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. 1993 Jun;91(6):2685–2692. doi: 10.1172/JCI116507

Restrictive lung function and asbestos-induced pleural fibrosis. A quantitative approach.

D A Schwartz 1, J R Galvin 1, S J Yagla 1, S B Speakman 1, J A Merchant 1, G W Hunninghake 1
PMCID: PMC443332  PMID: 8514875

Abstract

To assess further the clinical significance of asbestos-induced pleural fibrosis, we used a computer algorithm to reconstruct images three dimensionally from the high-resolution computerized tomography (HRCT) scan of the chest in 60 asbestos-exposed subjects. Pulmonary function tests, chest radiographs, and HRCT scans were performed on all study subjects. The volume of asbestos-induced pleural fibrosis was computed from the three-dimensional reconstruction of the HRCT scan. Among those with pleural fibrosis identified on the HRCT scan (n = 29), the volume of the pleural lesion varied from 0.01% (0.5 ml) and 7.11% (260.4 ml) of the total chest cavity. To investigate the relationship between asbestos-induced pleural fibrosis and restrictive lung function, we compared the computer-derived estimate of pleural fibrosis to the total lung capacity and found that these measures were inversely related (r = -0.40; P = 0.002). After controlling for age, height, pack-years of cigarette smoking, and the presence of interstitial fibrosis on the chest radiograph, the volume of pleural fibrosis identified on the three-dimensional reconstructed image from the HRCT scan was inversely associated with the total lung capacity (P = 0.03) and independently accounted for 9.5% of the variance of this measure of lung volume. These findings further extend the scientific data supporting an independent association between pleural fibrosis and restrictive lung function.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Aberle D. R., Gamsu G., Ray C. S., Feuerstein I. M. Asbestos-related pleural and parenchymal fibrosis: detection with high-resolution CT. Radiology. 1988 Mar;166(3):729–734. doi: 10.1148/radiology.166.3.3340770. [DOI] [PubMed] [Google Scholar]
  2. Aberle D. R., Gamsu G., Ray C. S. High-resolution CT of benign asbestos-related diseases: clinical and radiographic correlation. AJR Am J Roentgenol. 1988 Nov;151(5):883–891. doi: 10.2214/ajr.151.5.883. [DOI] [PubMed] [Google Scholar]
  3. Adams H., Bernard M. S., McConnochie K. An appraisal of CT pulmonary density mapping in normal subjects. Clin Radiol. 1991 Apr;43(4):238–242. doi: 10.1016/s0009-9260(05)80245-4. [DOI] [PubMed] [Google Scholar]
  4. Baker E. L., Dagg T., Greene R. E. Respiratory illness in the construction trades. I. The significance of asbestos-associated pleural disease among sheet metal workers. J Occup Med. 1985 Jul;27(7):483–489. [PubMed] [Google Scholar]
  5. Bourbeau J., Ernst P., Chrome J., Armstrong B., Becklake M. R. The relationship between respiratory impairment and asbestos-related pleural abnormality in an active work force. Am Rev Respir Dis. 1990 Oct;142(4):837–842. doi: 10.1164/ajrccm/142.4.837. [DOI] [PubMed] [Google Scholar]
  6. Britton M. G. Asbestos pleural disease. Br J Dis Chest. 1982 Jan;76(1):1–10. [PubMed] [Google Scholar]
  7. Broderick A., Fuortes L. J., Merchant J. A., Galvin J. R., Schwartz D. A. Pleural determinants of restrictive lung function and respiratory symptoms in an asbestos-exposed population. Chest. 1992 Mar;101(3):684–691. doi: 10.1378/chest.101.3.684. [DOI] [PubMed] [Google Scholar]
  8. Craighead J. E., Abraham J. L., Churg A., Green F. H., Kleinerman J., Pratt P. C., Seemayer T. A., Vallyathan V., Weill H. The pathology of asbestos-associated diseases of the lungs and pleural cavities: diagnostic criteria and proposed grading schema. Report of the Pneumoconiosis Committee of the College of American Pathologists and the National Institute for Occupational Safety and Health. Arch Pathol Lab Med. 1982 Oct 8;106(11):544–596. [PubMed] [Google Scholar]
  9. Craighead J. E., Mossman B. T. The pathogenesis of asbestos-associated diseases. N Engl J Med. 1982 Jun 17;306(24):1446–1455. doi: 10.1056/NEJM198206173062403. [DOI] [PubMed] [Google Scholar]
