population was 65.1 +/- 9.9 years, and the latency was 41.4 +/- 10.1 years (+/- SD). Most subjects (41.8%) had normal pulmonary function. Obstruction was the most common pulmonary function abnormality (25.4%), followed by restriction (19.3%) and a mixed pattern (6.0%). Most subjects (79.4%) had low ILO scores. Benign pleural abnormalities were the only findings in 54% of subjects with low ILO score. Subjects with high ILO scores were older, smoked more, and had a longer latency than subjects with low ILO scores and control subjects. Smokers were younger, had a shorter latency, and had paradoxically greater ILO scores than nonsmokers. Subjects with bronchogenic cancer and mesothelioma had longer latencies than control subjects and subjects with benign asbestos-induced lung disease. CONCLUSIONS: Asbestos-induced lung disease today is characterized by low ILO scores, long latencies, greater disease magnitude in smokers, and a normal or obstructive pattern of pulmonary function abnormality. Spirometric evaluation in the absence of lung volume measurements caused misclassification that resulted in overestimation of the presence of a restrictive pattern of pulmonary function.|Adult[MESH]|Age Distribution[MESH]|Aged[MESH]|Aged, 80 and over[MESH]|Asbestos/*adverse effects[MESH]|Asbestosis/*diagnostic imaging/epidemiology/*pathology[MESH]|Biopsy, Needle[MESH]|Case-Control Studies[MESH]|Cohort Studies[MESH]|Female[MESH]|Humans[MESH]|Immunohistochemistry[MESH]|Male[MESH]|Middle Aged[MESH]|Occupational Exposure/*adverse effects[MESH]|Probability[MESH]|Prognosis[MESH]|Regression Analysis[MESH]|Respiratory Function Tests[MESH]|Risk Assessment[MESH]|Severity of Illness Index[MESH]|Sex Distribution[MESH]|Smoking/*adverse effects[MESH]|Spirometry[MESH]|Tomography, X-Ray Computed[MESH] |
