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Correspondence |

New Disease—New Terminology FREE TO VIEW

Ai-Ping Chua, MBBS MRCP, MMed; Atul C. Mehta, MBBS, FCCP
Author and Funding Information

From the Respiratory Institute (Drs Chua and Mehta), Cleveland Clinic Foundation; Department of Respiratory and Critical Care Medicine (Dr Chua), National University Hospital, Singapore; and Sheikh Khalifa Medical Center (Dr Mehta).

Correspondence to: Ai-Ping Chua, MBBS MRCP, MMed, Respiratory Institute, Cleveland Clinic Foundation, 9500 EuclidAve, A90, Cleveland, OH 44195; e-mail: chuaa@ccf.org


Financial/nonfinancial disclosure: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;137(2):503-504. doi:10.1378/chest.09-1998
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To the Editor:

We read with interest the recent letter to the editor and response1 in CHEST (June 2009) by Naccache et al and Wynn et al, respectively, in reference to the article by Wynn and colleagues2 in CHEST (November 2008). They reported anthracofibrosis associated with dust exposure, in particular, coal dust and mixed mineral dust, as a new occupational lung disease. In these writings, anthracofibrosis was defined as “narrowing of the bronchial lumen with overlying anthracotic mucosa” and “a distinct entity of inflammatory bronchial stenosis with overlying anthracotic mucosa,” respectively. We propose a new term, “anthracostenosis,” to further characterize anthracofibrosis due to massive progressive fibrosis in patients with coal worker's pneumoconiosis (CWP), silicosis, or other forms of pneumoconiosis who present with bronchostenosis to distinguish it from other causes of anthracofibrosis.3

The diagnosis of anthracofibrosis is established bronchoscopically when bronchial narrowing or obliteration is seen in association with anthracotic pigmentation of the overlying bronchial mucosa. Albeit endobronchial anthracosis is not an uncommon finding on bronchoscopic airway inspection even in individuals with no reported environmental exposure, bronchial stenosis associated with it is rare. Anthracofibrosis is more widely described in Asian and black elderly women who present with respiratory symptoms. In contrast to endobronchial tuberculosis, its involvement of the bronchial wall is typically multifocal without contiguity in the distal lobar and/or segmental bronchi bilaterally and often sparing the trachea and main bronchial tree.4 Although prevalently imputed to TB infection previously, its causality has now been recognized to be linked to environmental air pollution or domestic biomass smoke (including cigarette smoke exposure), in addition to occupational dust inhalation.5

The pathogenesis of bronchostenosis in CWP and silicosis had been attributed to external luminal constriction from adjacent lymphadenopathy or fibrosis, erosion by enlarged or inflamed lymph, and extension of the progressive massive fibrosis into the bronchial wall. Besides lung transplantation, the treatment options of reversing or retarding progression of debilitating CWP or other pneumoconiosis are limited. Likewise, symptomatic anthracostenosis remains relatively immune to endoscopic ablation therapy.

In those regards, we support the use of “anthracostenosis” as the au courant expression to better reflect its distinct bronchial pathology and clinical implication. Rightfully, a newly coined disease entity is deserving of a novel terminology to claim its place in an expandingly complex medical arena.

Naccache JM, Monnet I, Guillon F, Valeyre D. Occupational anthracofibrosis. Chest. 2009;1356:1694-1695 response 1694.. [CrossRef] [PubMed]
 
Wynn GJ, Turkington PM, O”Driscoll BR. Anthracofibrosis, bronchial stenosis with overlying anthracotic mucosa: possibly a new occupational lung disorder: a series of seven cases from one UK hospital. Chest. 2008;1345:1069-1073. [CrossRef] [PubMed]
 
Mireles-Cabodevila E, Karnak D, Shah SS, Mehta AC. Anthracostenosis. J Bronchol. 2006;133:153-155. [CrossRef]
 
Park HJ, Park SH, Im SA, Kim YK, Lee KY. CT differentiation of anthracofibrosis from endobronchial tuberculosis. AJR Am J Roentgenol. 2008;1911:247-251. [CrossRef] [PubMed]
 
Kim YJ, Jung CY, Shin HW, Lee BK. Biomass smoke induced bronchial anthracofibrosis: presenting features and clinical course. Respir Med. 2009;1035:757-765. [CrossRef] [PubMed]
 

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References

Naccache JM, Monnet I, Guillon F, Valeyre D. Occupational anthracofibrosis. Chest. 2009;1356:1694-1695 response 1694.. [CrossRef] [PubMed]
 
Wynn GJ, Turkington PM, O”Driscoll BR. Anthracofibrosis, bronchial stenosis with overlying anthracotic mucosa: possibly a new occupational lung disorder: a series of seven cases from one UK hospital. Chest. 2008;1345:1069-1073. [CrossRef] [PubMed]
 
Mireles-Cabodevila E, Karnak D, Shah SS, Mehta AC. Anthracostenosis. J Bronchol. 2006;133:153-155. [CrossRef]
 
Park HJ, Park SH, Im SA, Kim YK, Lee KY. CT differentiation of anthracofibrosis from endobronchial tuberculosis. AJR Am J Roentgenol. 2008;1911:247-251. [CrossRef] [PubMed]
 
Kim YJ, Jung CY, Shin HW, Lee BK. Biomass smoke induced bronchial anthracofibrosis: presenting features and clinical course. Respir Med. 2009;1035:757-765. [CrossRef] [PubMed]
 
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