  10. Epler G. R., McLoud T. C., Gaensler E. A., Mikus J. P., Carrington C. B. Normal chest roentgenograms in chronic diffuse infiltrative lung disease. N Engl J Med. 1978 Apr 27;298(17):934–939. doi: 10.1056/NEJM197804272981703. [DOI] [PubMed] [Google Scholar]
  11. Fridriksson H. V., Hedenström H., Hillerdal G., Malmberg P. Increased lung stiffness of persons with pleural plaques. Eur J Respir Dis. 1981 Dec;62(6):412–424. [PubMed] [Google Scholar]
  12. Friedman A. C., Fiel S. B., Fisher M. S., Radecki P. D., Lev-Toaff A. S., Caroline D. F. Asbestos-related pleural disease and asbestosis: a comparison of CT and chest radiography. AJR Am J Roentgenol. 1988 Feb;150(2):269–275. doi: 10.2214/ajr.150.2.269. [DOI] [PubMed] [Google Scholar]
  13. GOLDMAN H. I., BECKLAKE M. R. Respiratory function tests; normal values at median altitudes and the prediction of normal results. Am Rev Tuberc. 1959 Apr;79(4):457–467. doi: 10.1164/artpd.1959.79.4.457. [DOI] [PubMed] [Google Scholar]
  14. Gould G. A., MacNee W., McLean A., Warren P. M., Redpath A., Best J. J., Lamb D., Flenley D. C. CT measurements of lung density in life can quantitate distal airspace enlargement--an essential defining feature of human emphysema. Am Rev Respir Dis. 1988 Feb;137(2):380–392. doi: 10.1164/ajrccm/137.2.380. [DOI] [PubMed] [Google Scholar]
  15. Hedenstierna G., Alexandersson R., Kolmodin-Hedman B., Szamosi A., Tollqvist J. Pleural plaques and lung function in construction workers exposed to asbestos. Eur J Respir Dis. 1981;62(2):111–122. [PubMed] [Google Scholar]
  16. Hemmy D. C., David D. J., Herman G. T. Three-dimensional reconstruction of craniofacial deformity using computed tomography. Neurosurgery. 1983 Nov;13(5):534–541. doi: 10.1227/00006123-198311000-00009. [DOI] [PubMed] [Google Scholar]
  17. Hillerdal G., Lindgren A. Pleural plaques: correlation of autopsy findings to radiographic findings and occupational history. Eur J Respir Dis. 1980 Dec;61(6):315–319. [PubMed] [Google Scholar]
  18. Hillerdal G. Nonmalignant pleural disease related to asbestos exposure. Clin Chest Med. 1985 Mar;6(1):141–152. [PubMed] [Google Scholar]
  19. Hillerdal G. Pleural plaques in a health survey material. Frequency, development and exposure to asbestos. Scand J Respir Dis. 1978 Oct;59(5):257–263. [PubMed] [Google Scholar]
  20. Hjortsberg U., Orbaek P., Aborelius M., Jr, Ranstam J., Welinder H. Railroad workers with pleural plaques: I. Spirometric and nitrogen washout investigation on smoking and nonsmoking asbestos-exposed workers. Am J Ind Med. 1988;14(6):635–641. doi: 10.1002/ajim.4700140602. [DOI] [PubMed] [Google Scholar]
  21. Hoffman E. A., Sinak L. J., Robb R. A., Ritman E. L. Noninvasive quantitative imaging of shape and volume of lungs. J Appl Physiol Respir Environ Exerc Physiol. 1983 May;54(5):1414–1421. doi: 10.1152/jappl.1983.54.5.1414. [DOI] [PubMed] [Google Scholar]
  22. Hourihane D. O., Lessof L., Richardson P. C. Hyaline and calcified pleural plaques as an index of exposure to asbestos. Br Med J. 1966 Apr 30;1(5495):1069–1074. doi: 10.1136/bmj.1.5495.1069. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Jones R. N., Diem J. E., Hughes J. M., Hammad Y. Y., Glindmeyer H. W., Weill H. Progression of asbestos effects: a prospective longitudinal study of chest radiographs and lung function. Br J Ind Med. 1989 Feb;46(2):97–105. doi: 10.1136/oem.46.2.97. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Järvholm B., Larsson S. Do pleural plaques produce symptoms? A brief report. J Occup Med. 1988 Apr;30(4):345–347. [PubMed] [Google Scholar]
  25. Järvholm B., Sandén A. Pleural plaques and respiratory function. Am J Ind Med. 1986;10(4):419–426. doi: 10.1002/ajim.4700100409. [DOI] [PubMed] [Google Scholar]
  26. Kipen H. M., Lilis R., Suzuki Y., Valciukas J. A., Selikoff I. J. Pulmonary fibrosis in asbestos insulation workers with lung cancer: a radiological and histopathological evaluation. Br J Ind Med. 1987 Feb;44(2):96–100. doi: 10.1136/oem.44.2.96. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Knudson R. J., Standen J. R., Kaltenborn W. T., Knudson D. E., Rehm K., Habib M. P., Newell J. D. Expiratory computed tomography for assessment of suspected pulmonary emphysema. Chest. 1991 Jun;99(6):1357–1366. doi: 10.1378/chest.99.6.1357. [DOI] [PubMed] [Google Scholar]
