A model for staging asbestos-related lung effects after cessation of exposure based on clinical demographic and bronchoscopic data.
Cullen-MR; Merrill-WW; Marenberg-ME
The Identification and Control of Environmental and Occupational Diseases: Asbestos and Cancers, M. A. Mehlman, and A. Upton, editors; Advances in Modern Environmental Toxicology 1994 Jan; :287-303
A model for the identification of factors predisposing asbestos (1332214) exposed workers to the development of fibrosis versus lung cancer was described. Patients previously identified with pulmonary asbestosis or asbestos related nonmalignant pleural disease were interviewed about their asbestos exposures and smoking and dietary histories and underwent a series of clinical procedures. Subjects were divided into four groups based on clinical findings and neutrophil concentrations in bronchoalveolar lavage (BAL) fluid. The first group demonstrated minimal radiographic changes, few BAL neutrophils, moderate functional changes, and rare airway metaplasia. The second group had minimal radiographic changes, higher BAL neutrophil levels, greater physiological alterations, and metaplasia in about half of the cases. Radiographic and functional evidence of asbestosis were seen in group three with little or no metaplasia, functional changes, or increased BAL neutrophils while the fourth group had high BAL neutrophil levels, a high rate of metaplasia, and progressive loss of function. Markedly higher rates of smoking and airway obstruction were seen in subjects in the fourth group compared with the third group and younger subjects tended to have higher BAL neutrophil levels compared with older subjects. The authors conclude that these results suggest that the progression of disease activity among asbestos exposed workers may be related to smoking, airway obstruction, age, and degree of metaplasia.
NIOSH-Publication; NIOSH-Grant; Pulmonary-system-disorders; Asbestos-workers; Lung-disease; Lung-cancer; Lung-fibrosis; Physiological-effects; Risk-factors; Cigarette-smoking; Age-factors;
Internal Medicine Yale University School of Med 109-Lci, P O Box 3333 New Haven, CT 06520
The Identification and Control of Environmental and Occupational Diseases: Asbestos and Cancers, M. A. Mehlman, and A. Upton, editors; Advances in Modern Environmental Toxicology
Yale University, New Haven, Connecticut