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Consensus Statement |

American College of Chest Physicians Consensus Statement on the Respiratory Health Effects of Asbestos: Results of a Delphi Study

Daniel E. Banks, MD, MS, FCCP; Runhua Shi, MD, PhD; Jerry McLarty, PhD; Clayton T. Cowl, MD, MS, FCCP; Dorsett Smith, MD, FCCP; Susan M. Tarlo, MBBS, FCCP; Feroza Daroowalla, MD, FCCP; John Balmes, MD, FCCP; Michael Baumann, MD, MS, FCCP
Author and Funding Information

*From the Department of Medicine (Drs. Banks, Shi, and McLarty), Louisiana State University School of Medicine, Shreveport, LA; the Divisions of Pulmonary & Critical Care Medicine, and Preventive, Occupational & Aerospace Medicine (Dr. Cowl), Mayo Clinic, Rochester, MN; the Department of Medicine (Dr. Smith), University of Washington School of Medicine, Seattle, WA; the Department of Medicine (Dr. Tarlo), University of Toronto, Toronto, ON, Canada; Stony Brook University Health Science Center (Dr. Daroowalla), Stony Brook, NY; the Department of Occupational and Environmental Medicine (Dr. Balmes), University of California at San Francisco, San Francisco, CA; and the Department of Medicine (Dr. Baumann), University of Mississippi Medical Center, Jackson, MS.

Correspondence to: Daniel E. Banks, MD, MS, Professor and Head, Department of Medicine, Louisiana State University School of Medicine, Room 6-203, 1501 Kings Hwy, Shreveport, LA 71130; e-mail: dbanks3@lsuhsc.edu


The questions were developed and revised for each round by the members of the working group as a whole. Drs. Shi and McLarty developed the Web site and the statistical analysis for each round. Drs. Banks, Shi, and McLarty wrote the manuscript with the approval of the members of the working group.

This work was performed at the Louisiana State University School of Medicine in Shreveport, LA. This project was commissioned by the ACCP and can be considered an “official” project of this organization. The ACCP provided a number of neckties embroidered with the ACCP logo to be distributed to participants who served on the expert panel in this study.

The Workers' Compensation Board of Alberta provided financial support of $25,000 to support the project. Vernon Lappi, MD, serves as the medical director of medical services at the Workers' Compensation Board of Alberta, Canada. The Feist-Weiller Cancer Center of the Louisiana State University School of Medicine in Shreveport provided computer support for this project.

Several physicians who participated in the Delphi project on asbestos have cared for patients, offered legal consultation, and/or testified in medical legal matters regarding asbestos-related diseases. Dr. Banks has served as a consultant for both plaintiffs and defendants regarding the pulmonary health effects of occupational dust exposure. He has provided no legal consulting regarding the health effects of asbestos exposure within the past 10 years. Dr. Cowl has evaluated and treated patients with asbestos-related lung disease but has not participated in any litigation or performed legal consulting work related to asbestos exposure or asbestos-related lung disease. Dr. Smith has evaluated > 1,000 patients with asbestos exposure and > 150 patients with mesothelioma. He has served as a legal expert witness on multiple occasions, testifying primarily for defendants. He has authored articles and book chapters related to asbestos-related disease; his latest publication was in 2005. Most recently, he has evaluated patients with asbestos exposure primarily for forensic aspects of workers' compensation systems in the northwestern United States. He has been a radiographic “B-reader” since 1980 and has read multiple radiographs with pneumoconioses. Dr. Tarlo has served as a clinical consultant for patients referred by their physicians or by the Ontario Workplace Safety and Insurance Board but has not been involved with litigation for asbestos-related diseases. Dr. Daroowalla has served as a clinical consultant for patients referred by their physicians but has not been involved with litigation for asbestos-related diseases. Dr. Balmes has served as a medical consultant for both plaintiffs and defendants, but primarily for plaintiff counsel, in the role of expert in the pulmonary health effects of occupational exposure to asbestos. However, he has performed no legal work regarding the topic of asbestos exposure or related disease in the past 5 years. Drs. Shi, McLarty, and Baumann have reported to the ACCP that no significant 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).


© 2009 American College of Chest Physicians


Chest. 2009;135(6):1619-1627. doi:10.1378/chest.08-1345
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Background:  The diagnosis of and criteria for the evaluation of asbestos-related disease impairment remains controversial after decades of research. Assessing agreement among experts who study pneumoconiosis, and diagnose and treat patients with asbestos-related respiratory conditions may be the first step in clarifying clinical and forensic/administrative issues associated with asbestos-related pulmonary conditions.

Methods:  We conducted a Delphi study, an iterative method of obtaining consensus among a group of experts. An expert panel was identified using an objective, nonbiased algorithm, based on the number of asbestos-related disease publications authored during the preceding 10-year period. Identified experts were invited to participate by accessing an Internet site. Each expert was presented statements developed by the authors regarding the diagnosis or treatment of asbestos-related disease; experts then ranked their degree of agreement or disagreement utilizing an 11-level modified Likert scale for each statement. Each expert was asked to justify their selection and to suggest references in support of their opinion. The Wilcoxon signed rank test and the interquartile range were used to define “consensus.” The results of the collective Likert rankings, deidentified comments, and suggested references as well as the initial consensus results were then provided to the participating experts. Each panel member then ranked their extent of agreement with a modified statement for which consensus was not achieved. The process was repeated three times.

Results:  Consensus was achieved on all but 9 of 32 statements.

Conclusions:  Consensus was not achieved for nine statements. These statements may be topics for future research.

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