  28. Lilis R., Miller A., Godbold J., Chan E., Selikoff I. J. Pulmonary function and pleural fibrosis: quantitative relationships with an integrative index of pleural abnormalities. Am J Ind Med. 1991;20(2):145–161. doi: 10.1002/ajim.4700200203. [DOI] [PubMed] [Google Scholar]
  29. McGavin C. R., Sheers G. Diffuse pleural thickening in asbestos workers: disability and lung function abnormalities. Thorax. 1984 Aug;39(8):604–607. doi: 10.1136/thx.39.8.604. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Miller A., Teirstein A. S., Selikoff I. J. Ventilatory failure due to asbestos pleurisy. Am J Med. 1983 Dec;75(6):911–919. doi: 10.1016/0002-9343(83)90863-x. [DOI] [PubMed] [Google Scholar]
  31. Morris J. F., Koski A., Johnson L. C. Spirometric standards for healthy nonsmoking adults. Am Rev Respir Dis. 1971 Jan;103(1):57–67. doi: 10.1164/arrd.1971.103.1.57. [DOI] [PubMed] [Google Scholar]
  32. Oliver L. C., Eisen E. A., Greene R., Sprince N. L. Asbestos-related pleural plaques and lung function. Am J Ind Med. 1988;14(6):649–656. doi: 10.1002/ajim.4700140604. [DOI] [PubMed] [Google Scholar]
  33. Picado C., Laporta D., Grassino A., Cosio M., Thibodeau M., Becklake M. R. Mechanisms affecting exercise performance in subjects with asbestos-related pleural fibrosis. Lung. 1987;165(1):45–57. doi: 10.1007/BF02714420. [DOI] [PubMed] [Google Scholar]
  34. Rosenstock L., Barnhart S., Heyer N. J., Pierson D. J., Hudson L. D. The relation among pulmonary function, chest roentgenographic abnormalities, and smoking status in an asbestos-exposed cohort. Am Rev Respir Dis. 1988 Aug;138(2):272–277. doi: 10.1164/ajrccm/138.2.272. [DOI] [PubMed] [Google Scholar]
  35. Sargent E. N., Boswell W. D., Jr, Ralls P. W., Markovitz A. Subpleural fat pads in patients exposed to asbestos: distinction from non-calcified pleural plaques. Radiology. 1984 Aug;152(2):273–277. doi: 10.1148/radiology.152.2.6739783. [DOI] [PubMed] [Google Scholar]
  36. Sartoris D. J., Resnick D., Gershuni D., Bielecki D., Meyers M. Computed tomography with multiplanar reformation and 3-dimensional image analysis in the preoperative evaluation of ischemic necrosis of the femoral head. J Rheumatol. 1986 Feb;13(1):153–163. [PubMed] [Google Scholar]
  37. Schwartz D. A., Fuortes L. J., Galvin J. R., Burmeister L. F., Schmidt L. E., Leistikow B. N., LaMarte F. P., Merchant J. A. Asbestos-induced pleural fibrosis and impaired lung function. Am Rev Respir Dis. 1990 Feb;141(2):321–326. doi: 10.1164/ajrccm/141.2.321. [DOI] [PubMed] [Google Scholar]
  38. Schwartz D. A., Galvin J. R., Dayton C. S., Stanford W., Merchant J. A., Hunninghake G. W. Determinants of restrictive lung function in asbestos-induced pleural fibrosis. J Appl Physiol (1985) 1990 May;68(5):1932–1937. doi: 10.1152/jappl.1990.68.5.1932. [DOI] [PubMed] [Google Scholar]
  39. Sison R. F., Hruban R. H., Moore G. W., Kuhlman J. E., Wheeler P. S., Hutchins G. M. Pulmonary disease associated with pleural "asbestos" plaques. Chest. 1989 Apr;95(4):831–835. doi: 10.1378/chest.95.4.831. [DOI] [PubMed] [Google Scholar]
  40. Skorton D. J., Collins S. M., Nichols J., Pandian N. G., Bean J. A., Kerber R. E. Quantitative texture analysis in two-dimensional echocardiography: application to the diagnosis of experimental myocardial contusion. Circulation. 1983 Jul;68(1):217–223. doi: 10.1161/01.cir.68.1.217. [DOI] [PubMed] [Google Scholar]
  41. Van Ganse W. F., Ferris B. G., Jr, Cotes J. E. Cigarette smoking and pulmonary diffusing capacity. (Transfer factor). Am Rev Respir Dis. 1972 Jan;105(1):30–41. doi: 10.1164/arrd.1972.105.1.30. [DOI] [PubMed] [Google Scholar]
  42. Wallace J. M., Oishi J. S., Barbers R. G., Batra P., Aberle D. R. Bronchoalveolar lavage cell and lymphocyte phenotype profiles in healthy asbestos-exposed shipyard workers. Am Rev Respir Dis. 1989 Jan;139(1):33–38. doi: 10.1164/ajrccm/139.1.33. [DOI] [PubMed] [Google Scholar]
  43. Wright P. H., Hanson A., Kreel L., Capel L. H. Respiratory function changes after asbestos pleurisy. Thorax. 1980 Jan;35(1):31–36. doi: 10.1136/thx.35.1.31. [DOI] [PMC free article] [PubMed] [Google Scholar]

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